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. 2007 Dec;10(4):153-60.
doi: 10.1016/j.jus.2007.09.006. Epub 2007 Oct 22.

The pathogenetic enigma of polycystic ovary syndrome

S Speca  1 , C Napolitano, G Tagliaferri
Affiliations

The pathogenetic enigma of polycystic ovary syndrome

S Speca et al. J Ultrasound. 2007 Dec.

Abstract
in English, Italian

Polycystic ovary syndrome (PCOS) is a complex disease with heterogeneous clinical and anatomical features that were first described in 1721 by Antonio Vallisneri. There is still a lack of consensus regarding the criteria to be used for diagnosis of PCOS. Transvaginal ultrasonography with Doppler studies of the ovarian and pelvic vasculature plays an important role in its diagnosis, but findings must be interpreted in light of the patient's symptoms and laboratory findings.

SommarioLa complessità e l'eterogeneità anatomica e clinica dell'espressione della sindrome dell'ovaio policistico (PCOS) costituisce a tutt'oggi una problematica nella quale la valutazione ecografica rappresenta una componente importante nella diagnosi, che si deve integrare con i sintomi clinici e le alterazioni biochimiche proprie della sindrome descritta per la prima volta da Antonio Vallisneri nel 1721. I criteri per la diagnosi sono eterogenei come la stessa patologia.

Keywords: Hyperandrogenism; Metabolic syndrome; PCOS; Ultrasonography.

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Figures

Fig. 1
Fig. 1
Measurement of the three diameters of the ovary to estimate its volume. The stroma surrounding the microfollicles shows clear signs of hypertrophy.
Fig. 2
Fig. 2
Echogenicity of the ovarian stroma is subjectively rated with a three-point score, where 3 indicates maximum intensity.
Fig. 3
Fig. 3
Multifollicular ovary (MFO): numerous follicles Ø 6–10 mm are distributed throughout the ovarian section.
Fig. 4
Fig. 4
PCOS: the stromal area is increased by more than 25%. This finding displays a specificity of 96% for diagnosis of this syndrome.
Fig. 5
Fig. 5
(a) PCOS: calculation of the S/A ratio. The stromal area corresponds to the hyperechoic zone located mainly in the center of the ovary. The total ovarian area is measured by outlining with the caliper the external limits of the ovary in the maximum plane section. (b) In patients with PCO, the S/A ratio is always >0.34. Those of patients with MFO and healthy controls always fall below this cut-off. Fulghesu et al. .
Fig. 6
Fig. 6
In patients with PCOS, the pulsatility index (PI: 1,85) of the intrauterine artery is higher than normal and vascularization is thus reduced.
Fig. 7
Fig. 7
In patients with PCOS, the intraovarian arterioles display lower than normal resistivity indices (RI: 0.46) indicative of enhanced stromal vascularization.
Fig. 8
Fig. 8
Three-dimensional ultrasound facilitates assessment of the ovarian stroma based on its mean grey signal intensity, volume, and vascularity. The stromal volume can be calculated by subtracting total follicular volume from total ovarian volume. Raine-Fenning and Fleischer .
See this image and copyright information in PMC

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