 Hello, everybody. I am Dr. Mohamad Sajid. I'm the final year resident in the department of radio diagnosis in the London Circle Medical College and Hospital. Today, my topic for world paper presentation is a comparative study on the diagnostic accuracy of USG and MSC being suspected with other pathologies in adults. Introduction. Obstructive jaundice is one of the most frequent and great form of hepatitis disease. It can pose problem in diagnosis and management, particularly in a particular disease. So the main aim of the radiologist is to confirm the presence of obstruction, its location, extent probable cause, and it should also attempt to obtain a map of the village tree that will help the surgeon to determine the best approach. There are various emerging modelities for the village tree and the two most common use modelities are USG and MSC. So it is mandatory to determine pre-operative to play the existence, the nature and site of obstruction because the wrongly chosen therapeutic approach can be dangerous. USG has been always the first choice of technique in the study of village disease because of its accessibility, speed, ease of performance, and low cost. So in our study, we are comparing the diagnostic accuracy of USG and MSC in village pathologies. For objectives, this is a prospective study to determine the diagnostic accuracy of USG and MSC in diagnosis of obstructive biographies and compare them with the final diagnosis materials and methods. We conducted this study in Nilvatham Circle Medical College and Hospital between September 2019 to August 2020. 30 patients between the age group of 18 to 80 years of obstructive genders were included in the study of thoroughly explaining about the study and taking their consent. They were subjected to USG and MSC. USG abdomen was performed using GE logic benign medicine and MSC was performed using GE sigma 1.5 deceleration. Standard MSC protocol was used in all the patients for final diagnosis which used MSC or interpreted findings in case of surgical intervention. Patient with clinical features of village obstructive diseases were included in the study and following patients were excluded from the study. Patient less than 18 years of age, number 22 is patient with contraindication to MRI. The results out of 30 patients, 19 patients were male and 11 patients were female. 16 cases were benign and 14 cases were malignant. Figure one showing the distribution of the benign and malignant cases in different age groups. In age group less than 40 years, all the cases were benign, there was total nine cases and all of them were benign cases. In the age group of 40 to 49 years, four cases were benign and only one malignant case was found. In the age group of 50 to 59 years of age, all together nine, eight malignant cases were found and only two benign cases were found. And in the age group more than 60 years, three malignant cases found and one benign case was found. Table number two showing the distribution of the different benign cases. The polydopleithiasis was the most common benign finding, it was seen at 56.2% followed by benign stretcher which was found in 25% of the cases. The other cases were in the 18.7% cases. Out of nine cases of polydopleithiasis, calculus in proximal symptoms was present in six cases and in three cases distal symptoms were noted. USG was able to detect five cases of the proximal symptoms and in one case of the distal symptoms whereas MRC we detected all of them correctly. One case of benign stretcher out of four was diagnosed in USG in the rest of the three cases, USG was unable to find specific causes. Here if you confirm them with benign stretchers and all of the four cases were accurately diagnosed by MOCP and findings related with the five diagnosis. Table number three showing sensitivity, specificity, and in preview of different benign cases in polydopleithiasis, the sensitivity, specificity, and in preview of USG were 66.6%, 95.2%, 85.7% and 86.9% and in case of MRC it is 100%, 95.2%, 90% and 100% and in case of benign stretchers, USG had a very poor sensitivity of 25%, specificity of 100%, in preview of 100% and in preview of 89% and in MRCP, sensitivity, specificity, and in preview all are 100%. Table number four showing the distribution of the different latent cases, there was five cases of periampillary CA, five cases of pulangio CA, and four cases of gallbladder CA. Out of the four gallbladder carcinoma, USG diagnosed three of them accurately, USG was also able to detect the hepatic inhibition and periportal lymph nodes. In one case, USG was diagnosed as chronic cholecystitis, MRCP was able to detect all of them accurately. Out of five pulangio carcinoma, USG was able to detect three cases. In one case, USG could not find any mass, which was later detected by MRCP. MRCP was able to detect four of them accurately. However, in one case, both USG and MRCP were only diagnosed as CBD calculus, which later turned out to be periampillary carcinoma in ERCP. Three cases of periampillary carcinoma was detected by USG, whereas in two cases, USG could not find any mass, but was able to detect the dilated CBD and when gridded up, MRCP was able to detect the mass in all of them correctly. So the sensitivity, specificity, PPP and NPP were different, but in 10 cases were calculated. In periampillaries here, the sensitivity, specificity, PPP and NPP of USG are 60%, 100%, 100%, and 92.5%. In MRCP, it was all of them are 100% because MRCP detected all of the five cases accurately. In case of pulangio carcinoma, USG had a sensitivity of 60%, specificity of 100%, PPP 100%, and NPP 92.5%. And in case of MRCP, sensitivity of 80%, specificity of 100%, PPP 100%, and NPP of 96%. In case of pulangio carcinoma, USG had a sensitivity of 75%, specificity of 100%, PPP 100%, and NPP of 96.2%. And in MRCP, it was all 100% because all the four cases were correctly diagnosed by MRCP. This is our discussion. So the obstructive geneticist is one of the most challenging cases for surgeon. Delaying in the proper diagnosis results in significant morbidity and mortality. For us radiologists, USG and MRCP are two main emerging modernities for biliary pathologies. In one study, the most common symptoms were ecterus and pain in the right upper quadrant for petrochlorobium and platelet stool. In this Burma et al. India study also noted similar clinical symptoms. Among the 30 cases, 16 cases are benign and 14 cases are malignant. Benign cases were most common in younger age group in less than 40 years, whereas the incidence of malignancy increases in older age groups. Among the benign cases, most common cases were colloidal ectasis, which was found in 56.2% followed by benign strictures. So their aim at all also noted most common cause of the benign obstruction to be colloidal ectasis in 24% cases, followed by post-collestructant strictures in 20%. USG is excellent in detecting proximal SIMD calculi, only in one case it was not able to pick up as the CBD was not dilated. Whereas for detecting distal CBD calculi, it is much less effective than MRCP because of several factors like non visualization of the distal CBD due to gas shadow or in case of obese patients. MRCP was able to pick up all the calculi correctly. Burma et al. India study found the sensitivity and specificity of MRCP for detecting SIMD calculi by 88.9% and 100% which is similar with our study. For this JC et al. India study noted MRCP at its sensitivity, specificity and diagnostic efficiency of 91%, 98% and 97% respectively in diagnosis of colloidal ectasis. USG was able to detect only one benign strictures out of four cases, but MRCP actively diagnosed all the four cases. Study conducted by all OBD et al. revealed much higher sensitivity at 100% specificity, 98.5% of MRCP, which is similar with our study. Catabatina fears et al. mentioned that MRCP is as sensitive at direct collageography and typically shows a short shipment of strictures of CHT or CBD with associated intraparticularity validation. Out of four ball bladder carcinoma cases, at the same time we diagnosed three of them accurately. USG was also able to detect liver inflammation and pinpotal demons. In one case, USG was diagnosed as chronic polycystitis. MRCP was able to detect all of them accurately. JC et al. India study found the sensitivity, specificity, PVB and NPV of USG to be 75%, 97%, 85% and 95% and of MRCP to be 100% all respectively. Our findings are similar with the experimental study. Three out of five cholangio carcinoma were correctly diagnosed by ultrasonography whereas MRCP detected four of them correctly. One case was incorrectly diagnosed as calculus in both USG and MRCP which was later confirmed by ERCP. Amandip Singh et al. in his study noted sensitivity and specificity for detection of cholangio carcinoma in USG as 66.67% and 100% and in MRCP as 83.3% and 100% respectively, which was similar to our present study. Sensitivity and specificity of USG and MRCP are 60%, 100%, 80% and 100% respectively. Out of five perium polycarcinoma cases, three were accurately detected by ultrasonography and MRCP was able to detect all of them correctly. Amandip Singh et al. mentioned their sensitivity and specificity of USG and MRCP to detect perium polycarcinoma to be 57%, 100%, 100% respectively. Which is consistent with the present study. However, G&E and S reported differently in their study probability larger sample size. So in conclusion, ultrasonography is the primary model of choice for evaluating related pathologies. It is a really good model for detecting all model pathologies and evaluation of the proximal part of the CBT. However, it has shown four results for detecting distal CBT calculus and strictures, MRCP superior to ultrason. Detecting all the related pathologies gives us excellent visualization of the related tree, hence detecting related pathologies becomes easier. So in conclusion, all the cases not clearly diagnosed by ultrasonography should be evaluated by MRCP. Here are some radiological images. This is a USG scan showing dilated, intracipatic bidery radical MRCP images, also showing the similar dilated IHBLs. This is a USG scan showing a dilated CBT with a calculus in the distal part of the CBT. This is a T2 weighted axial MRS scan showing a high-pointed mass at the CHD near the confluence of the right and left hepatic duct. This is a MRCP mass showing a bident structure, which is smooth tapering. This is the USG scan showing high-pointed heterogeneous mass near the neck of the GD region, which was good because we got better understanding of this. These are the abbreviations that these are the references. Thank you.