Interobserver reliability for computed tomography findings of adnexal torsion

Pelvic pain is a common presenting symptom in the emergency room, and prompt diagnosis of adnexal torsion is essential to reduce the risk of irreversible ovarian ischemia. Although ultrasound has been the study of choice for the diagnosis of adnexal torsion, patients with pelvic pain may often be imaged first with computed tomography given the prevalent use of computed tomography in the emergency department. Therefore, it is essential to be familiar with the computed tomography signs of adnexal torsion. A retrospective study of 40 patients with adnexal torsion with and without an adnexal mass was conducted to evaluate interobserver reliability for the computed tomography signs of adnexal torsion. With the exception of deviation of the uterus to the twisted side, interobserver reliability was fair for all computed tomography signs of adnexal torsion. There was no difference in interobserver reliability for most signs between patients with a mass and those without. However, for a twisted vascular pedicle, there was moderate agreement in patients with a mass and no agreement for patients without a mass. Although many computed tomography signs of adnexal torsion have been described, interobserver reliability for most of these signs was found to be fair.