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To assess the role of fluid aspiration in ovarian preservation from a great anechoic cystic adnexal mass. In addition, the diagnostic value of fluid levels of estradiol and CA 125 were examined. A prospective longitudinal study using clinical and ultrasound data collected for all patients under 19 years of age with clear cystic adnexal masses and ultrasonographic presence of the ipsilateral normal ovarian tissue, or the ovarian crescent sign (OCS) as a predictor of benign origin, with volume ≥200 ml, managed between January 2006 and November 2022. Aspiration was performed before surgery with the aim of strengthening the normal ovarian tissue to be whole preserved during laparoscopic stripping. In patients with suspicious for torsion samples was taken during laparoscopy. Pediatric and Adolescent Gynecology Departments in hospitals in three European countries. Surgical treated 92 patients with anechoic cystic adnexal masses. Ovarian volume, the presence of OCS and anechoic content were reported. From first syringe, fluid level of estradiol in pg/l and CA 125 in IU/ml were measured and correlated with postoperative histologic findings. The median cyst volume was 570 ml (range between 200 and 7600 ml). The normal ovarian tissue was reported, and no malignancy was found in all of 92 patients laparoscopically treated. Paraovarian cysts was considered on ultrasonography in 39 patients, but in four of them intrafilamentary ovarian cystadenomas was confirmed during laparoscopy. With laparoscopic stripping, the whole ovaries were preserved in nine patients with cystic mature teratomas and in 42 patients with serous cystadenomas including largest of 7600 ml. Torsion was reported in three of previous mentioned paraovarian cysts and in six ovarian cystic masses. Fluid levels of estradiol and CA 125 were successfully measured in all cystic masses except two ovarian torsions. CA 125 was significantly elevated in all serous cystadenomas and paraovarian cysts, Table 1, but estradiol was elevated only in four of functional ovarian cysts. In all large cystic mature teratomas both fluid markers remained low. Ovarian volume recovered to normal value within three months, as previous reported. ▪ Aspiration of cyst fluid before surgery in clearly defined patients may be very helpful to insuring ovarian tissue preservation in large cystic masses. Fluid levels of estradiol and CA 125 correlate with histology diagnosis and can be useful in distinguishing functional cysts from serous cystadenomas and paraovarian cyst, and cystic mature teratomas. [ABSTRACT FROM AUTHOR]

Background Thoracic and abdominal 4D flow MRI is typically acquired in combination with navigator respiration control which can result in highly variable scan efficiency (S eff ) and thus total scan time due to inter-individual variability in breathing patterns. The aim of this study was to test the feasibility of an improved respiratory control strategy based on diaphragm navigator gating with fixed S eff , respiratory driven phase encoding, and a navigator training phase. Methods 4D flow MRI of the thoracic aorta was performed in 10 healthy subjects at 1.5 T and 3 T systems for the in-vivo assessment of aortic time-resolved 3D blood flow velocities. For each subject, four 4D flow scans (1: conventional navigator gating, 2–4: new implementation with fixed S eff = 60%, 80% and 100%) were acquired. Data analysis included semi-quantitative evaluation of image quality of the 4D flow magnitude images (image quality grading on a four point scale), 3D segmentation of the thoracic aorta, and voxel-by-voxel comparisons of systolic 3D flow velocity vector fields between scans. Results Conventional navigator gating resulted in variable S eff = 74 ± 13% (range = 56%–100%) due to inter-individual variability of respiration patterns. For scans 2–4, the new navigator implementation was able to achieve predictable total scan times with stable S eff, only depending on heart rate. Semi- and fully quantitative analysis of image quality in 4D flow magnitude images was similar for the new navigator scheme compared to conventional navigator gating. For aortic systolic 3D velocities, good agreement was found between all new navigator settings (scan 2–4) with the conventional navigator gating (scan 1) with best performance for S eff = 80% (mean difference = − 0.01 m/s; limits of agreement = 0.23 m/s, Pearson's ρ = 0.89, p < 0.001). No significant differences for image quality or 3D systolic velocities were found for 1.5 T compared to 3 T. Conclusions The findings of this study demonstrate the feasibility of the new navigator scheme to acquire 4D flow data with more predictable scan time while maintaining image quality and 3D velocity information, which may prove beneficial for clinical applications. [ABSTRACT FROM AUTHOR]