Performance of non-contrast pelvic MRI for diagnosing adnexal torsion in children

This study reports the performance of magnetic resonance imaging (MRI) for diagnosing adnexal torsion in pediatric patients.

In this single-center retrospective study, the electronic medical record was queried from 1/1/2015-12/31/2022 for MRI reports of patients 0-18 years old presenting with acute undifferentiated abdominopelvic pain. At our institution, these patients routinely undergo first-line ultrasound (US) for assessment of appendicitis and other relevant differential diagnoses, while indeterminate cases subsequently undergo limited, non-contrast enhanced MRI for further assessment. MRI reports were reviewed, and adnexal findings categorized as normal or abnormal with inquiry into the actual images in equivocal cases. Medical and surgical records up to 6 months following the MRI acquisition were referenced for each case.

A total of 969 patient exams (median age 14.0 years) were analyzed, and 780 (80.5%) had no adnexal abnormality described on MRI with no evidence of torsion on follow-up. 166 (17.1%) had a (para)ovarian cyst/follicle(s) detailed on MRI, but no mention of concern for torsion and no evidence of torsion on follow-up either. 23 (2.4%) had MRI reports raising concern for adnexal torsion, of which 15 (65.2%) underwent surgery and 10 (43.5%) were found to have torsion. MRI, therefore, had a 100% sensitivity, 98.6% specificity, 43.5% PPV, and 100% NPV for identifying adnexal torsion.

Non-contrast enhanced MRI demonstrates excellent performance at both excluding and prospectively raising concern for adnexal torsion in children with undifferentiated abdominopelvic pain.

Question The performance of MRI for diagnosing adnexal torsion in pediatric patients is understudied and remains unclear. Findings In a sample of 969 pediatric patients, non-contrast MRI had a 100% sensitivity and negative predictive value for identifying adnexal torsion and a 98.6% specificity. Clinical relevance Physicians should increasingly trust non-contrast MRIs read without concern for adnexal torsion as accurately excluding this diagnosis in children with acute abdominopelvic pain and indeterminate US findings. as an excellent tool for identifying and excluding adnexal torsion in children.