Polycystic Ovary Syndrome (PCOS) Imaging
What are the imaging modalities used in PCOS?
@hanish Polycystic ovaries are most often diagnosed by means of laboratory studies. The initial screening tests may include determinations of the blood serum levels of thyroid-stimulating hormone (TSH), FSH, LH, and prolactin (PL). The ratio of the FSH level to the LH level is useful in the diagnosis. TSH or PL levels may be useful in identifying an etiology, such as hyperthyroidism or a prolactinoma. In some patients, testosterone and dihydroepiandrosterone sulfate (DHEAS) levels or a progesterone challenge is useful.
Typically, a radiologic evaluation for polycystic ovaries is reserved for patients who have equivocal laboratory findings. However, radiologists make a significant number of incidental diagnoses. Should the radiologist's assistance be requested in the diagnosis of polycystic ovary syndrome, the imaging method of choice is transabdominal and/or transvaginal ultrasonography. Magnetic resonance imaging (MRI) is useful as an adjunct; however, although MRI is more sensitive than ultrasonography, its findings are less specific. The benefits of cross-sectional imaging and functional neuroimaging have been studied.
In a case-control study, by Fondin et a,l of 110 adolescent girls (age range, 13-17 yr) who underwent pelvic MR imaging, the most accurate diagnostic criteria on MRI for PCOS were ovarian volume, follicles per ovary measuring 9 mm or less, and peripheral distribution of follicles.
Assessment of anti-Mullerian hormone levels may offer promise as a method of dertermining the presence of PCOS.
Polycystic ovary syndrome is not a primary disease process. When polycystic ovaries are discovered at radiologic examination, further diagnostic tests are needed to determine the etiology.