Objective: The aim of this study was to investigate the role of pelvic magnetic resonance imaging (MRI) in making the correct diagnosis of massive ovarian edema (MOE) and ovarian torsion (OT).
Methods: Contrast-enhanced (CE) pelvic MRI and diffusion-weighted imaging (DWI) was performed in 4 patients admitted to hospital with lower abdominal pain and had pre-diagnosis of OT and MOE with B-mode ultrasound and Doppler ultrasound
Results: Doppler ultrasound examination of ovaries in three patients with OT did not reveal arterial or venous flow. In the patients with MOE, monophasic arterial flow with prolonged acceleration was detected. Venous flow was not detected. Left ovary size of the patient with MOE increased. Heterogeneous low-intensity on T1W images and heterogeneous high intensity on T2A-weighted images were observed. CE fat-saturated T1WI revealed partial parenchymal enhancement. Size of the ovaries increased in two patients with OT. Homogeneous low and high intensity were observed respectively on T1WI and T2WI. There was no parenchymal enhancement on CE fat-saturated T1WI. Size of the ovaries increased in other patient with OT. Reduction and increment of intensity reflecting the hemorrhagic infarction were observed respectively on T2WI and T1WI, which became evident to the periphery. DWI of ovarian tissue in patients with ovarian torsion revealed diffusion limitations reflecting the infarction.
Conclusions: OT can be differentiated correctly from MOE with the CE pelvic MRI findings of patients. Pre-operatively information determined from DWI can help guide clinicians to decide for correct type of surgery.
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