Fulghesu, A. M., Ciampelli, M., Belosi, C., Apa, R., Pavone, V., & Lanzone, A. (2001). A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio. Fertility and Sterility, 76(2), 326-331. https://doi.org/10.1016/s0015-0282(01)01919-7
Fulghesu AM, Ciampelli M, Belosi C, Apa R, Pavone V, Lanzone A. A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio. Fertil Steril. 2001;76(2):326-331. doi:10.1016/s0015-0282(01)01919-7
Fulghesu, Anna Maria, et al. "A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio." Fertility and Sterility, vol. 76, no. 2, 2001, pp. 326-331.
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Ultrasound stroma-to-area ratio separated PCOS from other ovaries
A retrospective analysis of 110 women found an ultrasound ratio that separated polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS), from other women. The ratio flagged all 53 women with PMOS / PCOS in this study. None of 27 multifollicular women or 30 controls reached the cut-off.
Key Findings
Eleven of 53 women with PMOS / PCOS (21%) exceeded the ovarian volume cut-off. Two of 53 (4%) exceeded the total area cut-off, and 33 of 53 (62%) the stromal area cut-off.
The stroma-to-area ratio cut-off of 0.34 sat above all 27 multifollicular women and all 30 controls. All 53 women with PMOS / PCOS were above it, a sensitivity and specificity of 100%.
Two examiners scanned 30 women, and the ratio's coefficient of variation between them averaged 2.3%, with a maximum of 4.8%.
Across the 110 participants, the ratio correlated most strongly with androgen levels other than DHEAS, reaching R of 0.75 for testosterone. Total ovarian area had no significant relationship with any hormone.
Interpretation
This retrospective analysis included 80 consecutive women aged 18 to 38 with absent or infrequent periods. The women were referred to the authors' university department in Rome between June 1998 and May 1999 with suspected PMOS / PCOS. The authors defined PMOS / PCOS by cycle changes, hirsutism, chronic lack of ovulation, androgen levels at or above the upper normal limit and more than 10 small ovarian follicles. The cut-off values came from the control group within the same 110 participants. The 100% figures therefore describe separation within that definition. Insulin was not measured, so the authors' idea that insulin relates to the ratio remains a hypothesis.
RRM Context
The 2026 consensus that renamed PCOS as PMOS dropped the word cysts. Teede and colleagues describe the condition as endocrine, metabolic and ovarian dysfunction. Androgen levels correlated with the ultrasound ratio here, and body mass index did so weakly. Restorative reproductive medicine evaluates PMOS / PCOS as a condition with identifiable causes. Ultrasound is one part of that evaluation.
Our editorial summary of this paper, not the article's abstract.
Abstract
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.
Patients
Eighty amenorrheic or oligomenorrheic women and 30 normal ovulatory control participants.
Interventions
None.
Main Outcome Measures
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.
Results
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.
Conclusions
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.
