RD7.1 | Imaging in PCOD — Summary & Reflection

KEY TAKEAWAYS

Imaging in PCOD — Key Points

• PCOD/PCOS is a clinical-biochemical diagnosis; the scan is supportive. Polycystic ovarian morphology is ONE of three Rotterdam criteria (oligo/anovulation; hyperandrogenism; PCOM on USG); ANY TWO are required, after excluding mimics.
• Transvaginal ultrasound (TVS) is first-line in sexually active women — its high resolution allows reliable follicle counting and ovarian-volume measurement; best performed in the early follicular phase (days 3-5).
• Transabdominal ultrasound (TAS) is used in adolescents, non-sexually-active women, or when TVS is declined; its lower resolution means ovarian volume (>10 mL), not follicle count, is the usable criterion.
• MRI is problem-solving only (inconclusive USG, or to exclude an androgen-secreting tumour); CT has essentially no role (ionising radiation, no advantage).
• PCOM thresholds: ≥20 follicles of 2-9 mm per ovary with a modern high-frequency transducer (2018 guideline); ≥12 with older/lower-frequency equipment (2003 Rotterdam); OR ovarian volume >10 mL in either ovary. Only ONE ovary need meet the threshold.
• Do NOT use ovarian morphology to diagnose PCOS within 8 years of menarche — multifollicular ovaries are physiologically common in adolescence.
• Beware the multifollicular ovary and incidental PCOM — morphology alone, without clinical or biochemical features, is not PCOS.
• Imaging has an active role in fertility management — follicular-tracking ultrasound monitors ovulation induction; TVS also assesses endometrial thickness in prolonged amenorrhoea.

REFLECT

Next time you see an ultrasound request that simply says '?PCOD', pause and notice how the request is framed and how the report is used. Did the team consider whether the patient was sexually active before choosing transvaginal or transabdominal scanning? When the report came back, did the clinician place the morphology within the Rotterdam framework, or treat the scan as the diagnosis? Was the patient's age relative to menarche taken into account? Consciously linking the choice of imaging and the interpretation of its findings to the clinical decision — rather than letting the scan label the patient — is what turns radiological knowledge into sound gynaecological practice.