A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio

Fertil Steril. 2001 Aug;76(2):326-31. doi: 10.1016/s0015-0282(01)01919-7.


Objective: To evaluate whether some ultrasound parameters of ovarian morphology can discriminate between control women and patients with polycystic ovary syndrome (PCOS).

Design: Retrospective data analysis.

Setting: Volunteers women in an academic research environment.

Patient(s): Eighty amenorrheic or oligomenorrheic women and 30 normal ovulatory control participants.

Intervention(s): None.

Main outcome measure(s): We evaluated ovarian volume, area, stroma, and the stroma/total area (S/A) ratio by use of transvaginal pelvic ultrasound; and we assayed serum levels of gonadotropin, androgen, and estradiol during the early follicular phase (days 2 to 5) of the menstrual cycle in regularly cycling controls and on a random day in amenorrheic patients.

Result(s): Patients with PCOS showed significantly higher ovarian volume, area, stroma, and mean S/A ratio when compared to multifollicular and control groups. Cut-off values have been defined for ovarian volume (13.21 mL), area (7.00 cm2), stroma (1.95 cm2), and S/A ratio (0.34). The sensitivity for PCOS diagnosis was 21%, 4%, 62%, and 100%, respectively. The S/A ratio showed the most significant correlation with the androgen levels.

Conclusion(s): The evaluation of the S/A ratio can differentiate between PCOS and control or multifollicular women with both a sensitivity and a specificity of 100%. Furthermore, this ultrasound parameter is strictly related to hormonal milieu and to anthropometric characteristics.

MeSH terms

  • 17-alpha-Hydroxyprogesterone / blood
  • Adolescent
  • Adult
  • Amenorrhea / blood
  • Amenorrhea / complications
  • Androstenedione / blood
  • Dehydroepiandrosterone Sulfate / blood
  • Estradiol / blood
  • Female
  • Follicle Stimulating Hormone / blood
  • Humans
  • Luteinizing Hormone / blood
  • Oligomenorrhea / blood
  • Oligomenorrhea / complications
  • Ovary / diagnostic imaging*
  • Polycystic Ovary Syndrome / complications
  • Polycystic Ovary Syndrome / diagnosis*
  • Polycystic Ovary Syndrome / diagnostic imaging*
  • Sex Hormone-Binding Globulin / analysis
  • Testosterone / blood
  • Ultrasonography


  • Sex Hormone-Binding Globulin
  • Testosterone
  • Androstenedione
  • Estradiol
  • Dehydroepiandrosterone Sulfate
  • 17-alpha-Hydroxyprogesterone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone