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

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). METHODS Forty-eight patients diagnosed with PCOS and 48 healthy women were enrolled in the study. Ultrasonography and RTE were performed on the 3rd 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). RESULTS Both 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 (kappa=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.