Cerebrovascular Function in Women With Polycystic Ovary Syndrome: A Pilot Multi-Parameter Magnetic Resonance Imaging Study.

OBJECTIVE

Polycystic ovary syndrome (PCOS) is associated with an increased risk of cerebrovascular disease, but the effects on cerebrovascular function are unknown. In this pilot study, we sought to compare cerebrovascular perfusion, pulsatility, reactivity and metabolism between women with PCOS and healthy volunteers using MRI, and investigated the influence of testosterone and insulin resistance on these parameters.

DESIGN

Case-control pilot study.

PATIENTS: Fifteen patients with PCOS (age: 32.0 ± 7.4 years; body mass index [BMI]: 31.8 ± 5.7 kg/m2) and 12 healthy controls (HC) (age: 30.7 ± 6.4 years; BMI: 30.2 ± 5.8 kg/m2).

MEASUREMENTS: We used 3T magnetic resonance imaging (MRI) to assess several aspects of cerebrovascular function: (1) perfusion (cerebral blood flow [CBF] and arterial arrival time [AAT]; PCOS N = 15; HC N = 12), (2) pulsatility index (PCOS N = 15; HC N = 12), (3) breath-hold induced cerebrovascular reactivity (CVR; PCOS N = 15; HC N = 10), and (4) global oxygen metabolism (oxygen extraction fraction [OEF] and cerebral metabolic rate of oxygen [CMRO2]; PCOS N = 9; HC N = 8). Linear regression models investigated the contribution of PCOS status, serum testosterone and Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR). Regional analysis underwent false discovery rate (FDR) correction for multiple comparisons.

RESULTS

Overall baseline CBF was not statistically different in PCOS patients compared to controls after adjustment for other variables (χ2(1) = 3.29; p = 0.07) but did show evidence for regional reduction with PCOS status in the transverse temporal gyrus (χ2(84) = 110.31; p = 0.03; -29.05 mL/100 g/min ± 7.26 [standard error; SE]). Similarly, while PCOS status was not associated with overall CVR (χ2(1) = 0.78; p = 0.38), there was evidence of a regional interaction (χ2(84) = 154.25; p < 0.001) in the parahippocampus (1.37% signal change ± 0.27 [SE]) and pericalcarine cortex (1.04% signal change ± 0.26 [SE]). Neither testosterone nor HOMA2-IR was associated with any outcome measure.

CONCLUSIONS

We observed regional reduction in cerebral blood flow and regional increase in cerebrovascular reactivity in women with PCOS compared to healthy controls. However, due to the limited statistical power and unclear menstrual timing in this pilot study, these results require further replication.