Clinical significance of counting follicles in diagnosis of polycystic ovary syndrome by the three-dimensional ultrasound imaging with sonography based automated volume calculation method

Abstract

To investigate clinical significance of counting follicles classification by three-dimensional imaging with sonography based automated volume calculation (SonoAVC) in the diagnosis of polycystic ovary syndrome (PCOS). Eighty cases with PCOS were counted classified follicles and determined ovarian volume by three-dimensional (3D) imaging with SonoAVC method matched with 60 infertile women with fallopian tube or male factors as control. Main clinical, biological and other ultrasonographic markers were assessed during the early follicular phase, and the relationship between the follicle number range per ovary or the volume per ovary and the major hormonal features of PCOS was studied. Three-dimensional ultrasound imaging with SonoAVC method provides a new path for objective quantitative assessment of follicle count, ovarian volume, total follicle numbers. The volume of (11 ± 8) ml, total numbers of 27 ± 14 follicle and number of 22 ± 19 follicle with diameter of ≥ 2 - < 6 mm in PCOS patients were significantly higher than (6 ± 4) ml in ovarian volume, 6 ± 4 in total follicles and 2 ± 3 in follicle with diameter of ≥ 2 - < 6 mm in controls (P < 0.05), while follicles were similar for the ≥ 6 - ≤ 9 mm range (P > 0.05). Total follicle numbers and follicles ≥ 2 - < 6 mm had significantly positive relationships with ovarian volume (r = 0.600, 0.618, P < 0.01) and level of testosterones (r = 0.364, 0.291, P < 0.05), follicles ≥ 2 - < mm also had significantly positive relationships with total follicle number (r = 0.916, P < 0.01). The follicles within the ≥ 6 - ≤ 9 mm range was significantly and negatively related to ovarian volume and total follicle numbers (r = -0.618, -0.263, all P = 0.001), but no significantly related to the major hormonal features of PCOS. The ovarian volume was significantly positively related with luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio (r = 0.282, P = 0.010) but negatively related to FSH level (r = -0.226, P = 0.042). Ovarian volume, total follicle numbers and follicles ≥ 2 - < 6 mm in PCOS patients were significantly higher than those in controls. The larger ovarian volume might produce more total follicle and follicles ≥ 2 - < 6 mm. The higher level of testosterone might produce more total follicle probably, which mainly result in more follicles ≥ 2 - < 6 mm. These morphologically ultrasonographic characteristics could reflect pathophysiological changes in PCOS. Obviously, it has important clinical significance to count follicles in patients with PCOS by the three-dimensional ultrasound imaging with SonoAVC method.