COVARIAN - Contribution of Contrast Enhanced Ultrasound for Diagnosis of Adnexal Torsion: a Randomized Controlled Trial

Status: Recruiting
Location: See all (6) locations...
Intervention Type: Other, Drug
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

Adnexal torsion is the rotation of the ovary around its vascular axis resulting, in the absence of treatment, ischemia that can lead to peritonitis by necrosis or impaired fertility. It is a gynecological emergency affecting 3% of women of childbearing age, including from adolescence, and requires surgical treatment as soon as possible, classically within 6 hours. The symptomatology of adnexal torsion is dominated by pelvic pain of sudden onset and variable intensity, an aspecific sign that does not allow a diagnosis of certainty. There are no biological markers and, in the context of the emergency, the only imaging examination available is pelvic ultrasound associated with a Doppler flow analysis but with a low and variable diagnostic performance depending on the studies (sensitivity variable from 46 to 73%). There are currently no tests that can provide a diagnosis of certainty. Only surgical exploration, carried out at the discretion of the practitioner on the basis of a bundle of arguments, can confirm or refute the diagnosis. However, this management strategy leads to the realization of emergency surgical interventions wrongly since 3 out of 10 women will finally not have an adnexal torsion (PMSI data from participating centers: 30 to 45% false positives). Contrast ultrasound is a technique that uses a strict intravascular product to assess the vascularization of the ovary and offers a high diagnostic performance in the context of adnexal torsion. Indeed, a retrospective study, published in 2021, reports a sensitivity of 94% and a specificity of 100%. The preliminary results of our pilot study (AGATA APJC 2019, Dr Bertholdt, NCT04522219) also go in this direction with a sensitivity of 100%, a specificity of 86% and a negative predictive value of 100% (data being published). The COVARIAN project, second stage of the AGATA project, aims to demonstrate that the addition of a contrast evaluation to standard ultrasound in the diagnostic strategy in case of suspicion of adnexal torsion improves the health of women by reducing the rate of wrongly surgery, that is, without proven torsion. COVARIAN will be the first prospective multicenter randomized study evaluating the direct benefit for women of using ultrasound contrast evaluation in the management strategy in case of suspicion of adnexal torsion.

Eligibility
Participation Requirements
Sex: Female
Minimum Age: 18
Healthy Volunteers: f
View:

• Age 18 or over

• Person who has carried out a preliminary clinical examination adapted to the clinical trial

• Strong suspicion of adnexal torsion with surgery planned

• No ongoing pregnancy or breastfeeding

• Affiliation to or beneficiary of a social security scheme

• Person who has received complete information on the organization of the research and has signed their informed consent

Locations
Other Locations
France
CHU
NOT_YET_RECRUITING
Besançon
CHU
NOT_YET_RECRUITING
Dijon
CHRU Nancy - Maternité Régionale
RECRUITING
Nancy
CHU
NOT_YET_RECRUITING
Reims
CMCO
NOT_YET_RECRUITING
Schiltigheim
CHU Hautepierre
NOT_YET_RECRUITING
Strasbourg
Contact Information
Primary
Charline BERTHOLDT, Pr
c.bertholdt@chru-nancy.fr
+33 383 344 312
Backup
Dorine MANHERTZ, MSc
d.manhertz@chru-nancy.fr
Time Frame
Start Date: 2025-05-14
Estimated Completion Date: 2028-02-07
Participants
Target number of participants: 256
Treatments
Experimental: ultrasound with contrast injection
Patients consulting the gynecological emergencies as part of the management of a strong suspicion of adnexal torsion (after the clinical examination and standard ultrasound)
Active_comparator: Control
Patients consulting the gynecological emergencies as part of the management of a strong suspicion of adnexal torsion (after the clinical examination and standard ultrasound)
Sponsors
Leads: Central Hospital, Nancy, France

This content was sourced from clinicaltrials.gov