Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

Abstract

ABDOMINAL IMAGINGORIGINAL ARTICLE PURPOSE We aimed to assess the feasibility and reproducibility of real-time elastography (RTE) for displaying the effects of morphological changes in the ovary in polycystic ovary syndrome (PCOS). METHODSForty-eight patients diagnosed with PCOS and 48 healthy women were enrolled in the study. Ultrasonography and RTE were performed on the 3 rd day of the menstrual cycle. Evaluations were performed independently by two radiologists. Ovarian volume, number of follicles, elasticity pattern, and strain ratio were measured. Elasticity patterns were assessed as hard (type 1; blue or blue-green), moderate (type 2; green or green-yellow) or soft (type 3; red or orange-red). RESULTSBoth radiologists determined the elasticity pattern as mostly type 1 in the PCOS group and type 3 in the control group (P < 0.01). The mean strain ratios obtained by the first and second radiologist were 6.1±1.8 (2.7-10.1) and 6.0±1.5 (3.0-9.0) in PCOS and 3.3±1.2 (1.7-7.2) and 3.2±0.9 (1.7-6.8) in the control group, respectively (P < 0.001). Interobserver agreement was moderate for the elasticity pattern (κ=0.48) and good for the strain ratio (intraclass correlation coefficient, 0.77). A strain ratio of 3.8 was determined as the optimized cutoff point by receiver operating curve analysis. Strain ratio was correlated with the ovarian volume and the number of detected follicles (P < 0.001). CONCLUSION Elasticity pattern and strain ratio can help identify morphological changes that make PCOS ovaries stiffer than normal ovaries. In reproductive-aged women, polycystic ovary syndrome (PCOS) is an important cause of infertility and is characterized by menstrual irregularities, hirsutism and signs of hyperandrogenism, and polycystic ovary appearance (1-3). In addition to insulin resistance, serum androgenic hormone levels are increased, causing undesired effects on women's metabolic, reproductive, and cardiovascular health (1-5). PCOS is characterized by enlarged ovaries containing small cysts, for which the syndrome was named (6).Real-time elastography (RTE) is a novel and dynamic imaging technique that is simply based on the hardness or softness of tissues or organs under the appropriate compression and can be used with conventional ultrasonography (US) probes after performing gray-scale and Doppler US. Displacement of soft tissues is greater than hard tissues, and tissue hardness is displayed as a color-coded image that lays over the gray-scale US image translucently (7). Elastography has been used previously for differentiation of pathologies of tissues and organs, such as thyroid, breast, kidneys, and liver (7-9). There are limited studies about the elastographic properties of the ovaries, mostly focused on ovarian neoplasms and, to the best of our knowledge, there is no medical data concerning the elasticity properties of the ovary in PCOS (10, 11). In this study, our purpose was to assess the feasibility and reproducibility of RTE for displaying the effects of morphological changes in the ovary in PCOS and to p...

Is shear wave elastography relevant in the diagnosis of polycystic ovarian syndrome?

“…Although a slight correlation of SWE with BMI and ovarian volume was detected, clinical relevance of SWE to determine PCOS was not obvious given the results of our study. Our results are in contrast with Ciraci et al study [17], the authors demonstrating high stiffness of the ovarian stroma when PCOS is present. However, Ciraci et al [17] used SE which is highly subjective and lacks quantifiable parametric values.…”

“…Our results are in contrast with Ciraci et al study [17], the authors demonstrating high stiffness of the ovarian stroma when PCOS is present. However, Ciraci et al [17] used SE which is highly subjective and lacks quantifiable parametric values. We used SWE to evaluate elasticity of ovarian stroma, a method in which the elasticity is objectively calculated by the regular software of US device [15].…”

“…We used SWE to evaluate elasticity of ovarian stroma, a method in which the elasticity is objectively calculated by the regular software of US device [15]. Also, our patients were younger than those in the Ciraci et al [17] study (21.4±3.7 and 25.7 ± 4.2, respectively). In addition, the difference may be caused by the lack of superpose infections and/or drug interactions that may be the cause of fibrosis, due to the shorter disease process.…”

Evaluation of the Optic Nerve by Strain and Shear Wave Elastography in Patients With Migraine

“…These elastographic techniques are strain elastography (SE), which compresses the tissues axially, and shear wave elastography (SWE), which uses waves that are generated by transducers and interact with the tissue . In some studies, it has been reported that there is a connection between the tissue elasticity and histologic features . The purpose of this work is to describe the optic nerve's elastic characteristics in patients with migraine using SE and SWE and to compare the findings to those of healthy participants to establish whether these elastic characteristics can be used to assist in the diagnosis of optic nerve involvement in patients with migraine.…”

“…[14][15][16][17] In some studies, it has been reported that there is a connection between the tissue elasticity and histologic features. [14][15][16][17][18] The purpose of this work is to describe the optic nerve's elastic characteristics in patients with migraine using SE and SWE and to compare the findings to those of healthy participants to establish whether these elastic characteristics can be used to assist in the diagnosis of optic nerve involvement in patients with migraine.…”