Summary OBJECTIVE By using vaginal endosonography, ovarian stromal hypertrophy has been shown to be a strong diagnostic feature of polycystic ovarian syndrome and related states. However, this sign is difficult to quantify and to correlate with other findings because of its subjectivity. We have evaluated the use of computer assisted analysis of ultrasound scans to provide more objective measurements of ovarian structure and size. DESIGN We used a computer assisted method for the reading of ultrasound scans. It allowed selective calculation of the stromal area by subtraction of the cyst area from the total ovarian area on a longitudinal ovarian section. PATIENTS A consecutive series of 57 patients with hyper‐androgenism (group 1), 17 patients with hypothalamic anovulation (group 2) and 20 normal women (group 3). RESULTS By computerized measure, 75% patients from group 1 had a bilateral stromal area above the mean +2 SD (700 mm2) of women from group 3. All patients from group 2 were below this threshold. Serum LH level was above the normal range in 45% patients from group 1. The stromal area correlated positively with the serum A4‐androstenedione (r= 047, P < 0.005) and 17α‐hydroxy‐progesterone (r= 039, P < 0.005) levels, exclusively in group 1. It did not correlate with the basal serum testosterone, LH or Insulin levels. The cyst area did not correlate with any hormonal parameter. CONCLUSION Ovarian stromal hypertrophy is a frequent and specific feature of hyperandrogenism. It correlates with the ovarian androgenic dysfunction. Its presence is not always linked with elevated serum Immunoreactive LH levels. Further data are needed to elucidate the role of insulin and ovarian growth factors.
OBJECTIVE By using vaginal endosonography, ovarlan stromal hypertrophy has been shown to be a strong diagnostic feature of polycystlc ovarian syndrome and related states. However, thls sign Is difficult to quantify and to Correlate wlth other findings because of Its sub-Jectlvlty. We have evaluated the use of computer assisted analysis of ultrasound scans to provlde more objective measurements of ovarian structure and size. DESIGN We used a computer assisted method for the readlng of ultrasound scans. It allowed selective calculatlon of the stromal area by subtractton of the cyst area from the total ovarian area on a longltudlnal ovarian section. PATIENTS A consecutive series of 57 patients with hyperandrogenlsm (group 1), 17 patients wlth hypothalamic anovulation (group 2) and 20 normal women (group 3). RESULTS By computerlzed measure, 75% patients from group 1 had a bilateral stromai area above the mean +2 SD (700mm2) of women from group 3. All patients from group 2 were below thls threshold. Serum LH level was above the normal range in 45% patients from group 1. The stromai area correlated posltlvely with the serum A4androstenedione (r = 0.47, P < 0.005) and 17a-hydroxyprogesterone (r = 0.39, P < 0.005) levels, excluslvely in group 1. It dld not correlate with the basal serum testosterone, LH or Insulin levels. The cyst area dld not correlate with any hormonal parameter. CONCLUSION Ovarian stromai hypertrophy Is a frequent and specific feature of hyperandrogenlsm. It correlates wlth the ovarlan androgenic dydunctlon. Its presence Is not always linked wlth elevated serum lmmunoreactlve LH levels. Further data are needed to elucidate the role of insulin and ovarian growth factors.Correspondence to Pr D. Dewailly, USNA, 6, rue du Pr Laguesse, 59037 Lille Cedex, France. Fax: 33 20 44 41 84.
In order to compare the diagnostic significance of hormonal and ultrasonic criteria of polycystic ovarian syndrome (PCOS), the presence or the absence of ultrasonographic and hormonal features of PCOS were recorded in a heterogeneous population of 90 women presenting with hyperandrogenism and/or menstrual disorders. On clinical and hormonal grounds exclusively, these patients could be separated into five diagnostic subgroups: presumed cases of PCOS (n = 21), idiopathic hirsutism (IH) (n = 26), hypothalamic anovulation (HA) (n = 11), hyperprolactinemia (HPRL) (n = 9), and miscellaneous or undetermined diagnosis (n = 23). By the means of a computed automatic classification of patients (cluster analysis) using five hormonal and ultrasonic criteria of PCOS, four homogeneous clusters of patients were obtained. Cluster #1 (25 patients) had the most characteristic profile of PCOS. It included 15 cases of PCOS and 7 cases of IH. Cluster #4 (47 patients) had the less characteristic profile of PCOS. It included the majority of patients with HA and HPRL and the half of the patients with IH. Cluster #2 included only two hyperandrogenic patients, who were massively obese and in whom ultrasonography may have failed to detect PCOS. Cluster #3 (16 patients) included patients from each diagnostic group, who were gathered together because ultrasonographic and hormonal features were, respectively, present and absent in nearly all of them. With the same analysis, the criteria of PCOS could be graded according to their grouping potential. The presence of an abnormal ovarian stroma by ultrasonography appeared as the most potent criterion. Elevated serum testosterone and androstenedione levels and the polyfollicular pattern of ovaries gave intermediate results, while elevated basal LH level was a much weaker grouping parameter. In conclusion, the automatic classification of patients by cluster analysis using both hormonal and ultrasonographic criteria revealed that the classical diagnostic classification, relying upon hormonal data exclusively, may arbitrarily separate patients having the same disease; and that ultrasonography affords pertinent information that should help provide a better diagnostic definition of PCOS.
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