POLYCYSTIC OVARY SYNDROME: THE ROLE OF ULTRASONIC DIAGNOSTICS
DOI:
https://doi.org/10.11603/24116-4944.2019.2.10922Keywords:
polycystic ovary syndrome, ultrasonic diagnosticsAbstract
Nowadays polycystic ovary syndrome (PCOS) is the most common endocrine pathology among females of reproductive age (about 6 % are affected). One of the main methods for diagnostics of this pathology is ultrasonography. The main criteria are measurements of the volume of ovaries and determination of the number of antral follicles. Transvaginal sensor is best suited for this reason, as it allows good visualization of the ovaries and their internal structure. In women with obesity and a regular menstrual cycle, ultrasound should be performed in the early follicular phase. In patients with oligomenorrhea or amenorrhea, the test should be performed between 3 and 5 days after menstruation, caused by progesterone.
The calculation is based upon a simple formula. The volume of the ovary 10 cm2 is considered to be the threshold for polycystic ovaries. The ovary with a volume of more than 10 cm2 should be considered as one with polycystic alterations. When counting follicles in the ovary, a key technical point in assessing their quantity is the presence of anthropocytic follicles around the stroma of ovary, which has increased echogenity. 12 or more antral follicles with a diameter 2–9 mm in one ovary is an ultrasound criterion for polycystic ovaries.
All females with suspected PCOS, as well as with ovulatory dysfunction and hyperandrogenism, need to be exposed to transvaginal sonography in the follicular phase of the menstrual cycle where two main criteria are determined – the volume of ovaries and the number of antral follicles there.
References
Knochenhauer, E.S., Key, T.J., Kahsar-Miller, M., Waggoner, W., Boots, L.R., & Azziz, R. (1998). Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J. Clin. Endocrinol. Metab., 83 (9), 3078-3082. DOI:10.1210/jcem.83.9.5090. DOI: https://doi.org/10.1210/jcem.83.9.5090
Guzick, D.S. (2004). Polycystic ovary syndrome. Obstet. Gynecol., 103 (1), 181-193. DOI:10.1097/01.AOG.0000104485.44999.C6 DOI: https://doi.org/10.1097/01.AOG.0000104485.44999.C6
Battaglia, C. (2003) The role of ultrasound and Doppler analysis in the diagnosis of polycystic ovary syndrome. Ultrasound Obstet. Gynecol., 22 (3), 225-232. DOI:10.1002/uog.228 DOI: https://doi.org/10.1002/uog.228
Zawadski, J.K., & Dunaif, A. (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Dunaif, A., Givens, J.R., & Haseltine, F.P. (Eds.). Polycystic Ovary Syndrome, 377-384. Boston: Blackwell Scientific Publications.
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril., 81 (1), 19-25. DOI: https://doi.org/10.1016/j.fertnstert.2003.10.004
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2003) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum. Reprod., 19 (1), 41-47. DOI:10.1093/humrep/deh098. DOI: https://doi.org/10.1093/humrep/deh098
Azziz, R., Carmina, E., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H.F., Futterweit, W., Janssen, O.E. et al. (2006). Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J. Clin. Endocrinol. Metab. 91 (11), 4237-4245. DOI:10.1210/jc.2006-0178. DOI: https://doi.org/10.1210/jc.2006-0178
Goldzieher, J.W., & Green, J.A. (1962). The polycystic ovary. I. Clinical and histologic features. J. Clin. Endocrinol. Metab., 50, 113-116. DOI:10.1210/jcem-22-3-325. DOI: https://doi.org/10.1210/jcem-22-3-325
Guzick, D.S. (1996) Cardiovascular risk in women with polycystic ovarian syndrome. Semin. Reprod. Endocrinol., 14 (1), 45-49. DOI:10.1055/s-2007-1016308. DOI: https://doi.org/10.1055/s-2007-1016308
Legro, R.S.1, Kunselman, A.R., Dodson, W.C., & Dunaif, A. (1999). Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J. Clin. Endocrinol. Metab., 84 (1), 165-169. DOI:10.1210/jcem.84.1.5393. DOI: https://doi.org/10.1210/jcem.84.1.5393
Chang, R.J., Nakamura, R.M., Judd, H.L., Kaplan, S.A. (1983). Insulin resistance in nonobese patients with polycystic ovarian disease. J. Clin. Endocrinol. Metab., 57 (2), 356-359. DOI:10.1210/jcem-57-2-356. DOI: https://doi.org/10.1210/jcem-57-2-356
Dunaif, A., Graf, M., Mandeli, J., Laumas, V., & Dobrjansky, A. (1987). Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J. Clin. Endocrinol. Metab., 65 (3), 499-507. DOI:10.1210/jcem-65-3-499. DOI: https://doi.org/10.1210/jcem-65-3-499
Ehrmann, D.A., Barnes, R.B., Rosenfield, R.L., Cavaghan, M.K., Imperial, J. (1999). Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 22 (1), 141-146. DOI:10.2337/diacare.22.1.141. DOI: https://doi.org/10.2337/diacare.22.1.141
Azziz, R., Ehrmann, D., Legro, R.S., Whitcomb, R.W., Hanley, R., Fereshetian, A.G., & O'Keefe, M. et al. PCOS/Troglitazone Study Group. (2001) Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J. Clin. Endocrinol. Metab., 86 (4), 1626-1632. DOI:10.1210/jcem.86.4.7375. DOI: https://doi.org/10.1210/jcem.86.4.7375
Velazquez, E.M.1, Mendoza, S., Hamer, T., Sosa, F., & Glueck, C.J. (1994). Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism, 43 (5), 647-654. DOI: https://doi.org/10.1016/0026-0495(94)90209-7
Rebar, R., Judd, H.L., Yen, S.S., Rakoff, J., Vandenberg, G., & Naftolin, F. (1976). Characterization of the inappropriate gonadotropin secretion in polycystic ovary syndrome. J. Clin. Invest., 57 (5), 1320-1329. DOI:10.1172/JCI108400. DOI: https://doi.org/10.1172/JCI108400
Baird, D.T., Corker, C.S., Davidson, D.W., Hunter, W.M., Michie, E.A., Van Look, P.F. (1977) Pituitary-ovarian relationships in polycystic ovary syndrome. J Clin Endocrinol. Metab., 45 (4), 798-809. DOI:10.1210/jcem-45-4-798. DOI: https://doi.org/10.1210/jcem-45-4-798
Kaiser, U.B., Sabbagh, E., Katzenellenbogen, R.A., Conn, P.M., Chin, W.W. (1995). A mechanism for the differential regulation of gonadotropin subunit gene expression by gonadotropin-releasing hormone. Physiology, 92 (26), 12280-12284. DOI:10.1073/pnas.92.26.12280. DOI: https://doi.org/10.1073/pnas.92.26.12280
Chang, R.J., Mandel, F.P., Lu, J.K., & Judd, H.L. (1982) Enhanced disparity of gonadotropin secretion by estrone in women with polycystic ovarian disease. J. Clin. Endocrinol. Metab., 54 (3), 490-494. DOI:10.1210/jcem-54-3-490. DOI: https://doi.org/10.1210/jcem-54-3-490
Balen, A.H., Laven, J.S., Tan, S.L., & Dewailly, D. (2003). Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum. Reprod. Update, 9 (6), 505-514. DOI:10.1093/humupd/dmg044. DOI: https://doi.org/10.1093/humupd/dmg044
Adams, J., Franks, S., Polson, D.W., Mason, H.D., Abdulwahid, N., Tucker, M., Morris, D.V. et al. (1985). Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet, 2 (8469-70), 1375-1379. DOI:10.1016/s0140-6736(85)92552-8. DOI: https://doi.org/10.1016/S0140-6736(85)92552-8
Mahmutyazicioğlu, K., Tanriverdi, H.A., Ozdemir, H., Barut, A., Davşanci, H., & Gündoğdu, S. (2005) Transabdominal pulse inversion harmonic imaging improves assessment of ovarian morphology in virgin patients with PCOS: comparison with conventional B-mode sonography. Eur. J. Radiol., 53 (2), 280-286. DOI:10.1016/j.ejrad.2004.03.024. DOI: https://doi.org/10.1016/j.ejrad.2004.03.024
Allemand, M.C., Tummon, I.S., Phy, J.L., Foong, S.C., Dumesic, D.A., & Session, D.R. (2006). Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound. Fertil. Steril., 85 (1), 214-219. DOI:10.1016/j.fertnstert.2005.07.1279. DOI: https://doi.org/10.1016/j.fertnstert.2005.07.1279
Hassan, M.A., & Killick, S.R. (2003) Ultrasound diagnosis of polycystic ovaries in women who have no symptoms of polycystic ovary syndrome is not associated with subfecundity or subfertility. Fertil. Steril., 80 (4), 966-975. DOI: https://doi.org/10.1016/S0015-0282(03)01010-0
Carmina, E., Wong, L., Chang, L., Paulson, R.J., Sauer, M.V., Stanczyk, F.Z., & Lobo, R.A. (1997). Endocrine abnormalities in ovulatory women with polycystic ovaries on ultrasound. Hum. Reprod., 12 (5), 905-909. DOI:10.1093/humrep/12.5.905. DOI: https://doi.org/10.1093/humrep/12.5.905
Lam, P.M., & Raine-Fenning, N. (2006). The role of three-dimensional ultrasonography in polycystic ovary syndrome. Hum. Reprod., 21 (9), 2209-2215. DOI:10.1093/humrep/del161. DOI: https://doi.org/10.1093/humrep/del161
Zaidi, J., Campbell, S., Pittrof, R., Kyei-Mensah, A., Shaker, A., Jacobs, H.S., & Tan, S.L. (1995) Ovarian stromal blood flow in women with polycystic ovaries - a possible new marker for diagnosis? Hum. Reprod., 10 (8), 1992-1996. DOI:10.1093/oxfordjournals.humrep.a136222. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a136222
Ozkan, S., Vural, B., Calişkan, E., Bodur, H., Türköz, E., & Vural, F. (2007). Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome. J. Clin. Ultrasound, 35 (6), 305-313. DOI:10.1002/jcu.20358. DOI: https://doi.org/10.1002/jcu.20358
Tugrul, S., Oral, O., Güçlü, M., Kutlu, T., Uslu, H., & Pekin, O. (2006). Significance of Doppler ultrasonography in the diagnosis of polycystic ovary syndrome. Clin. Exp. Obstet. Gynecol., 33 (3), 154-158.
Pinkas, H., Mashiach, R., Rabinerson, D., Avrech, O.M., Royburt, M., Rufas, O., Meizner, I. et al. (1998). Doppler parameters of uterine and ovarian stromal blood flow in women with polycystic ovary syndrome and normally ovulating women undergoing controlled ovarian stimulation. Ultrasound Obstet. Gynecol., 12 (3), 197-200. DOI:10.1046/j.1469-0705.1998.12030197.x. DOI: https://doi.org/10.1046/j.1469-0705.1998.12030197.x
Yoo, R.Y., Sirlin, C.B., Gottschalk, M., Chang, R.J. (2005). Ovarian imaging by magnetic resonance in obese adolescent girls with polycystic ovary syndrome: a pilot study. Fertil. Steril., 84 (4), 985-995. DOI:10.1016/j.fertnstert.2005.04.039. DOI: https://doi.org/10.1016/j.fertnstert.2005.04.039
Outwater, E.K., & Schiebler, M.L. (1994) Magnetic resonance imaging of the ovary. Radiol. Clin. North Am., 2 (2), 245-274. DOI: https://doi.org/10.1016/S1064-9689(21)00343-3
Kimura, I., Togashi, K., Kawakami, S., Nakano, Y., Takakura, K., Mori, T., & Konishi, J. (1996). Polycystic ovaries: implications of diagnosis with MR imaging. Radiology, 201 (2), 549-552. DOI:10.1148/radiology.201.2.8888256. DOI: https://doi.org/10.1148/radiology.201.2.8888256
Erdem, C.Z., Bayar. U., Erdem, L.O., Barut, A., Gundogdu, S., & Kaya, E. (2004). Polycystic ovary syndrome: dynamic contrast-enhanced ovary MR imaging. Eur. J. Radiol., 51 (1), 48-53. DOI:10.1016/j.ejrad.2003.08.005. DOI: https://doi.org/10.1016/j.ejrad.2003.08.005
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
