 Hello everyone, my name is Dr. Farhana Hassan and today's topic of discussion is role of MRI in perimenopausal bleeding and its correlation with TBS. UB is one of the most prevalent gynecological issues up to 30% of reproductive age women are affected because of it and up to 50% of perimenopausal women. It is defined as excessive bleeding that occurs outside of normal cyclic menstruation. ACOJ has adopted the palm coin classification to solve the issue of what exactly are the various causes of abnormal uterine bleeding. The palm stands for structural causes and coin stands for various other causes. Like palm is polypedinomyosis, leomyoma, malignancy and coin stands for coagulopathy, ovulatory dysfunction, endometrial, pauses, itrogenic and unclassified. It is very important to judiciously evaluate the causes and ascertain whether it is benign or malignant because it is very crucial to determine the treatment strategy and the final clinical outcome. The aim of study is to assess the role of TBS and MRI in the characterization and to know the extent of lesions in perimenopausal bleeding and to compare the accuracy of TBS and MRI. To assess the diagnostic potential of TBS and MRI in terms of sensitivity and specificity, secondary objective is to know the most useful imaging modality of choice for the same. Now it's a prospective study hospital-bound referred to patients are taken that fulfill the criteria of inclusion criteria and the exclusion criteria of all patients are not taken. Final confirmation was done by histopath examination and the color Doppler was also used. Inclusion criteria, the patients that were referred to the department of radio diagnosis for radiological evaluation of abnormal uterine bleeding. Exclusion criteria, the pregnant women, unmarried ones, women having endocrine abnormalities and bleeding disorders, women with an intra-uterine device and C2. All patients in whom histopath reports couldn't be operated as a patient in an endocrine surgery. Now we have many age group patients but 40 to 49 year old patients were making the majority of our sample. Now presenting a print, most of women almost all had bleeding for vagina complain and then vaginal discharge, pelvic pain, weight loss, fever could also be another symptoms. Comorbidities, anemia was the most common abnormality, a comorbidity associated with these women. And then next one is hypertension. Let's discuss some pieces. The first case is 47 year old women having heavy uterine bleeding. On transvaginal sonography we get globular enlarged uterus with heterogeneous myometrium and indistinct junctional zone along with tiny myometriosis. Now on MRI it is showing enlarged uterus with thickened indometrial junctional zone and C2 hyperintense cysts in myometrium. On HPE it is shown as a diffuse adenomyosit. 54 year old women with irregular bleeding and weight loss. Now on TDS we get a lobulated hyperequic lesion with fluid in the indometrial cavity corresponding to a Doppler image is showing internal vascularity. On MRI it shows high iso intense mass in the indometrial cavity with hyper intense fluid surrounding it on T2 without invasion of the myometrium and showing restriction on DW image. Indometrial carcinoma on histopath examines. Case 3, 53 year old female presented with perimenopause of bleeding. On transvaginal sonography it depicts diffuse homogenous thickening of endometrium with a few tiny cystic areas. Diffuse endometrial thickening predominantly in the fundal region with tiny hyper intense areas within it on MRI. On histopath diagnosis we have simple endometrial hyperphesia. Case 4, 55 year old women presented with perimenopause of bleeding and pelvic pain. On PPS a well defined homogenous hyperequic lesion seen in the endometrial cavity with feeding vessel on corresponding Doppler. On MR also we have a well defined T1 iso T2 iso to hyper intense lesion in endometrial without restriction on DW images. Endometrial polyp for diagnosed on histopath examines. Case 5, 38 year old female with abnormal bleeding through vagina and pelvic pain. On TVS we get a well defined heterogeneously hyperequic lesion in the fundal region with minimal fluid surrounding it and showing peripheral vascularity. On MR we get a well defined lesion having intermediate signal intensity on T1 and low signal intensity on T2. In the fundal region of uterus with fluid surrounding it and no restriction on DW image. On histopath it is confirmed to be diomyroma. These are the typical features observed in various lesions on MRI as I have discussed with the cases. To conclude we have established that TVS has been the imagined modality of choice in the evaluation of EUB for the past few decades. However most of them provide ambiguous results. A total of 65 patients came to us, 52 undergone MR and HPE examination, 9 were lost to follow up and 4 got operated without MRI. So we have lots of findings to discuss and in our study the diffuse thickening of endometrium was found as a common cause of both benign and malignant etiology. Most of the cases having focally thickened endometrium was suspected as a polyp and focally endometrial hyperplasia in our study. In our study no malignancy was found with endometrial thickness of 10 mm. 30 cases displayed a heterogeneous endometrial ecotexture while 22 had homogenous endometrial ecotexture on TVS. On evaluation with TVS 13 had distended endometrial cavity, 3 had obliterated and the rest had a normal endometrial cavity and these findings were reassured on MRI. Now on TV, cystic changes were the most common ancillary finding in endometrial. Intralesional cysts were found in similar frequency on MRI. The presence of an intralesional cyst in endometrial pathology suggests the benign nature of lesions particularly endometrial hyperplasia and polyp. Calcification was second most ancillary finding on TVS and MR showed necrosis, hemorrhage, calcification, endometrial fluid as associated findings. On examination of the cervix with TVS only 6 had a cervical mass and out of these 1 with perimetrial invasion, 1 with adnexil involvement and 3 with bladder involvement. However MRI showed 9 cases with cervical lesions and most of them about 6 had a perimetrial invasion, about 5 had adnexil involvement and 7 had pelvic organ involvement. So MRI was found to be more efficient as compared to TVS in the detection of cervical masses and other pelvic organ involvement. And for lymph nodes also TVS failed to detect lymph node involvement while MRI can reveal lymph node metastasis quite a change. So most of the uterine lesions distributed were mainly fibroids and adenomyosis are quite common and then endometrial carcinoma. With the histopathological detection we have most common finding as endometrial carcinoma followed by adenomyosis and then fibroid. On comparison with the histopath examination MRI is quite useful in detection of endometrial carcinoma. It has almost equal to or more than efficiency in detecting endometrial carcinoma. Adenomyosis is quite efficiently diagnosed on TVS also. So the sensitivity and specificity sensitivity is quite comparable for TVS and MRI. But specificity is quite high for MRI and also accuracy. To conclude perimenopausal bleeding is commonly encountered in day to day practice and because it has such a huge impact on women's health early detection is crucial. With early detection alone it is possible to improve the survival rate. With sensitivity and specificity of 60 and 93.75% respectively for malignant uterine lesions TVS is a good primary imaging modality. But there are many false positive and there are many false negatives. So that can lead to unnecessary intervention and neglect neglecting serious disease respectively. With the sensitivity and specificity of 100% and 96.87% for MRI the diagnostic performance of MRI was better than TVS. Thank you.