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. 2023 Oct 6;30(1):109–130. doi: 10.1093/humupd/dmad027

Table 1.

General characteristics of included studies examining the role of ovarian ultrasound markers in PCOS diagnosis.

First author, year of publication Participants’ N Country Setting PCOS diagnosis Ultrasound machine Transducer frequency (MHz) Age (y) BMI (kg/m2) Reported markers evaluated Proposed diagnostic thresholds
Ahmad et al., 2019

  • Total: 1001

  • Control: 756

  • PCOS: 245

 USA

  • Control: Community

  • PCOS:

  • Academic Medical Center

 1990 NIH Shimadzu SDU-450XL, General Electric Voluson s8 E8C-RS 4–8 (Shimadzu), 4–10 (Voluson)

  • Control:

  • N/A

  • PCOS:

  • N/A

  • Control:

  • N/A

  • PCOS:

  • N/A

  • FNPO,

  • OV (Max)

  • FNPO ≥15

  • (25 to <30 yo)

  • FNPO ≥14

  • (30 to <35 yo)

  • FNPO ≥12

  • (35 to <40 yo)

  • OV ≥8.50 cm3

  • (25 to <30 yo)

  • OV ≥7.00 cm3

  • (30 to <35 yo)

  • OV ≥6.25 cm3

  • (35 to <40 yo)
Allemand et al., 2006

  • Total: 39

  • Control: 29

  • PCOS: 10

 USA Academic Medical Center 1990 NIH Philips ATL HDI 5000 4–8

  • Control:

  • 30.90 ± 3.50

  • PCOS:

  • 31.20 ± 3.90

  • Control:

  • 24.00 ± 5.50

  • PCOS:

  • 32.20 ± 10.80

 FNPO, OV, FNPS

  • FNPO ≥20.1

  • OV ≥ 13.00 cm3

  • FNPS ≥10
Alsamarai et al., 2009

  • Total: 876

  • Control: 382

  • PCOS: 494

 USA Academic Medical Center 1990 NIH Philips ATL HDI 1500 5

  • Control:

  • 28.10 ± 6.40

  • (Younger)

  • 48.10 ± 6.60

  • (Older)

  • PCOS:

  • 27.80 ± 5.70

  • (Younger)

  • 46.30 ± 4.50

  • (Older)

  • Control:

  • 24.40 ± 5.10

  • (Younger)

  • 26.70 ± 5.40

  • (Older)

  • PCOS:

  • 30.60 ± 8.70

  • (Younger)

  • 31.30 ± 8.50

  • (Older)

  • OV (Max),

  • FNPS (Max)

  • OV ≥7 cm3

  • FNPS ≥12
Bili et al., 2014

  • Total: 83

  • Control: 40

  • PCOS: 43

 Greece Academic Medical Center Rotterdam General Electric Voluson 730 5–7

  • Control:

  • 30.80 ± 4.30

  • PCOS:

  • 28.90 ± 5.00

  • Control:

  • 22.50 ± 3.70

  • PCOS:

  • 24.90 ± 5.90

 OV, Ovarian Contour (OC)

  • OV ≥9.64 cm3

  • OC ≥8.75 cm
Carmina et al., 2016

  • Total: 160

  • Control: 47

  • PCOS: 113

 Italy Academic Medical Center Rotterdam Biosound Esaote MyLab 50 Xvision 8–10

  • Control:

  • 23.10 ± 4.00

  • PCOS:

  • 23.00 ± 4.30

  • Control:

  • 27.00 ± 4.00

  • PCOS:

  • 27.60 ± 6.00

 FNPO, OV

  • FNPO ≥22

  • OV ≥8.00 cm3
Chen et al., 2008a

  • Total: 585

  • Control: 153

  • PCOS: 432

 China Academic Medical Center 1990 NIH Toshiba Sonolayer SSA-220A (Transvaginal or Transrectal) 6

  • Control:

  • 27.15 ± 2.33

  • PCOS:

  • 26.25 ± 2.01

  • Control:

  • N/A

  • PCOS:

  • N/A

  • FNPO, FNPO (Max), OV,

  • OV (Max),

  • FNPO ≥10

  • FNPO (Max) ≥12

  • OV ≥6.40 cm3

  • OV (Max) ≥7.90 cm3
Chen et al., 2008b
[adolescent]

  • Total: 95

  • Control: 69

  • PCOS: 26

 China Academic Medical Center 1990 NIH Toshiba Sonolayer SSA-220A (Transrectal) 6

  • Control:

  • 13.00 ± 1.23

  • PCOS:

  • 12.57 ± 1.25

  • Control:

  • 21.77 ± 4.60

  • PCOS:

  • 20.12 ± 2.17

  • OV,

  • OV (Max)

  • OV ≥6.74 cm3

  • OV (Max) ≥7.82 cm3
Christ et al., 2014

  • Total: 142

  • Control: 60

  • PCOS: 82

 USA/Canada

  • Control: Community

  • PCOS:

  • Academic Medical Center

 1990 NIH Ultrasonix RP, General Electric Voluson E8

  • 5–9 (Ultrasonix)

  • 6–12 (Voluson)

  • Control:

  • 27.00 ± 5.19

  • PCOS:

  • 28.00 ± 5.19

  • Control:

  • 23.70 ± 3.93

  • PCOS:

  • 31.20 ± 10.44

 FNPO, OV, OA, SA, FNPS

  • FNPO ≥28

  • OV ≥10.00 cm3

  • OA ≥5.00 cm2

  • SA ≥3.00 cm2

  • FNPS ≥9
Çiraci et al., 2015

  • Total: 96

  • Control: 48

  • PCOS: 48

 Turkey Academic Medical Center Rotterdam General Electric Logiq E9 6.5

  • Control:

  • 27.10 ± 5.20

  • PCOS:

  • 25.70 ± 4.20

  • Control:

  • N/A

  • PCOS:

  • N/A

 FNPO, OV, Stromal Strain Ratio (SSR)

  • FNPO ≥12

  • OV ≥10.00 cm3

  • SSR ≥3.80
Dewailly et al., 2011

  • Total: 128

  • Control: 66

  • PCOS: 62

 France Academic Medical Center 1990 NIH General Electric Voluson E8 Expert 5–9

  • Control:

  • 30.00 ± 3.86

  • PCOS:

  • 27.60 ± 4.22

  • Control:

  • 24.00 ± 5.74

  • PCOS:

  • 28.00 ± 6.99

 FNPO, OV

  • FNPO ≥19

  • OV ≥7.00 cm3
Dewailly et al., 2014a

  • Total: 716

  • Control: 621

  • PCOS: 95

 Croatia Academic Medical Center 1990 NIH Toshiba Nemio 5–7

  • Control:

  • 32.50 ± 3.86

  • PCOS:

  • 29.80 ± 4.29

  • Control:

  • 23.00 ± 3.34

  • PCOS:

  • 27.00 ± 6.08

 FNPO FNPO ≥12
Diamanti-Kandarakis et al., 2011

  • Total: 97

  • Control: 47

  • PCOS: 50

 Greece Academic Medical Center 1990 NIH N/A N/A

  • Control:

  • 27.15 ± 6.72

  • PCOS:

  • 26.46 ± 5.86

  • Control:

  • 26.27 ± 5.30

  • PCOS:

  • 26.49 ± 5.00

 FNPO FNPO ≥19.5
Ertekin et al., 2019

  • Total: 53

  • Control: 16

  • PCOS: 37

 Turkey Academic Medical Center Rotterdam Samsung RS80 6

  • Control:

  • 23.0 ± 5.0

  • PCOS:

  • 21.5 ± 3.7

  • Control:

  • 25.5 ± 3.8

  • PCOS:

  • 24.5 ± 4.8

 OV OV ≥7.5
Fulghesu et al., 2001

  • Total: 83

  • Control: 30

  • PCOS: 53

 Italy Academic Medical Center Rotterdam (Frank) General Electric Logiq 500 6.5

  • Control:

  • N/A

  • PCOS:

  • N/A

  • Control:

  • 23.15 ± 4.49

  • PCOS:

  • 23.61 ± 3.88

 S/A S/A ≥ 0.34
Giménez-Peralta et al., 2022

  • Total: 311

  • Control: 111

  • PCOS: 200

 Spain Academic Medical Center Rotterdam Aplio 500 7

  • Control:

  • 31.60 ± 0.59

  • PCOS:

  • N/A

  • Control:

  • 22.90 ± 0.55

  • PCOS:

  • N/A

 FNPO FNPO ≥12
Jarrett et al., 2019

  • Total: 154

  • Control: 67

  • PCOS: 87

 USA/Canada

  • Control: Community

  • PCOS:

  • Academic Medical Center

 1990 NIH Ultrasonix RP, General Electric Voluson E8 5–9 (Ultrasonix), 6–12 (Voluson)

  • Control:

  • 27.00 ± 5.93

  • PCOS:

  • 27.00 ± 5.19

  • Control:

  • 23.60 ± 4.22

  • PCOS:

  • 32.00 ± 10.74

 OV

  • OV ≥10.00 cm3

  • (Right)

  • OV ≥9.00 cm3

  • (Left)
Jonard et al., 2005

  • Total: 155

  • Control: 57

  • PCOS: 98

 France Academic Medical Center 1990 NIH General Electric Logiq 400 7

  • Control:

  • 29.00 ± 4.10

  • PCOS:

  • 27.20 ± 5.27

  • Control:

  • 22.90 ± 4.88

  • PCOS:

  • 27.90 ± 8.07

 FNPO, OV, OA

  • FNPO ≥12

  • OV ≥7.00 cm3

  • OA ≥5.00 cm2
Kar and Swoyam, 2018

  • Total: 131

  • Control: 45

  • PCOS: 86

 India Tertiary Care Hospital Rotterdam General Electric Voluson E8 6–12

  • Control:

  • 28.45 ± 4.62

  • PCOS:

  • 26.03 ± 3.52

  • Control:

  • 23.02 ± 3.58

  • PCOS:

  • 25.71 ± 4.87

 FNPO, OV, SV

  • FNPO ≥12

  • OV ≥6.15 cm3

  • SV ≥6 cm3
Khashchenko et al., 2020
[adolescent]

  • Total: 160

  • Control: 30

  • PCOS: 130

 Russia Academic Medical Center Rotterdam

  • General Electric

  • Vivid-q

 1.8–6.0

  • Control:

  • 16.0 ± 1.48

  • PCOS:

  • 16.0 ± 1.48

  • Control:

  • 20.2 ± 2.52

  • PCOS:

  • 22.4 ± 5.41

 OV, OUI

  • OV ≥10.7 cm3

  • OUI ≥3.95
Kim et al., 2017

  • Total: 1210

  • Control: 666

  • PCOS: 544

 USA Academic Medical Center 1990 NIH ATL HDI 1500 Ultrasound, Phillips HD11 XE 4–8

  • Control:

  • 22.1 ± 1.8

  • (18–24 yo)

  • 27.2 ± 1.3

  • (25–29 yo)

  • 32.3 ± 1.3

  • (30–34 yo)

  • 37.3 ± 1.4

  • (35–39 yo)

  • PCOS:

  • 22.0 ± 1.9

  • (18–24 yo)

  • 27.3 ± 1.4

  • (25–29 yo)

  • 32.4 ± 1.4

  • (30–34 yo)

  • 37.8 ± 1.5

  • (35–39 yo)

  • Control:

  • 23.8 ± 4.4

  • (18–24 yo)

  • 24.3 ± 4.8

  • (25–29 yo)

  • 23.8 ± 4.7

  • (30–34 yo)

  • 26.3 ± 5.8

  • (35–39 yo)

  • PCOS:

  • 29.4 ± 8.0

  • (18–24 yo)

  • 30.4 ± 9.5

  • (25–29 yo)

  • 32.0 ± 9.0

  • (30–34 yo)

  • 33.5 ± 7.5

  • (35–39 yo)

 OV (Max), FNPS (Max)

  • OV ≥12 cm3

  • (18–24 yo)

  • OV ≥10 cm3

  • (25–29 yo)

  • OV ≥9 cm3

  • (30–34 yo)

  • OV ≥8 cm3

  • (35–39 yo)

  • OV ≥10 cm3

  • (40–44 yo)

  • OV ≥6 cm3

  • (>44 yo)

  • FNPS ≥13

  • (18–24 yo)

  • FNPS ≥14

  • (25–29 yo)

  • FNPS ≥10

  • (30–34 yo)

  • FNPS ≥10

  • (35–39 yo)

  • FNPS ≥9

  • (40–44 yo)

  • FNPS ≥7

  • (>44 yo)
Köninger et al., 2014

  • Total: 128

  • Control: 48

  • PCOS: 80

 Germany Academic Medical Center Rotterdam General Electric Voluson E8 Expert 3–9

  • Control:

  • 34.00 ± 5.50

  • PCOS (Severe):

  • 27.10 ± 5.80

  • PCOS (Mild):

  • 29.30 ± 5.80

  • Control:

  • 24.30 ± 4.40

  • PCOS (Severe):

  • 29.10 ± 7.40

  • PCOS (Mild):

  • 26.70 ± 7.00

 FNPO (Max), OV (Max)

  • FNPO ≥9.5

  • (Severe PCOS)

  • FNPO ≥8.5

  • (Mild PCOS)

  • OV ≥10.50 cm3

  • (Severe PCOS)

  • OV ≥10.20 cm3

  • (Mild PCOS)
Köşüş et al. 2011a

  • Total: 310

  • Control: 100

  • PCOS: 210

 Turkey Academic Medical Center Rotterdam General Electric Logic 200 Pro 6.5

  • Control:

  • 26.70 ± 5.60

  • PCOS:

  • 26.30 ± 5.40

  • Control:

  • 20.80 ± 2.40

  • PCOS:

  • 26.50 ± 5.30

 OV OV ≥6.43 cm3
Köşüş et al. 2011b

  • Total: 316

  • Control: 65

  • PCOS: 251

 Turkey Academic Medical Center AE-PCOS General Electric Logic 200 Pro 6.5

  • Control:

  • 26.70 ± 5.60

  • PCOS:

  • 24.90 ± 6.10

  • Control:

  • 20.80 ± 2.40

  • PCOS:

  • 27.10 ± 6.20

 FNPO, OV

  • FNPO ≥8

  • OV ≥6.43 cm3
Le et al., 2021

  • Total: 392

  • Control: 273

  • PCOS: 119

 Vietnam Academic Medical Center Rotterdam ALOKA ProSound SSD-3500 9

  • Control:

  • 33.99 ± 4.78

  • PCOS:

  • 32.66 ± 4.10

  • Control:

  • 20.82 ± 2.56

  • PCOS:

  • 21.31 ± 2.80

 OV OV ≥6.03 cm3
Lie Fong et al., 2017

  • Total: 945

  • Control: 297

  • PCOS: 648

 Nether-lands/ USA Academic Medical Center 1990 NIH N/A N/A

  • Control:

  • N/A

  • PCOS:

  • N/A

  • Control:

  • N/A

  • PCOS:

  • N/A

 FNPO

  • FNPO ≥12.25 (Young)

  • FNPO ≥10.75

  • (Old)
Lujan et al., 2013

  • Total: 168

  • Control: 70

  • PCOS: 98

 USA/Canada

  • Control: Community

  • PCOS:

  • Academic Medical Center

 1990 NIH Ultrasonix RP, General Electric Voluson E8 5–9 (Ultrasonix), 6–12 (Voluson)

  • Control:

  • 27.00 ± 8.89

  • PCOS:

  • 28.00 ± 5.19

  • Control:

  • 23.90 ± 4.07

  • PCOS:

  • 30.10 ± 10.07

 FNPO, OV, FNPS

  • FNPO ≥26

  • OV ≥10.00 cm3

  • FNPS ≥9
Özay et al., 2022

  • Total: 152

  • Control: 46

  • PCOS: 106

 Cyprus Academic Medical Center Rotterdam General Electric Voluson 730 Expert 7–9

  • Control:

  • 22.00 ± 3.25

  • PCOS:

  • 21.00 ± 3.00

  • Control:

  • 22.00 ± 3.25

  • PCOS:

  • 21.00 ± 3.00

 ST (Max) N/A
Vanden Brink et al., 2023

  • Total: 117

  • Control: 51

  • PCOS: 66

 USA Academic Medical Center, Community 1990 NIH General Electric Voluson N/A

  • Control:

  • 28.00 ± 5.40

  • PCOS:

  • 26.00 + 5.30

  • Control:

  • 27.10 ± 6.70

  • PCOS:

  • 31.20 ± 9.30

 FNPO, OV, FNPS

  • FNPO ≥26

  • OV ≥8.2 cm3

  • FNPS ≥8

  • Total: 134

  • Control: 48

  • PCOS: 86

 Italy Academic Medical Center 1990 NIH Biosound Esaote MyLab 25 Gold 3.5–5

  • Control:

  • 15.3 ± 1.7

  • PCOS:

  • 15.7 ± 1.4

  • Control:

  • 23.9 ± 4.9

  • PCOS:

  • 25.7 ± 5.4

 OV OV ≥5.596 cm3

  • Total: 89

  • Control: 63

  • PCOS: 26

 Chile Academic Medical Center 1990 NIH Medison SonoAce 6000C 5

  • Control:

  • 16.6 ± 1.5

  • PCOS:

  • 17.3 ± 1.9

 N/A FNPO, OV

  • FNPO ≥12

  • OV ≥10 cm3
Wongwananuruk et al., 2018

  • Total: 118

  • Control: 63

  • PCOS: 55

 Thailand Academic Medical Center 1990 NIH Aloga Alpha 6 (Transvaginal or Transrectal) 8

  • Control:

  • 29.70 ± 7.20

  • PCOS:

  • 25.10 ± 5.30

  • Control:

  • 23.50 ± 5.10

  • PCOS:

  • 25.30 ± 6.30

 FNPO (Max), OV (Max), FNPS (Max)

  • FNPO ≥15

  • OV ≥6.50 cm3

  • FNPS ≥7

PCOS: polycystic ovary syndrome; NIH: National Institutes of Health; AE-PCOS: Androgen Excess & PCOS Society; FNPS: follicle number per cross-section; SA: stromal area; S/A: stromal area/ovarian area; ST: stromal thickness; SV: stromal volume; OA: ovarian area; OUI: ovarian to uterine index; OV: ovarian volume; FNPO: follicle number per ovary.