Can shear wave elastography be used as a diagnostic marker in polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. Diagnosing PCOS remains challenging due to the subjectivity of clinical assessments and the reliance on operator-dependent ultrasonographic findings. The present study investigated the potential of shear wave elastography (SWE) as a non-invasive and reliable diagnostic tool for assessing ovarian stromal stiffness in PCOS. The main objective was to evaluate the diagnostic utility of SWE in PCOS by comparing SWE parameters between women with PCOS and healthy controls. Additionally, the study examined the relationship between SWE measurements and clinical, biochemical, and ultrasonographic parameters in PCOS, with a particular focus on infertility, hirsutism, menstrual irregularities, hair loss, and acne.

A total of 150 women diagnosed with PCOS based on the Rotterdam criteria and 150 age-matched healthy controls were enrolled. Shear wave elastography measurements including shear wave velocity (SWV) and SWE values were obtained using a Toshiba Apio 500 ultrasound machine. The diagnostic performance of SWE was evaluated using receiver operating characteristic (ROC) analysis to determine optimal cutoff values for sensitivity and specificity. Correlations between SWE parameters and clinical markers, including body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), homeostasis model assessment-insulin resistance (HOMA-IR), total testosterone levels, and symptoms such as infertility, hirsutism, acne, and menstrual irregularities, were also assessed.

Significantly higher SWE values were observed in women with PCOS compared to healthy controls. Increased ovarian stromal stiffness was associated with elevated clinical and biochemical markers, including BMI, HOMA-IR, and total testosterone levels. Notably, SWE parameters showed significant correlations with clinical features of PCOS, including higher SWE values in women with infertility, hirsutism, menstrual irregularities, hair loss, and acne. These findings indicate that SWE is not only a diagnostic tool but could also reflect the severity of clinical manifestations in PCOS. SWE demonstrated high diagnostic accuracy, with mean SWV providing superior sensitivity and specificity for identifying women with PCOS.

SWE is a promising non-invasive tool for diagnosing PCOS and offers a reliable method to assess ovarian stromal stiffness. The correlation between SWE parameters and clinical features, such as infertility, hirsutism, and menstrual irregularities, highlights its potential to serve as a marker for disease severity. This study supports the inclusion of SWE in clinical practice for improved diagnosis and management of PCOS. Further studies are needed to validate these findings and explore the role of SWE in monitoring treatment outcomes and disease progression.