Ovarian morphology in polycystic ovary syndrome: estimates from 2D and 3D ultrasound and magnetic resonance imaging and their correlation to anti-Müllerian hormone

Abstract

Background

Due to improved ultrasound scanners, new three-dimensional (3D) modalities, and novel Anti-Müllerian hormone (AMH)-assays, the ultrasound criteria for polycystic ovarian morphology are under debate and the appropriate thresholds are often requested.

Purpose

To quantify the differences in estimates of ovarian volume and antral follicle count (AFC) from two-dimensional (2D) and 3D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI).

Material and Methods

A cross-sectional study on 66 overweight women with polycystic ovary syndrome (PCOS) according to Rotterdam criteria. Ovarian volume and AFC were estimated from MRI, 2D TVUS, and 3D TVUS, and serum AMH levels were assessed. Bland–Altman statistics were used for comparison.

Results

Participants had a median age of 29 years (age range, 19–44 years) with a mean BMI of 32.7 kg/m² (SD 4.5). Ovarian volume from 2D TVUS was 1.48 mL (95% confidence interval [CI], 0.94–2.03; P < 0.001) and 1.25 mL (95% CI, 0.62–1.87; P < 0.001) smaller than from 3D TVUS and MRI, respectively. AFC from 2D TVUS was 18% (95% CI, 13–23; P < 0.005) and 16% (95% CI, 6–25; P < 0.005) smaller than estimates from 3D TVUS and MRI, respectively. Correlations between AMH and AFC from 2D TVUS, 3D TVUS, and MRI were 0.67, 0.78, and 0.70, respectively (P < 0.001 for all).

Conclusion

In an overweight PCOS population, 2D TVUS underestimated ovarian volume and AFC as compared with 3D TVUS and MRI. Serum AMH correlated best with AFC from 3D TVUS, followed by MRI and 2D TVUS. The advantage of 3D TVUS might be of minor clinical importance when diagnosing PCOS, but useful when the actual AFC are of interest, e.g. in fertility counseling and research.

Keywords

3D transvaginal ultrasound magnetic resonance imaging (MRI)polycystic ovary syndrome (PCOS)polycystic ovaries Anti-Müllerian hormone

Get full access to this article

View all access options for this article.

References

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19–25.

Dewailly

Gronier

Poncelet

. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26: 3123–3129.

Dewailly

Lujan

Carmina

. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014; 20: 334–352.

Allemand

Tummon

Phy

. Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound. Fertil Steril 2006; 85: 214–219.

Dumesic

Oberfield

Stener-Victorin

. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev 2015; 36: 487–525.

Bozdag

Salman

Mumusoglu

. Is ovarian volume estimation reliable when compared with true volume? Am J Obstet Gynecol 2012; 206: 44.e1–4.

Rosendahl

Ernst

Rasmussen

. True ovarian volume is underestimated by two-dimensional transvaginal ultrasound measurement. Fertil Steril 2010; 93: 995–998.

Jokubkiene

Sladkevicius

Valentin

. Number of antral follicles, ovarian volume, and vascular indices in asymptomatic women 20 to 39 years old as assessed by 3-dimensional sonography: a prospective cross-sectional study. J Ultrasound Med 2012; 31: 1635–1649.

Lam

Johnson

Raine-Fenning

. Three-dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters. Hum Reprod 2007; 22: 3116–3123.

10.

Hauth

Jaeger

Libera

. Magnetic resonance imaging of the ovaries of healthy women: determination of normal values. Acta Radiol 2006; 47: 986–992.

11.

Barber

Alvey

Greenslade

. Patterns of ovarian morphology in polycystic ovary syndrome: a study utilising magnetic resonance imaging. Eur Radiol 2010; 20: 1207–1213.

12.

Leonhardt

Gull

Stener-Victorin

. Ovarian volume and antral follicle count assessed by MRI and transvaginal ultrasonography: a methodological study. Acta Radiol 2014; 55: 248–256.

13.

Battaglia

Morotti

. Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med 2012; 31: 1015–1024.

14.

Deb

Campbell

Clewes

. Quantitative analysis of antral follicle number and size: a comparison of two-dimensional and automated three-dimensional ultrasound techniques. Ultrasound Obstet Gynecol 2010; 35: 354–360.

15.

Jayaprakasan

Walker

Clewes

. The interobserver reliability of off-line antral follicle counts made from stored three-dimensional ultrasound data: a comparative study of different measurement techniques. Ultrasound Obstet Gynecol 2007; 29: 335–341.

16.

Scheffer

Broekmans

FJM

Bancsi

. Quantitative transvaginal two- and three-dimensional sonography of the ovaries: reproducibility of antral follicle counts. Ultrasound Obstet Gynecol 2002; 20: 270–275.

17.

Frøssing S, Nylander M, Kistorp C, et al. The LIPT-Study: on risk markers of vascular thrombosis in polycystic ovary syndrome. A randomized, double-blind, placebo-controlled study of the effect of Liraglutide. J Obes Weight Loss Ther 2015 DOI:10.4172/2165-7904.1000254.

18.

Bland

Altman

. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 8476: 307–310.

19.

Kenigsberg

Agarwal

Sin

. Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls. Fertil Steril 2015; 104: 1302–1309.e4.

20.

Raine-Fenning

Campbell

Clewes

. The interobserver reliability of ovarian volume measurement is improved with three-dimensional ultrasound, but dependent upon technique. Ultrasound Med Biol 2003; 29: 1685–1690.

21.

Deb

Jayaprakasan

Campbell

. Intraobserver and interobserver reliability of automated antral follicle counts made using three-dimensional ultrasound and SonoAVC. Ultrasound Obstet Gynecol 2009; 33: 477–483.

22.

Jayaprakasan

Campbell

Clewes

. Three-dimensional ultrasound improves the interobserver reliability of antral follicle counts and facilitates increased clinical work flow. Ultrasound Obstet Gynecol 2008; 31: 439–444.

23.

Deb

Campbell

Pincott-Allen

. Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti-Müllerian hormone and small antral follicle count using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 39: 574–580.

24.

Chen

M-J

Yang

W-S

Chen

C-L

. The relationship between anti-Mullerian hormone, androgen and insulin resistance on the number of antral follicles in women with polycystic ovary syndrome. Hum Reprod 2008; 23: 952–957.

25.

Leonhardt

Hellström

Gull

. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and associations with antimüllerian hormone, free testosterone, and glucose disposal rate. Fertil Steril 2014; 101: 1747–1756.