ROTTERDAM CRITERIA FOR POLYCYSTIC OVARY

ROTTERDAM CRITERIA FOR POLYCYSTIC OVARY

Ø In 1935, Stein and Leventhal were the first to describe a condition consisting of amenorrhea, obesity, and masculinizing symptoms that is now known as polycystic ovarian syndrome (PCOS).

Ø Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age and carries with it significant health risks, including infertility, endometrial hyperplasia, diabetes, and cardiovascular disease

Ø Insulin resistance appear be central to the etiology of the syndrome  and related to many of the health consequences of PCOS.

Ø Women with PCOS are at an increased risk for hypertension, hyperlipidemia, type 2 diabetes mellitus, coronary artery disease, and cerebral vascular disease.

US Findings (Rotterdam criteria)

Ø The goal of imaging in PCOS is to properly identify and document the presence of polycystic ovaries.

Ø The 2003 joint ESHRE/ASRM meeting in Rotterdam created a consensus definition for the polycystic ovary, which was reaffirmed by the Androgen Excess and PCOS Society in 2009 and subsequently incorporated into American College of Obstetricians and Gynecologists guidelines.

Ø The definition acknowledges two criteria on the basis of which a polycystic ovary may be identified: ovarian volume and number of follicles.

Ø According to the consensus definition, polycystic ovaries are present when ---

1.one or both ovaries demonstrate 12 or more follicles measuring 2–9 mm in diameter, or

2.the ovarian volume exceeds 10 cm³.

  Only one ovary meeting either of these criteria is sufficient to establish the presence of polycystic ovaries

Ø Prior work defines the polycystic ovary on the basis of its appearance in a single US imaging plane. This includes the often-cited definition of the polycystic ovary as one that contains (in one plane) at least 10 follicles arranged peripherally(“string of pearls” appearance of a polycystic ovary) around an echodense stroma

Ø With regard to the imaging of polycystic ovaries, transvaginal US is preferred because it often provides optimal visualization of the internal structure of the ovary, particularly in obese patients.

Ø Regularly menstruating women should undergo scanning during the early follicular phase (days 3–5). Oligo- or amenorrheic women may be scanned at random, or between days 3 and 5 after progesterone-induced bleeding.

Ø A history of oral contraceptive use should be elicited, since oral contraceptives cause a decrease in ovarian size, thereby decreasing the sensitivity.

Ø Women with PCOS are frequently ovulatory. The presence of a dominant follicle (defined as a follicle whose longitudinal, transverse, and anteroposterior diameters average more than 10 mm or corpus luteum ,may increase the ovarian volume above the 10-cm³ threshold. Such a finding should prompt repeat scanning during the next menstrual cycle.

Ø Similarly, the presence of asymmetry in ovarian volume should prompt further investigation for an underlying cause, such as an isoechoic cyst or corpus luteum

Ø In the absence of ovulatory dysfunction or either clinically or biochemically diagnosed hyperandrogenism, findings are nonspecific and do not indicate the presence of polycystic ovarian syndrome.

Ø Data suggest that 23% of women of reproductive age will have findings of polycystic ovaries  However, only 5%–10% of these women will have classic symptoms of PCOS such as infertility, amenorrhea, signs of hirsutism, or obesity.

Ø In conclusion ,ovarian imaging is crucial in the evaluation of patients with suspected PCOS. The imaging report should be specific and should include ovarian volumes and antral follicle counts, in addition to pertinent findings such as the presence of a dominant follicle or corpus luteum.

Radiographics October 2012 32:1643-1657