The need for a calibrated imaging of polycystic ovaries (PCO) is now stronger than ever since the recent consensus conference held in Rotterdam in 2003. Indeed, the subjective criteria that were proposed 20 years ago and still used until recently by the vast majority of authors are now replaced by a stringent definition using objective criteria (Balen et al. 2003, The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004).
Imaging PCO is not an easy procedure. It requires a thorough technical and medical background. The goal of this chapter is to provide the reader with the main issues ensuring a well-controlled imaging for the diagnosis of PCO. Two-dimensional (2D) ultrasonography will be first and extensively addressed since it remains the standard for imaging PCO. Other techniques such as Doppler, three-dimensional ultrasonography, and magnetic resonance imaging (MRI) will be then more briefly described.
Two-dimensional (2D) ultrasonography: technical aspects and recommendations
The transabdominal route should always be the first step of pelvic sonographic examination, followed by the transvaginal route, except in virgin or refusing patients. Of course, a full bladder is required for visualization of the ovaries. However, one should be cautious that an overfilled bladder can compress the ovaries, yielding a falsely increased length. The main advantage of the abdominal route is that it offers a panoramic view of the pelvic cavity. Therefore, it allows excluding associated uterine or ovarian abnormalities with an abdominal component. Indeed, lesions with cranial growth could be missed by using the transvaginal approach exclusively.