 Good afternoon to the scientific committee of CTBus. I am Dr. Sameer Aaluwalia, currently a postgraduate resident third year in the department of radio diagnosis at Sabdajung Hospital, New Delhi. I'll be presenting my oral paper on the topic, multi-point Dixon technique for evaluating sacroiliatus and axils from the Aaluwathropati under the guidance of my guide, Dr. Rupi Jamwal, who is a consultant and associate professor at Sabdajung Hospital, New Delhi. I have nothing to disclose and there is no conflict of interest. My aim was to compare conventional MRI sequences with deteriorated, deteriorated multi-point Dixon for the imaging of sacroiliatus in patients of axils from the Aaluwathropati. As we know that axils from the Aaluwathropati is also a common DD for lower backache and it's an inflammatory type of backache. That nature helps us to differentiate it from the mechanical backache and the sacroiliatus is the hallmark of axils from the Aaluwathropati and earlier only since radiography was available, we used to miss out on the patients with acute features and the diagnosis and the consequent treatment hence was delayed by almost 10 to 14 years. The assessment of spondyloarthritis International Society then included MRI as the new imaging arm for the diagnosis of spondyloarthropathy in 2009 since it could actually pick up acute features of the disease and the disease could be handled and controlled at that stage itself. And fat suppression is used most commonly in MSK imaging and abdominal pelvis imaging and Dixon technique is one of them named after the physicist W. Thomas Dixon and it allows the signal of fat to be suppressed in the post-processing and we get four images. Basically it works on the chemical shift imaging and provides us with fat and water distribution maps. The methodology was that sacroiliac joint was acquired in a single session on a 3 Tesla GE Discovery MRI system used in a hospital. The quiet sequences in the routine protocol they were taken and the T1 and the STIR sequences were looked up for any imaging feature of sacroiliatus be it acute or chronic. And once in a patient we found we added the Dixon sequence protocol to it and hence we obtained four images. It was named as lava flex in our machine, water only in phase post-processing fat only. And then the image analysis was done as follows. The contrast to noise ratios of the fat lesions in T1 and fat only Dixon and the bone marrow edema and STIR and water only Dixon in all patients was calculated using the formula mean of the lesion the signal intensity of the lesion minus the signal intensity of the bone surrounding bone marrow the normal bone marrow upon the standard deviation of air. For evaluating the fatty lesion and erosions, the comprehensive Berlin score was used and one sacroiliac joint was divided as such into four quadrants with the vertical plane passing through the joint itself and the horizontal plane passing through the lower border of the first sacral neural for amino. So accordingly for every patient we have eight quadrants that need to be assessed. And the scoring of the bone marrow edema of the erosions and the fatty lesions was done as follows the number of erosions on a zero to three scale. Zero meant no lesions are there one was less than 33%, two was 33 to 66% and three was more than 66% that is of the bone joint surface in the respective quadrant. So accordingly eight quadrants were to be evaluated the score ranging from zero to 24. The results were as follows the CNR of both the fatty lesions and bone marrow edema was statistically significantly more than the conventional sequences on the Dixon sequences. And the CBM of the fatty lesions and erosions was also more on the Dixon sequences. And we can see in these images the left is the T1 weighted axial cut showing hyper intense fatty lesions but Dixon sequence shows it at the better contrast to noise ratio. The bone marrow edema that can be seen we can see it on star and we can see on water only Dixon technique and we can see that the water only Dixon technique shows a relatively larger surface area of the bone marrow edema with better contrast to noise ratio. Same for the coronal cut of the T1 weighted and the fat only Dixon and we can see a better contrast to noise ratio in the fat only Dixon and this is for the bone marrow edema again. So the previous literature a study was done by Ali Osgan in 2017 that determined the value of T2 weighted multipoint Dixon for the active and chronic sacroiliac on 73 patients and they actually found the results to be statistically significant and more on the Dixon sequences. We concluded that the T2 weighted multipoint Dixon can be used as a single MR sequence instead of a conventional T1 weighted T2 weighted on a contrast enhanced pad saturated T1 weighted image in that. So it saves time it saves contrast administration. And this is very important and the images are obtained in the images are generally 3D so we can reconstruct it into various planes as well. This study was an observational cross sectional study on sample size of 42 patients with science of inflammatory back pain the age range was 18 to 45 years and lower back it and morning early morning stiffness were the most common symptoms and they were subjected to a non contrast MRI scan of the sacroiliac joints first and for the patients who showed signs of either active or chronic sacroiliac is for pertaining to. Axis fund all over the only those were for only those patients T2 weighted multipoint Dixon was used and after completion using if we calculated the CNR and CBM scores and then we compared them and the mean CNR of bone marrow edema and. And the fatty regions on the Dixon sequences and sorry was more than that on the conventional sequences same goes for the CBM scores. These are my references. Thank you very much.