ESPE Abstracts

Background: Polycystic ovary syndrome (PCOS) is a common reproductive endocrinopathy in women of childbearing age, affecting 5–10% women in this age group. Its suggestive cardinal features are hyperandrogenism, ovulatory dysfunction and/or polycystic ovary appearance. The diagnostic gold standard tool is pelvic ultrasound (PUS) which may be limited in overweight and obese adolescent girls.

Objective and hypotheses: To evaluate the contribution of pelvic MRI in diagnosis of PCOS in overweight and obese adolescent girls.

Method: Six adolescent girls seen for signs and symptoms of hyperandrogenism and menstrual irregularity were biochemically screened (LH, FSH, testosterone, S-DHEA, Δ4 androstenedione, 17(OH) P, SHBG, TSH, fT₄ and lipid profile, fasting blood sugar and HOMA IR and HOMA-B). Each had PUS and/or pelvic MRI (PMRI) performed. Other causes of hyperandrogenism were excluded.

Imaging: PUS performed with trans-abdominal transducer (Acuson scanner, using 3.5–7.5 MHz transducer; PMRI performed with phased array coil of 1.5 T Siemens MRI scanner, with T₁ and T₂-weighted axial and coronal images. The diagnosis of PCOS defined according to Rotterdam PCOS consensus Workshop (Hum Reprod 2004; 19: 41–7).

Results: Six adolescent girls (mean age 15.2 years, mean BMI 34.91 kg/m², mean age at menarche 12.03 years), with menstrual irregularities, acanthosis nigricans (5/6), acne, hirsutism, and biochemical characteristics of PCOS (high plasma androgens, insulin resistance, glucose/insulin ratio <4.5, decreased SHBG) were identified. PUS was not contributive, but PMRI showed typical aspect with well delineated peripheral ovarian cysts, increased ovarian volume and stroma.

Conclusion: PUS remains gold standard diagnostic tool for PCOS, its limitations in overweight and obese girls are real and should be known. Endo-vaginal transducer cannot, however, be utilized in young virgin girls. PMRI is a useful and accurate alternative, allowing greater delineation of structural components of the ovary and better appreciation of its volume or structural alterations.