“T2-hypointense dot sign”: A novel and highly suggestive clue for the diagnosis of ovarian torsion


      • Early and accurate diagnosis is crucial for preserving the viability of ovaries.
      • We recently noticed a unique MRI sign, seen as a hypointense dot on the pedicle of a torsed ovary.
      • T2-hypointense dot sign is a novel sign for the imaging-based diagnosis of ovarian torsion.



      We aimed to describe “T2-hypointense dot sign” for the diagnosis of ovarian torsion and compare its diagnostic capability with whirlpool sign.


      Pelvic MRIs of 31 patients with surgically proven ovarian torsion were used for the analysis. The control group was comprised of 30 patients with adnexal neoplasm and 15 patients with tubo-ovarian abscess. The MRIs of all 76 patients were retrospectively evaluated by two independent radiologists for the presence of T2-hypointense dot sign and whirlpool sign using a three-point scale.


      The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values for the T2-hypointense dot sign for the diagnosis of ovarian torsion for observer 1 and observer 2 were 0.90, 1, 1, 0.93, and 0.96 and 0.87, 1, 1, 0.91, and 0.94, respectively. These same values for the whirlpool sign for observer 1 and observer 2 were 0.58, 1, 1, 0.77, and 0.82 and 0.42, 1, 1, 0.71, and 0.76, respectively. Both signs were definitely negative in patients with adnexal neoplasm and tubo-ovarian abscess. Interobserver agreement was excellent for the T2-hypointense dot sign (κ = 0.83), but poor for the whirlpool sign (κ = 0.31).


      The presence of T2-hypointense dot sign could be a valuable clue for the accurate and early diagnosis of ovarian torsion in non-contrast MRI scans.


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        • Chang H.C.
        • Bhatt S.
        • Dogra V.S.
        Pearls and pitfalls in diagnosis of ovarian torsion.
        Radiographics. 2008; 28: 1355-1358
        • Duigenan S.
        • Oliva E.
        • Lee S.I.
        Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation.
        AJR. 2012; 198: 122-131
        • Graif M.
        • Shalev J.
        • Strauss S.
        • Engelberg S.
        • Mashiach S.
        • Itzchak Y.
        Torsion of the ovary: sonographic features.
        AJR. 1984; 143: 1331-1334
        • Phillips G.S.
        • Parisi M.T.
        • Chew F.S.
        Imaging diagnosis of right lower quadrant pain in children.
        AJR. 2011; 196: 527-534
        • Jain K.A.
        Magnetic resonance imaging findings in ovarian torsion.
        Magn Reson Imaging. 1995; 13: 111-113
        • Anders J.F.
        • Powell E.C.
        Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients.
        Arch Pediatr Adolesc Med. 2005; 159: 532-535
      1. Rha SE, Byun JY, Jung SE, Jung JI, Choi BG, Kim BS et al. CT and MR imaging features of adnexal torsion. Radiographics 2002;22:283–94.

        • Graif M.
        • Itzchak Y.
        Sonographic evaluation of ovarian torsion in childhood and adolescence.
        AJR. 1988; 150: 647-649
        • Lourenco A.P.
        • Swenson D.
        • Tubbs R.J.
        • Lazarus E.
        Ovarian and tubal torsion: imaging findings on US, CT, and MRI.
        Emerg Radiol. 2014; 21: 179-187
        • Choudhary S.
        • Fasih N.
        • Innes M.M.
        • Marginean C.
        Imaging of ovarian teratomas: appearances and complications.
        J Med Imaging Radiat Oncol. 2009; 53: 480-488
      2. Ghossain MA, Hachem K, Buy JN, Hourany-Rizk RG, Aoun NJ, Haddad-Zebouni S et al. Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance. J Magn Reson Imaging 2004;20:451–62.

        • Mandoul C.
        • Verheyden C.
        • Curros-Doyon F.
        • Rathat G.
        • Taourel P.
        • Millet I.
        Diagnostic performance of CT signs for predicting adnexal torsion in women presenting with an adnexal mass and abdominal pain: a case-control study.
        Eur J Radiol. 2018; 98: 75-81
      3. Béranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M et al. Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology 2015;279:461–470.

        • Bekci T.
        • Polat A.V.
        • Aslan K.
        • Tomak L.
        • Bilgici M.C.
        • Danaci M.
        Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries.
        Clin Imaging. 2016; 40: 1029-1033