Two hits on one spectral scan...
35 yo F with sudden onset of abdominal pain while watching TV. Conventional CT shows right adnexal cyst, otherwise unremarkable.
On spectral analysis, obvious gallstones are visualized, confirmed on ultrasound, where there was no evidence of acute cholecystitis. It is not uncommon to find gallstones on spectral CT that are not seen on conventional images, and spectral curves nicely illustrate the reason.
The right adnexal cyst is without iodine uptake, consistent with hemorrhagic cyst. Ovarian tissue below the cyst appears enlarged, and on spectral analysis, shows absent iodine uptake. Ovarian torsion was suspected. On ultrasound, blood flow was seen in the right ovary. On radiology resident exam, the patient was highly tender over the right ovary.
So we stuck to our spectral guns, and suspected ovarian torsion. Patient was taken to the operating room.
There was no evidence of torsion. Cystic and solid lesion of the right ovary was removed, found to be a serous cystadenofibroma on pathology.
On follow-up exam, patients symptoms had resolved.
Was this a poorly perfused benign ovarian tumor? Was this intermittent torsion, which had resolved by surgery? Or can torsion be called based on spectral CT at all?
As always, we will continue to learn....
Iodine overlay image shows absent iodine uptake.