The Role of D-Dimer and Ischemia Modified Albumin (IMA) in Adnexal Torsion: A Literature Review

Literature Review

Abstract

Adnexal torsion is a gynaecological emergency in which timely diagnosis is critical to preserve ovarian function. This review examines the emerging roles of D-dimer and ischemia-modified albumin (IMA) as diagnostic biomarkers in ovarian (adnexal) torsion. A systematic search of recent literature (2015–2025) identified both animal experiments and clinical studies evaluating these markers. D-dimer, a fibrin degradation product, rises significantly in ovarian torsion due to thrombosis and tissue necrosis, while IMA increases in response to ischemia-induced albumin modification. Key studies show that D-dimer and IMA levels are significantly elevated in torsion versus controls, with diagnostic sensitivities and specificities reaching 67–82% and 78–100% for D-dimer, and ~90% each for IMA. Both markers demonstrate strong positive likelihood ratios (>10) for torsion. IMA levels also correlate with the severity of ovarian ischemic damage, suggesting a prognostic value. However, their accuracy can be influenced by confounders such as pregnancy and inflammatory conditions. In practice, these biomarkers could complement imaging (e.g. ultrasound) to improve early detection of torsion and guide urgent intervention. Further large-scale studies are needed to validate their clinical utility and to determine whether combining markers in a diagnostic panel could reliably distinguish torsion from other acute pelvic pathologies.