Polycystic ovarian disease: Ultrasonic evaluation and correlations with clinical and hormonal data

Luigi Parisi, Maria Tramonti, Lorenzo E. Derchi, Silvio Casciano, Alberto Zurli, Pietro Rocchi

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Ultrasonography permits direct analysis of pathological changes in the ovaries. The present authors have found that in polycystic ovary disease the ovaries are enlarged, oval or rounded in shape, and composed of many small cystic spaces. This article presents additional ultrasonic findings and their correlations with clinical and laboratory data on the disease. From June 1980 to July 1982, 187 patients between the ages of 14 and 33 years, with clinical indications of polycystic ovary syndrome, were studied by Ultrasonography and by endocrinological and clinical methods. For those with a final diagnosis of polycystic disease, the ultrasonic images were reviewed. The sizes, shapes, margins, and structures of the ovaries were analyzed, and the uterine/ovarian ratio (defined as the maximum anteroposterior diameter of the uterine fundus/longitudinal diameter of the ovary) was evaluated. The ovary was considered as an ellipsoid, and its minimum surface area was calculated by means of a formula: maximum diameter × minimum diameter × π/4 (0.7854). In regard to the shape of the ovary, the authors calculated a “roundness index” (minimum diameter perpendicular to longest diameter × 100/longest diameter). In perfectly rounded ovaries, this index should be 100. Both ovaries were identified by ultrasound examination in 176 patients. They could not be identified in five cases, and in each of six others, only one ovary could be distinguished. Polycystic ovary disease was diagnosed in 26 of the 187 patients. A final diagnosis of Stein-Leventhal syndrome was made in 25 of these cases, and the remaining patient had polycystic enlarged ovaries due to a prolactin-secreting pituitary microadenoma. The ovaries of the remaining 150 patients were normal on ultrasound examination. Histological confirmation of the diagnosis was available in seven cases, either by surgery or by laparoscopy. In all polycystic ovary disease patients, both ovaries were identified by ultrasonography. Symmetrical and bilateral ovarian enlargement was present in all cases. The maximum surface areas of the organs ranged from 9.5 to 17.3 cm2, with an average value of 12.9 (± 2.6 SD) cm2. The “roundness index” ranged from 100 (one case with perfectly rounded ovaries) to 54, with an average value of 73 (±16.1 SD). Ovarian margins were always regular and had a slight polycystic appearance in some cases. In 19 patients, the ovarian structure was made up of many small cystic spaces, all of the same size (approximately 0.5 cm in diameter; Fig. 1). In each of two other cases, a cyst of 1.5 cm in diameter was present inside one ovary. A polycystic pattern could not be distinguished in the remaining five patients. The ovarian structure in these patients was formed of many thick echoes arranged along parallel lines. The uterine/ovarian ratio ranged from 0.5 to 1.0, with an average value of 0.8 (± 0.14 SD). The authors correlated sonographic results (maximum surface area, roundness index, and uterine/ovarian ratio) with clinical findings (patient’s age, duration of symptoms, presence of hirsutism, and obesity). When the maximum surface area was considered to be the dependent variable, the correlation coefficient was 0.935. Analysis of variance was F(6,19) = 22.16 (P = 5 × 10-6). When the dependent variable was the roundness index, the correlation coefficient was 0.843 and analysis of variance was F(6,19) = 7.78 (P = 4 × 10-4). A significant correlation, however, was present between the roundness index (dependent variable) and the maximum surface area (independent variable). The correlation coefficient was 0.824, and analysis of variance was F(1,24) = 50.85 (P = 8 × 10-6). A highly significant result was obtained when the maximum surface area and the patient’s age were correlated (correlation coefficient = 0.852), as well as the maximum surface area and duration of symptoms (correlation coefficient = 0.731). Similar results were obtained in the evaluation of the roundness index and the patient’s age (correlation coefficient = 0.695) and the roundness index and duration of disease (correlation coefficient = 0.671). The ovarian size (defined as maximum surface area), patient’s age, and roundness index were correlated with the hor- monal tests (progesterone levels, basal values of LH and FSH, LH-RH test, total testosterone, and urinary 17-keto-steroids levels). When the ovarian size was considered to be the dependent variable, the correlation coefficient was 0.938, and analysis of variance was F(8,17) = 15.49 (P = 2 × 10-5). Other correlations were not significant. In the 150 patients without polycystic ovary disease, the ovaries were smaller in size, the maximum surface area ranging from 1.57 to 7.22 cm2, with an average value of 4.8 (± 1.25 SD) cm2. They always appeared to have an oval shape and regular margins. The ovarian structure was homogeneous, with many small low-level echoes. In some patients, solitary or multiple cystic spaces due to oophoric follicles were present. Although multiple follicles may resemble polycystic ovaries, a differentiation could be made. These cysts were often unilateral, there was usually a larger sized cyst, and changes could be observed in the patients during different stages of the menstrual cycle.

Original languageEnglish
Pages (from-to)389-391
Number of pages3
JournalObstetrical and Gynecological Survey
Issue number6
Publication statusPublished - 1984

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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