eMedicine Specialties > Radiology > Obstetrics/Gynecology

Polycystic Ovarian Disease (Stein-Leventhal Syndrome): Imaging

Author: Greg Marrinan, MD, Staff Physician, Department of Radiology, Bridgeport Hospital
Coauthor(s): Marjorie Stein, MD, Clinical Assistant Professor of Radiology, Albert Einstein College of Medicine; Consulting Staff, Department of Radiology, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Aug 11, 2009

Radiography

Findings

See Introduction, Preferred Examination above.

Magnetic Resonance Imaging


Axial T2-weighted magnetic resonance image of the...

Axial T2-weighted magnetic resonance image of the pelvis. This image reveals multiple subcapsular follicles in both ovaries; the follicles are more conspicuous on the left side on this image.

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Axial T2-weighted magnetic resonance image of the...

Axial T2-weighted magnetic resonance image of the pelvis. This image reveals multiple subcapsular follicles in both ovaries; the follicles are more conspicuous on the left side on this image.



Axial T2-weighted magnetic resonance image of the...

Axial T2-weighted magnetic resonance image of the pelvis. This image demonstrates multiple subcapsular follicles in both ovaries; the follicles are more conspicuous on the right side on this image.

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Axial T2-weighted magnetic resonance image of the...

Axial T2-weighted magnetic resonance image of the pelvis. This image demonstrates multiple subcapsular follicles in both ovaries; the follicles are more conspicuous on the right side on this image.


Findings

Ovaries can be identified on MRIs in more than 95% of premenopausal women. On T1-weighted images, the ovaries have homogeneously low signal intensity, and they are easily distinguished from the surrounding pelvic fat. T2-weighted images reveal high signal intensity within the fluid-filled follicles of the ovarian cortex. The ovarian stroma remains dark on these images.22,23,24

Polycystic ovaries are characterized by numerous, small (<1 cm), peripheral cysts that are located throughout the cortex. The ovaries may be slightly larger than normal; however, the ovarian stroma is hypertrophic. Often, the fibrous capsule surrounding the ovary is prominent.

Degree of Confidence

Although MRI is sensitive to the presence of follicular cysts, this modality is not specific enough to permit the diagnosis of polycystic ovarian disease without corroborating laboratory values and features from the patient's history.

False Positives/Negatives

Greater experience is necessary before sufficient criteria can be determined for the diagnosis of polycystic ovarian disease. Changes seen in polycystic ovaries have also been noted in patients without polycystic ovarian syndrome, in patients with oligomenorrhea without a diagnosis of polycystic ovaries, and in patients taking exogenous steroids or clomiphene. The diagnosis remains a clinical one.

Ultrasonography


Longitudinal transabdominal sonogram of an ovary....

Longitudinal transabdominal sonogram of an ovary. This image reveals multiple peripheral follicles.

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Longitudinal transabdominal sonogram of an ovary....

Longitudinal transabdominal sonogram of an ovary. This image reveals multiple peripheral follicles.



Transverse endovaginal sonogram of the left ovary...

Transverse endovaginal sonogram of the left ovary. This image exhibits numerous peripheral follicles and hyperechoic stroma. Note that none of the follicles is larger than 1.2 cm.

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Transverse endovaginal sonogram of the left ovary...

Transverse endovaginal sonogram of the left ovary. This image exhibits numerous peripheral follicles and hyperechoic stroma. Note that none of the follicles is larger than 1.2 cm.


Findings

Polycystic ovaries typically exhibit 3 characteristics on ultrasonographic examination: bilateral enlarged ovaries, multiple small follicles, and increased stromal echogenicity.25,26,27,28,29,30,31,32

Usually, the ovaries are enlarged symmetrically, and the shapes change from ovoid to spherical. Ovarian volume can increase by as much as 6 mL; however, almost 30% of patients with a biochemical and pathologic diagnosis of polycystic ovaries have no increase in ovarian volume.

The typical polycystic ovary contains numerous follicles at any given time. The follicles are small (0.5-0.8 cm), and no dominant follicle is present. Characteristically, the follicles are peripherally located in the cortex; however, they can occur anywhere in the ovarian parenchyma. The diagnosis of polycystic ovaries should be reserved for patients with at least 5 of these follicles in each ovary.

Typically, the ovaries are hypoechoic in relation to the surrounding pelvic fat and myometrium. Polycystic ovaries often display increased echogenicity; however, as many as one third may remain isoechoic or hypoechoic relative to the myometrium.

Degree of Confidence

Ultrasonography has a largely corroborative role in the diagnosis of polycystic ovarian syndrome. In a patient with a biochemical diagnosis of polycystic ovaries, ultrasonographic findings may confirm the clinical diagnosis, but they cannot exclude it. Alternatively, the incidental discovery of polycystic ovaries during ultrasonography is not a reliable indicator of polycystic ovarian syndrome.

False Positives/Negatives

Almost 30% of patients with endocrinologic findings of polycystic ovaries may have normal-sized ovaries on sonograms. Less than 50% of patients with biochemical features of polycystic ovaries and increased ovarian volume have the classic finding of multiple, small, peripheral follicles. Ultimately, the diagnosis should be made on clinical and biochemical grounds. However, normal ultrasonographic findings should not exclude the diagnosis.

Alternatively, when polycystic ovaries are an incidental radiologic finding, approximately 25% of the patients have no clinical abnormality. Whether these patients have polycystic ovarian syndrome remains a matter of debate. Again, correlation with biochemical and clinical findings is necessary before a definitive diagnosis is made.

More on Polycystic Ovarian Disease (Stein-Leventhal Syndrome)

Overview: Polycystic Ovarian Disease (Stein-Leventhal Syndrome)
Imaging: Polycystic Ovarian Disease (Stein-Leventhal Syndrome)
Follow-up: Polycystic Ovarian Disease (Stein-Leventhal Syndrome)
Multimedia: Polycystic Ovarian Disease (Stein-Leventhal Syndrome)
References
Further Reading
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Further Reading

Related eMedicine topics

Polycystic Ovarian Syndrome (Obstetrics and Gynecology)

Amenorrhea, Primary

Amenorrhea, Secondary

Hirsutism

Anovulation

Clinical guidelines

Long-term consequences of polycystic ovary syndrome. Royal College of Obstetricians and Gynaecologists - Medical Specialty Society.  2003 May.  8 pages.  NGC:004478

American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. American Association of Clinical Endocrinologists - Medical Specialty Society.  2005 Mar/Apr.  10 pages.  NGC:004279

Diagnosis and management of polycystic ovarian syndrome. University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution.  2006 May.  21 pages.  NGC:005059

Clinical trials

Health Benefits of Vitamin D and Calcium in Women With PCOS (Polycystic Ovarian Syndrome)

Letrozole Versus Clomifene Citrate for Ovulation Induction

Menopur® Versus Follistim® in Polycystic Ovarian Syndrome (PCOS)

Exhaled Breath Biomarkers in Finding Ovarian Epithelial Cancer in Patients With Newly Diagnosed Ovarian Epithelial Cancer, Polycystic Ovarian Syndrome, or Endometriosis and in Healthy Participants

The Genetics of Polycystic Ovarian Syndrome

Surgical Ovarian Drilling Versus Hormonal Treatment for Infertility Associated to PolyCystic Ovaries Syndrome (PCOS)

Cortisol Regulation in Polycystic Ovary Syndrome (PCOS)

PCOS Twin Study - Environmental Factors in the Development of Polycystic Ovary Syndrome, Phase 2

Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (PCOS) Women

A Six-Week Randomized Trial of Lipitor(Atorvastatin) for the Treatment of PCOS Women With Elevated LDL Cholesterol

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Keywords

polycystic ovarian disease, polycystic ovary disease, Stein-Leventhal syndrome, sclerocystic disease of the ovaries, microcystic degeneration, polyfollicular ovarian disease, enlarged ovaries, amenorrhea, hirsutism, anovulation, PCOD, PCOS

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Contributor Information and Disclosures

Author

Greg Marrinan, MD, Staff Physician, Department of Radiology, Bridgeport Hospital
Greg Marrinan, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, North American Society for Cardiac Imaging, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Marjorie Stein, MD, Clinical Assistant Professor of Radiology, Albert Einstein College of Medicine; Consulting Staff, Department of Radiology, Montefiore Medical Center
Marjorie Stein, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Christopher L Sistrom, MD, Associate Chair for Research, Assistant Professor, Department of Radiology, University of Florida School of Medicine
Christopher L Sistrom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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