Neşat ÇULLU, Neşe Gül HİLALİ, Adnan İNCEBIYIK, Aysun CAMUZCUOĞLU, Ekrem KARAKAŞ, Ömer KARAKAŞ, Nihat KILIÇASLAN, Fatıma Nurefşan BOYACI

Over torsiyonu ve masif over ödemi manyetik rezonans görüntüleme bulguları

Amaç: Yazımızda, masif over ödemi (MOÖ) ve overtorsiyonu (OT) hastalarında doğru tanıda pelvik manyetik rezonans görüntülemenin (MRG) rolünü araştırmayıamaçladık.Yöntemler: Alt karın ağrısı ile hastanemize başvuran, B-mod USG ve Doppler USG ile masif over ödemi ve over torsiyonu ön tanısı düşünülen 4 hastaya kontrastlı pelvik MRG ve difüzyon ağırlıklı görüntüleme (DAG) yapıldı.Bulgular: Patolojik overlerde, Doppler USG’de OT’li 3 hastada arteryal ya da venöz akım saptanmadı. MOÖ’lü hastada ise akselerasyonu uzamış, monofazik arteryal akım saptandı. Venöz akım saptanmadı. MOÖ’lü hastanın sol over boyutu artmış olup T1A görüntülerde heterojen düşük intensite, T2A görüntülerde heterojen yüksek intensite izlendi. Postkontrast yağ baskılı T1A görüntülerde kısmi parankimal kontrastlanma saptandı. OT’li iki hastada ise over boyutları artmıştı. T1A görüntülerde homojen düşük intensite, T2A görüntülerde homojen yüksek intensite izlendi. Postkontrast yağ baskılı T1A görüntülerde parankimal kontrastlanma saptanmadı. OT’li diğer hastada over boyutu artmıştı. Overde hemorajik enfarktı yansıtan perifere doğru belirginleşen T1A görüntülerde intensite artımı, T2A görüntülerde intensite azalması izlendi. Over torsiyonlu hastaların over dokularında DAG’da enfarktı yansıtan difüzyon kısıtlanmaları saptandı. Sonuç: MOÖ ve OT’li hastaların kontrastlı pelvik MRG bulgularıyla doğru olarak ayrılabileceğini düşünmekteyiz. Ayrıca DAG, operasyon öncesi cerrahi seçiminde yol gösterici olabilir

Magnetic resonance imaging findings of massive ovarian edema and ovarian torsion

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-satu- rated 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-op- eratively information determined from DWI can help guide clinicians to decide for correct type of surgery.

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