Subsequent Ultrasonographic Non-Visualization of the Ovaries Is Hastened in Women with Only One Ovary Visualized Initially

Abstract

Because the effects of age, menopausal status, weight and body mass index (BMI) on ovarian detectability by transvaginal ultrasound (TVS) have not been established, we determined their contributions to TVS visualization of the ovaries when one or both ovaries are visualized on the first ultrasound exam. A total of 29,877 women that had both ovaries visualized on their first exam were followed over 202,639 prospective TVS exams and 9703 women that had only one ovary visualized on their first exam were followed over 63,702 ultrasonography exams. All images were reviewed by a physician. While non-visualization of both ovaries increased with age in women selected on the basis of the visualization of only one ovary on their first ultrasound exam, one or both ovaries could be visualized in two out of every three women at 80 years of age and more than 50% of women over 80 years of age. At each age, more non-visualizations were associated with women that had only one ovary visualized on their first visit. Having only one ovary visualized on the first exam advanced non-visualizations by an average of ~10 years across all ages and by >20 years in women under 40 years of age. Conclusions: Having only one ovary visualized on an initial ultrasound exam considerably hastens complete non-visualization for this population; however, in these women, ovaries can still be visualized well past menopause, and body habitus is not limiting to TVS ovarian imaging, thus TVS should be considered capable of capturing an ovarian image in two out of every three women at 80 years of age.

Keywords: BMI; age; body type; detection; menopausal status; ovary; transvaginal ultrasound; visualization; weight.

Figure 1

Ovarian visualization relative to age. Panel (A). Sonographic findings visualizing both ovaries (black line), one ovary (blue line) or neither ovary (red line) when only one ovary was visualized on the first visit. The line of best fit for visualization of neither ovary is shown in gray (5th degree polynomial, (R = 0.997474, y = −324.904195 + 31.873955X − 1.205511X² − 0.021956X³ − 0.000191X⁴ − 0.00000063935X⁵). Panel (B). An increase in non-visualization of both ovaries as a function of age was determined when both ovaries were visualized on the first visit (solid red symbols, R = 0.999619) or when only one ovary was visualized on the first visit (open red symbols). For when only one ovary was visualized on the first visit, the line of best fit for visualization of neither ovary is shown in blue (5th degree polynomial, (R = 0.997474, y = −324.904195 + 31.873955X − 1.205511X² − 0.021956X³ − 0.000191X⁴ − 0.00000063935X⁵), open symbols), while when both ovaries were visualized on the first visit, the line of best fit for visualization of neither ovary is shown in blue (5th degree polynomial, (R = 0.999610, y = −33.913696 + 3.453024X − 0.126511X² − 0.001996X³ − 0.000012X⁴ − 0.00000002428358X⁵), solid symbols). Panel (C). Shortening of visualization results when only one ovary is observed on the first visit. Best fit curves are shown with the gray curve showing the number of years that non-visualization is advanced when only one ovary is visualized on the first visit. Where N = number of TVS observations. Age was self-reported and associated with 29,877 women that received 202,639 TVS encounters when both ovaries were visualized on the first visit and with 9703 women who received 63,697 TVS encounters when only one ovary was visualized on the first visit. Percentages were determined within each age group.

Figure 2

Ovarian visualization relative to weight, BMI and menopausal status when only one ovary is visualized on the first visit. Panel (A): Weight was reported in 63,244 TVS encounters. Panel (B): Weight and height were reported for the calculation of BMI in 63,183 TVS encounters. Panel (C): Menopausal status was self-reported at the time of the TVS exam in 62,297 TVS encounters. Sonographic findings visualizing both ovaries (black bar), one ovary (blue bar) or neither ovary (red bar). Differences in the number of TVS exams reflect unreported events (missing data) resulting in exclusion from analysis. Percentages were determined for each group.