Polycystic ovary syndrome on ultrasound
Polycystic ovary syndrome on ultrasound Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by a combination of hormonal imbalance, metabolic issues, and ovarian dysfunction. While clinical symptoms such as irregular periods, hirsutism, and acne are often the initial clues, ultrasound imaging plays a pivotal role in diagnosing PCOS. An ultrasound provides a non-invasive window into the ovaries, revealing characteristic features that support the diagnosis.
On ultrasound, women with PCOS typically exhibit an increased number of small follicles, often described as a “string of pearls” appearance. These follicles are usually less than 9 mm in diameter and are located peripherally around the ovary, giving a distinct pattern. The ovarian volume in PCOS is also generally enlarged, often exceeding 10 mL, which further supports the diagnosis. The combination of increased follicle count and enlarged ovaries constitutes the Rotterdam criteria, one of the most widely used standards for PCOS diagnosis.
The typical ultrasound finding involves multiple small, cystic follicles arranged along the ovarian periphery. These follicles represent arrested or immature follicles that have failed to develop properly, leading to the characteristic polycystic appearance. It’s important to distinguish these features from other ovarian cysts, which tend to be larger and fewer in number. The “string of pearls” or “necklace” appearance is distinctive and helps clinicians differentiate PCOS from other ovarian pathologies.
Despite its diagnostic utility, ultrasound findings should always be interpreted in conjunction with clinical features and hormonal profiles. Not all women with polycystic ovarian morphology on ultrasound have clinical PCOS, and some women with typical symptoms may have normal ultrasound findings. Additionally, the ovarian morphology can vary with age, menstrual cycle phase, and even ethnic background. Therefore, a comprehensive assessment is critical for an accurate diagnosis.
Advances in ultrasound technology, especially transvaginal ultrasound, have increased the sensitivity and specificity of detecting polycystic ovarian features. Transvaginal scans provide clearer images of the ovaries, allowing for precise follicle counting and volume estimation. However, in women who are not sexually active or in certain age groups, transabdominal ultrasound remains an option, though it may provide less detailed imagery.
In conclusion, ultrasound imaging is an invaluable tool in the diagnosis and evaluation of PCOS. Recognizing the characteristic ovarian morphology—multiple small follicles arranged peripherally and increased ovarian volume—helps confirm clinical suspicions. Still, it’s essential for clinicians to interpret ultrasound findings within the broader clinical and biochemical context to ensure accurate diagnosis and appropriate management.
