(Ultrasound Review) According to researchers from the Royal Devon and Exeter Hospital in England, this study, published in Ultrasound in Medicine and Biology, is the first that investigates the value of each of the criteria defined by Adams for ultrasound diagnosis of polycystic ovary syndrome (PCOS).
Adams described the ultrasound criteria as the presence of 10 or more small follicles throughout or around the periphery of the ovary, increased ovarian volume, and a stroma of increased echogenicity compared with the uterine myometrium. Previous studies have shown that not all women with PCOS have sonographic features of the disease, and in one study 22% of women without PCOS showed one of the ultrasound features described by Adams.
The ultrasound examinations of 72 women, 32 with PCOS and 40 volunteers, were analyzed to determine the sensitivity of each ultrasound feature, as well as a combination. Transvaginal ultrasound was performed in all but four volunteers using a 7-MHz transducer.
The number of follicles was estimated by counting the number of follicles in each of two non-overlapping longitudinal images in each ovary. This method was employed to avoid double-counting follicles, but the authors concede that this method may underestimate the number of follicles.
It was found that the most sensitive features were the presence of 10 or more follicles (82% left, 69% right), and the peripheral distribution of follicles (81.8% left, 71.9% right). Using a combination of all the criteria, researchers correctly diagnosed the presence or absence of PCOS in 86.4% of cases. The ultrasound criteria were more sensitive for the left ovary, and one explanation for this was a difference in ovulatory capacity.
The authors summarized their research by reporting that "established sonographic criteria of polycystic ovarian syndrome remain of value in the diagnosis of this condition. It is possible that the left ovary is a better indicator of metabolic and follicular dysfunction than the right, and that discriminant analysis of a combination of all sonographic criteria correctly identifies or excludes PCOS in 86.4% of cases."
Ultrasound in Medicine and Biology 2000; 26:977–980
William U Atiomo et al
Dept of Obstetrics & Gynaecology, Royal Devon and Exeter Hospital, Exeter EX1 2ED, UK
By Ultrasound Review
December 28, 2000
Copyright © 2000 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
