Introduction/Background Adnexal torsion is a rather common matter of urgency surgery. However, it is a quite difficult diagnosis to make, since there is no specific test that can diagnose it with certainty.

Methodology A search was performed in PubMed/MEDLINE, CINAHL, Scopus, Cochrane, ClinicalTrials.gov and Web of Science databases (January 1990 to November 2021) for studies evaluating the presence of ovarian edema, adnexal mass, Doppler flow findings and the whirlpool sign as ultrasound signs (index tests) fordetecting AT, using surgical findings as reference standard. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, positive and negative likelihood ratios were calculated separately, and the post-test probability of AT following a positive or negative test also was determined.

Results The search identified 1267 citations after excluding duplicates. Twenty studies were ultimately included in the qualitative and quantitative syntheses. Ten studies (983 patients) analyzed ovarian edema. Eleven studies (1295 patients) analyzed the presence of adnexal mass. Fifteen studies (2212 patients) analyzed the Doppler flow. Finally, seven studies (654 patients) analyzed whirlpool sign. Overall, quality was considered as moderate or good for most studies. Pooled sensitivity, specificity and positive and negative likelihood ratios of each ultrasound sign were 57%, 88%,4.9 and 0.48 for ovarian edema, 72%, 39%, 1.2 and 0.73 for adnexal mass, 65%, 92%, 8.0 and 0.38 for whirlpool sign, and 55%, 94%, 9.6 and 0.48 for Doppler findings. Heterogeneity was high for all them.

Conclusion Diagnostic accuracy of the presence of an adnexal mass as ultrasound sign mass for suspecting an adnexal torsion is poor, while it is good for ovarian edema, whirlpool sign and Doppler flow, all of them with high specificity but moderate sensitivity