Computed tomography imaging features of surgically confirmed ovarian torsion: A retrospective analysis

To evaluate preoperative computed tomography (CT) findings in surgically confirmed ovarian torsion and assess the diagnostic value of key imaging features. This retrospective study included 25 patients (26 torsed ovaries) with confirmed ovarian torsion and available preoperative contrast-enhanced pelvic CT. Images were reviewed by an experienced abdominal radiologist blinded to surgical results. CT features assessed included ovarian size, pedicle thickness, whirlpool sign, adnexal position, uterine deviation, tubal changes, and pelvic free fluid. Statistical analysis included t-tests, logistic regression, and ROC analysis. Torsed ovaries showed significantly greater pedicle thickness (mean: 12.2 ± 3.5 mm) and size (mean: 55.4 ± 15.2 mm) compared to contralateral ovaries (p < 0.001). A combined model of pedicle thickness and ovarian size demonstrated excellent diagnostic performance (AUC: 0.963). Uterine deviation was present in 64% of cases, abnormal ovary position in 88%, whirlpool sign in 58%, and pelvic free fluid in 92%. Optimal thresholds were > 12 mm for pedicle thickness and > 45 mm for ovarian size. On emergency CT, the combination of ovarian enlargement and thickened or twisted pedicle is highly predictive of torsion. Secondary signs such as uterine deviation, whirlpool sign, and pelvic fluid further strengthen the diagnosis. Recognizing these findings may enable earlier detection and timely surgical management. Larger prospective studies are needed to validate these CT indicators in broader clinical settings.