Purpose To evaluate the validity and reproducibility of magnetic resonance (MR) imaging-based ovarian morphologic measurements for diagnosis of polycystic ovary syndrome (PCOS) in adolescents. Materials and Methods This case-control study included 110 adolescent girls (age range, 13-17 years) who underwent pelvic MR imaging in 2006-2015. The case group included girls with high (n = 40, hyperandrogenism and oligomenorrhea or amenorrhea), intermediate (n = 8, hyperandrogenism), or low (n = 7, oligomenorrhea or amenorrhea) suspicion of PCOS. Control subjects were 55 age-matched (± 2 years) girls with no clinical hyperandrogenism, oligomenorrhea, or amenorrhea. The validity (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) of the number of follicles per ovary (FPO) measuring 9 mm or smaller (FPO-9) and FPO measuring 5 mm or smaller (FPO-5), ovarian volume (OV), sphericity index, peripheral distribution of follicles, and absence of a dominant follicle were determined, with girls who were highly suspected of having PCOS compared with control subjects as the reference. Two radiologists independently measured these criteria in 50 girls who were suspected of having PCOS to assess reproducibility (κ and intraclass correlation coefficients [ICCs]). Results All criteria except sphericity index and absence of a dominant follicle were significantly associated with the level of suspicion of PCOS (P ≤ .05). The AUCs for FPO-9 (0.78; 95% confidence interval [CI]: 0.68, 0.87), FPO-5 (0.73; 95% CI: 0.62, 0.83), and OV (0.77; 95% CI: 0.68, 0.87) were significantly greater than 0.5; that was not true for sphericity index (AUC, 0.58; 95% CI: 0.47, 0.70). Sensitivity and specificity for peripheral distribution of follicles were 33% (95% CI: 19%, 49%) and 95% (95% CI: 85%, 99%), respectively; for absence of a dominant follicle, they were 90% (95% CI: 76%, 97%) and 27% (95% CI: 16%, 41%), respectively. Reproducibility was almost perfect for OV (ICC, 0.89), substantial for absence of a dominant follicle (κ, 0.74), moderate for FPO-9 (ICC, 0.54) and FPO-5 (ICC, 0.61), and fair for peripheral distribution of follicles (κ, 0.37). Conclusion The most accurate MR imaging-based diagnostic criteria for PCOS were OV, FPO-9, and peripheral distribution of follicles; however, reproducibility of these measures was moderate, except that for OV (ICC, 0.89). RSNA, 2017 Online supplemental material is available for this article.

A 44-year-old woman with no prior medical history or symptoms was admitted through the emergency room with abdominal pain, progressive over 36 hours, with associated nausea and vomiting. The patient was afebrile. Physical examination showed tympanitic abdominal distention with guarding in the right gutter. Laboratory findings indicated a moderate inflammatory syndrome. Abdominopelvic CT with IV contrast showed small bowel obstruction due to volvulus with evidence of intestinal malrotation (incomplete common mesentery); there was a moderate amount of free peritoneal fluid. In addition, there was evidence of a Situs Ambiguus type malformation syndrome with multiple spleens (Fig. 1) and a short pancreas (Fig. 2).The patient's pain persisted and she underwent surgical detorsion of the volvulus, division of the adhesive band, restoration of a complete common mesentery (Fig. 3) and appendectomy. The postoperative course was uncomplicated and the patient returned home on the seventh postoperative day.The polysplenic syndrome is defined by the presence of multiple spleens, usually numbering between two and six. In contrast to accessory spleens, the spleens are of uniform size. Accessory spleens usually measure between 1 and 2 cm and are not considered as a form of the polysplenic syndrome. Splenosis, an acquired rather than congenital condition that arises in the context of traumatic splenic rupture, can be ruled out by patient history. Splenosis typically consists of multiple small implants of splenic tissue; it can mimic peritoneal carcinomatosis or endometriosis depending on the clinical context.The syndrome of polysplenia is often accompanied by a variable spectrum of visceral and vascular developmental anomalies. It is rarely diagnosed in adults. While it is estimated that 2.5/100,000 infants are born with this anomally, fewer than 5% are still alive at five years of age due to the associated severe cardiac anomalies [1].The syndrome is associated with multiple congenital malformations that may involve the solid organs and digestive tube of the abdominal cavity, the heart, or the great vessels [1,2]. The diagnosis is often made during surgical exploration for an associated cardiac or digestive anomaly. Among the most common vascular anomalies are agenesis of the suprarenal inferior vena cava with persistent continuity of the azygos vein, and pre-duodenal position of the portal vein. Biliary atresia is found in nearly 50% of cases, common mesentery in more than 75% of cases, and an abbreviated or annular pancreas in 85-90% of cases [1][2][3][4][5].