Polycystic Ovary Syndrome in Adolescents: Which MR Imaging–based Diagnostic Criteria?

Abstract

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.

Ovarian follicle count by magnetic resonance imaging is greater in adolescents and young adults with polycystic ovary syndrome than in controls

“…It is important to highlight that OV by use of MRI captured the real three-dimensional volume of the ovaries. This is in contrast to most studies that have analyzed ovarian morphology by use of MRI, which used the ellipsoid formula to estimate OV ( 20 , 23 , 28 ), the same method used when calculating OV by use of ultrasound. The OV by use of ultrasound is known to have less diagnostic potential for PCOM than FNPO in adults ( 13 ).…”

“…The levels of AMH were also higher in participants with PCOS than controls, as expected, and correlated with FNPO by use of biplanar MRI. Several studies have suggested that the AMH level is a useful marker for PCOM ( 28 , 29 , 30 , 31 , 32 ); however, its use is limited because of issues with assay accuracy and reproducibility and the lack of an established threshold ( 13 ). We also found that the mean FNPO positively correlated with the androgen levels.…”

ACR Appropriateness Criteria® Female Infertility

“…A recent study in obese adolescents with suspected PCOS demonstrated that MRI without IV contrast can provide reproducible and reliable ovarian volume assessment; however, ovarian follicle counts had only moderate interobserver agreement. Nonetheless, in the obese adolescent or patient in whom TVUS is unacceptable and transabdominal US limited, MRI may provide additional information on PCOM [25,26,30].…”

Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review

“…Ovarian stromal to total area ratio was most significantly correlated with androgen levels in adolescents with PCOS [ 87 , 88 ]. Pelvic magnetic resonance imaging in particular for overweight adolescents with PCOS can accurate estimate ovarian stromal to total area ratio and antral follicle count; however, it is not be feasible to use this imaging modality routinely [ 89 , 90 ].…”