title: Transabdominal pulse inversion harmonic imaging improves assessment of ovarian morphology in virgin patients with PCOS: comparison with conventional B-mode sonography.
abstract: OBJECTIVE
  In virgin policystic ovary syndrome (PCOS) patients transabdominal sonography is the preferential method of the pelvic examination. The purpose of this study was to determine ovarian morphology by the transabdominal route by pulse inversion harmonic imaging (PIHI) in virgin PCOS patients and to compare the diagnostic image quality with conventional B-mode ultrasonography (CBU).
  
  
  METHODS
  Fifty-two ovaries in 26 virgin patients were evaluated by the transabdominal approach. Each ovary was examined using both PIHI and CBU. The sharpness of the follicular cysts walls, degree of internal echo definitions of the follicle cysts and overall ovarian conspicuity was assessed subjectively, using 4 point scoring (0, being worst; 3, being best score). The number of countable follicles, the size of largest and smallest ovarian follicle and ovarian volumes were assessed quantitively by both techniques. The effect of body mass index (BMI) on qualitative and quantitative scoring was evaluated.
  
  
  RESULTS
  The sharpness of the cyst wall and internal echo structure was significantly better with PIHI than with CBU (P < 0.001 P < 0.001 and P < 0.001, respectively). PIHI improved overall ovarian conspicuity in 41 (78.8%) of 52 examination. The number of countable follicles was significantly lower with CBU (P < 0.001). The maximum diameter of the largest follicle was larger with PIHI sonography to compared CBU (P < 0.001). Mean ovarian volume was significantly larger with CBU (P < 0.001). When data were analyzed separately according to BMI, number of non-diagnostic overall ovarian conspicuity scores with CBU was markedly high in obese patients (88% with CBU versus 3.8% with PIHI). On the other hand, mean number of countable follicles with CBU became much more lower in the obese group (P < 0.001).
  
  
  CONCLUSIONS
  In virgin PCOS patients, when compared to transabdominal CBU, PIHI significantly improved the detection of ovarian follicles, especially in high BMI obese subjects, through increased contrast sensitivity for cystic structures and decreased intrafollicular artifactual echoes. Transabdominal ultrasonographic examination by PIHI mode can contribute to the evaluation of ovaries.
authors.affiliation: Department of Radiology, Faculty of Medicine, Zonguldak Karaelmas University, Kozlu 67600, Zonguldak, Turkey. kmyazicioglu@yahoo.com
authors.forename: Kamran
authors.initials: K
authors.lastname: Mahmutyazicioğlu
authors.forename: H Alper
authors.initials: HA
authors.lastname: Tanriverdi
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ozdemir
authors.forename: Aykut
authors.initials: A
authors.lastname: Barut
authors.forename: Halit
authors.initials: H
authors.lastname: Davşanci
authors.forename: Sadi
authors.initials: S
authors.lastname: Gündoğdu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D014463:Ultrasonography / Q000379:methods*