Preliminary Diagnosis: Polycystic Ovarian Disease

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound of the pelvis. Transvaginal offers better resolution compared to transabdominal imaging.

II. Describe the advantages and disadvantages of this technique for diagnosing polycystic ovarian disease?

Advantages

  • Does not expose patients to ionizing radiation.

  • Highly portable.

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  • The transvaginal approach is the gold standard in visualizing and characterizing the bilateral ovaries.

  • Able to evaluate for any evidence of ovarian torsion.

  • Highly specific in detecting the “string of pearls” sign pathognomic in diagnosing polycystic ovarian syndrome.

Disadvantages

  • Highly operator dependent.

  • Limited in evaluating the surrounding soft tissues and osseous structures.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • CT imaging of the pelvis with IV contrast.

  • MR imaging of the pelvis.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing polycystic ovarian disease?

CT imaging of the pelvis with IV contrast
Advantages

  • Offers better evaluation of the surrounding soft tissues and osseous structures than ultrasound.

  • Less operator dependent than ultrasound.

  • More sensitive and specific in evaluating for secondary complications than ultrasound.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less sensitive and specific in evaluating for ovarian torsion.

MR imaging of the pelvis
Advantages

  • Does not expose patients to ionizing radiation.

  • Highly sensitive and specific in evaluating for cystic change of the bilateral ovaries.

  • Highly useful when transvaginal sonographic evaluation is suboptimal.

  • Offers exquisite evaluation of the uterus and surrounding soft tissues.

Disadvantages

  • Expensive.

  • Time consuming.

  • May be subject to metallic susceptibility weighted artifact and motion artifact.

  • Limited in evaluating for ovarian torsion.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging of the pelvis with IV contrast

Contraindicated in pregnant patients.

MR imaging of the pelvis

May be contraindicated in pregnant patients, and contraindicated in patients with non-MR compatible hardware.

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