(Ultrasound Review) London physicians from the North Middlesex and Royal Free Hospitals and University College Medical School collectively wrote a review article concerning polycystic ovaries (PCO), which was published in the British Journal of Radiology. Their aim was to revisit the role of ultrasound in diagnosing this condition, particularly new developments such as Doppler and 3-D ultrasound.
They presented an interesting table of studies spanning 15 years that listed ultrasound variables and diagnostic criteria. The introduction of high- resolution transvaginal ultrasound has enabled visualization of smaller follicles, and improvements in contrast resolution have allowed assessment of stromal echogenicity.
"The high resolution of the technique allows visualization of follicles less than 5mm in diameter as well as echogenic stroma, which corresponds closely to the characteristic histopathological changes, and this is now accepted as the gold standard for diagnosis of PCO," they reported. The precise criteria described in 2000 by Atiomo and colleagues for PCO were: ovarian volume > 9cm3, >10 follicles 2-8mm, and increased echogenicity of ovarian stroma.
The authors suggested that 3-D ultrasound should enable more precise calculations of ovarian volume and improve the accuracy of PCO diagnosis. Doppler ultrasound research by Battaglia et al reported that women with PCO had a higher pulsatility index in the uterine artery and decreased resistive index within the ovarian stroma. However, these authors showed no significant difference comparing the ovarian haemodynamics of women with normal ovaries and women with PCO. Although MRI enabled easier visualization of the ovaries, research has not shown a significant improvement in diagnosing PCO compared with transvaginal ultrasound, a more cost-effective modality.
The relationship between increased LH levels, PCO, and early pregnancy loss remains controversial, with different studies showing conflicting results. In a study of 56 women, Sagle et al demonstrated that 82% of women with three or more miscarriages demonstrated ultrasound appearances of PCO. Women with PCO have associated risks such as obesity, insulin resistance, hypertension, and altered lipid profiles making them prone to cardiovascular disease later in life.
According to the authors "although it is not quite clear whether the estimated risk of health problems in women with PCO actually translate into long-term morbidity and/or mortality, asymptomatic women with PCO must indeed have an increased likelihood of adverse health outcomes as a result of their PCO status."
"Polycystic ovaries"K Lakhani et al
Ultrasound department, North Middlesex Hospital
The British Journal of Radiology, 2002 (January); 75: 9-16
By Ultrasound Review
March 18, 2002
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