(Ultrasound Review) London physicians from the North Middlesex and Royal Free Hospitals and University College Medical School collectively wrote a review article concerning polycystic ovaries (PCO), which was published in the British Journal of Radiology. Their aim was to revisit the role of ultrasound in diagnosing this condition, particularly new developments such as Doppler and 3-D ultrasound.
They presented an interesting table of studies spanning 15 years that listed ultrasound variables and diagnostic criteria. The introduction of high- resolution transvaginal ultrasound has enabled visualization of smaller follicles, and improvements in contrast resolution have allowed assessment of stromal echogenicity.
"The high resolution of the technique allows visualization of follicles less than 5mm in diameter as well as echogenic stroma, which corresponds closely to the characteristic histopathological changes, and this is now accepted as the gold standard for diagnosis of PCO," they reported. The precise criteria described in 2000 by Atiomo and colleagues for PCO were: ovarian volume > 9cm3, >10 follicles 2-8mm, and increased echogenicity of ovarian stroma.
The authors suggested that 3-D ultrasound should enable more precise calculations of ovarian volume and improve the accuracy of PCO diagnosis. Doppler ultrasound research by Battaglia et al reported that women with PCO had a higher pulsatility index in the uterine artery and decreased resistive index within the ovarian stroma. However, these authors showed no significant difference comparing the ovarian haemodynamics of women with normal ovaries and women with PCO. Although MRI enabled easier visualization of the ovaries, research has not shown a significant improvement in diagnosing PCO compared with transvaginal ultrasound, a more cost-effective modality.
The relationship between increased LH levels, PCO, and early pregnancy loss remains controversial, with different studies showing conflicting results. In a study of 56 women, Sagle et al demonstrated that 82% of women with three or more miscarriages demonstrated ultrasound appearances of PCO. Women with PCO have associated risks such as obesity, insulin resistance, hypertension, and altered lipid profiles making them prone to cardiovascular disease later in life.
According to the authors "although it is not quite clear whether the estimated risk of health problems in women with PCO actually translate into long-term morbidity and/or mortality, asymptomatic women with PCO must indeed have an increased likelihood of adverse health outcomes as a result of their PCO status."
"Polycystic ovaries"K Lakhani et al
Ultrasound department, North Middlesex Hospital
The British Journal of Radiology, 2002 (January); 75: 9-16
By Ultrasound Review
March 18, 2002
Copyright © 2002 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)
