IS Case 386: Polycystic ovarian syndrome

Sam McCabe, MD

2009 URMC Imaging Sciences
Publication Date: 2010-03-02


Patient is a 21-year-old female undergoing MRI for evaluation of Müllerian duct abnormality.


MR images demonstrated moderately enlarged ovaries with numerous peripheral sub-centimeter cysts bilaterally. Septate uterine configuration is also noted (this was the indication for the exam - polycystic ovarian syndrome (PCOS) is typically first evaluated with transvaginal US).


Polycystic ovarian syndrome


Polycystic ovarian syndrome, also known as Stein Leventhal syndrome, is one of the most common human endocrinopathies, affecting 6-10% of reproductive age women. Diagnostic criteria include: 1) oligo/anovulation, 2) hyperandrogenism resulting in acne and hirsutism, and 3) polycystic ovaries. Two of these three criteria must be met and other causes must be excluded for the diagnosis to be made. Features seen in only one ovary are sufficient for diagnosis. Patients also exhibit insulin resistance, obesity and hyperlipidemia.

Imaging evaluation typically begins with transvaginal US, although MR is useful in the setting of patients who are obese and/or virgins. Imaging findings include enlarged ovaries (> 10 mL; normal = 8 cm +/- 2 cm) with >12 sub-cm follicles. PCOS morphology is seen in up to 20% of women, including those taking oral contraceptives, which suppress ovulation and may result in multiple small follicles. These women should have small ovaries, however.

Treatment involves induction of ovulation with clomiphene, a selective estrogen receptor modulator (SERM). Standard anti-diabetic and acne treatments are also used.


  1. Essah PA, Nestler JE.: The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest. 2006 Mar;29(3):270-80. PMID: 16682845
  2. Balen AH, Laven JS, Tan SL, Dewailly D: Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003 Nov-Dec;9(6):505-14. PMID: 14714587

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