 Hello, my name is Dr. Arma Deshosa. I'm a second year radiology resident at Pardham Mulder Medical College. Today I'll be presenting my oral paper. So the title is prostate imaging reporting and data system version 2 staging or that is pirate version 2 as tool for risk assessment and prostatic lesion for retrospective study. Coming to introduction, prostate cancer is one of the most common and deadly cancer in men throughout the world. So inadequacy of screening tools to distinguish subclinical illness from clinically significant prostate cancer is a primary barrier to early diagnosis. Despite evidence that most cancers detected through the prostate cancer screening programs are clinically significant rather than insignificant disease. An abnormal digital examination or an increased blood prostate specific antigen levels are the most common science for prostate cancer. Multi parametric magnetic resonant imaging is the diagnostic tool of choice in early diagnosis. So the parameters for early identification of prostate cancers are debatable due to the high incidence of prostate cancer. Multi parametric MRI of the prostate these involves sequences such as the high resolution T2 weighted images, function sequences such as diffusion and perfusion imaging. So this not only evaluates the anatomy but also the cellularity and tissue vascularity. This improves the diagnostic accuracy. So European Society of Neurogenital Radiology, they produced a set of guidelines in 2012 that recommended using this multi parametric MR images to describe and get a pirate's report. So later the American College of Radiologist, the European Society of Radiology and the Admitek Foundation they refined and updated this to pirate's version 2. Coming to aims and objective, the purpose of the study was to assess the accuracy of multi planer, multi parametric MR paste pirate's version 2 for prostate cancer evaluation and staging and to correlate with the serum prostate specific antigen level and histopathological results. The materials and methods that are used, so the available data and MRI images of the patients which was performed in the Department of Radiology of Fadumura Medical College, we used Philips Achiva 1.5 Tesla MRI machine and the data was collected between January 2019 to September 2021. And these were retrospectively assigned a pirate's version 2 score while they were blinded to the HP impression and we correlated with the serum prostate specific antigen and HP. Coming to the results, so 22 patients MRA and HP were available and we selected for the study out of which 21 cases showed diffusion restriction. 16 out of the 21 proved to have SNR adenocarstoma. 3 out of the 21 had benign nodular hypoplasia and 2 out of the 21 turned out to be prostatitis. One case which did not show the fusion restriction that was diagnosed as SNR adenocarstoma on HP. So this is a pie chart showing the same. So 16 patients proved to have adenocarstoma that was around 76.2 percent. 3 patients turned out to be BPH that was around 14.3 percent and 2 had prostatitis. So this is the mean age distribution which was 96. sorry 69.9 years. Pirate's version 2 score 8 was performed in all the patients. So majority of the cases around 61.9 percent had pirate's version score of 5 which was followed by pirate's version score of 4 that was around 9.5 percent. 5 patients had a score of 3 and was based on based on no abnormal contrast enhancement on dynamic contrast enhancement. These were kept at 3. No cases had a score of 2 and there was a single case with the score of 1. So this is a pie chart showing the same. So around 13 had a score of 5. So next was score of 3. Around 5 patients had a score of 3. Around 2 had a score of 4. No patients had a score of 2 and we had one patient with score 1. The serum prostate specific antigen level they ranged between 0.003 nano grams per ml to more than 5000. So majority of the patients with a score of 5 they had a serum PSA level of more than 40 nanograms per ml. The pirate's version 2 score 1 and 2 were considered as negative for scancer in our study and a score 3, 4 and 5 were considered positive. Biopsies were performed in all the cases. So 15 out of the 21 patients with a score of 3, 4 and 5 they had evidence of malignancy on HP. Among 5 patients with a score of 3, 3 were negative for malignancy. Among 2 patients with score 4, 1 turned out to be negative and among 13 patients with score of 5, 1 turned out to be prostatitis. So this was a total number of patients out of them 16 turned out to be positive for malignancy and 5 were negative. And there was a single case which had a score of 1 which turned out to be carcinoma and but the carcinoma was low grade. So coming to the statistics, so the sensitivity of my study was 94.12%. Specificity was 80%. So these are a few of the images. So this figure 1, it is a score 5 lesion. So the first figure shows an axial Q2ated sequence which reveals a large ill-defined hypotenensity in the peripheral zone on the left side. So the corresponding area was showing diffusion restriction and this patient had a serum PSA level of 6.18. And biopsy of this lesion revealed a low grade adenocarcinoma. This is a second image which shows pirates, it's a pirates score 5 lesion. So here first we see an axial T2ated image with an ill-defined hypotenensity in the peripheral zone. This also on the left side. The corresponding images on diffusion showed diffusion restriction and this patient had a serum PSA level of 1076. And biopsy of this lesion revealed a high grade adenocarcinoma. So these are images of HPE showing the gleason's grades. Coming to discussion, so MRA can aid in the diagnosis and localization of prostate CA based on clinical and or biochemical suspicion. So adoption of this multi-parametric MRA has a screening tool to identify patients with suspicious tumor who must undergo biopsy could drastically alter the current situation. So for the assessment of clinically significant prostate cancer, pirates version 2 adopts a 5 point scoring system for T2ated and diffusion and a 2 point scale for the dynamic contrast enhancement. Score 1 indicates a very low chance of clinically significant cancer whereas score 4 indicates a very high chance of prostate cancer. And score 3 is ambiguous. The dynamic contrast enhancement is only useful in a peripheral zone lesion that are in category 3. So the diffusion weighted imaging score was used as a final score in our investigation and there was no upgradeation of category 3 lesion based on the DC sequence. In our study all among all negative patients on MRA that is the ones with score 1 and 2, one patient had a clinically significant tumor on biopsy. Most of the positive patients in our study that is the ones which have scored 3 and above, these had the evidence of malignancy of biopsy. Hence the MRA had a high sensitivity and specificity in diagnostic prostate cancer. All patients with clinically significant tumor had a pirates score of 3 to 5 indicating that the pirates version 2 score 3 can be used as a biopsy cutoff level. Similar conclusions were also derived from Gupta R et al in India study. The false negative tumors in our study was a low grade cancer with Gleason score of 6. Patients having a pirates version 2 multi planner MR score of 1 or 2 can be monitored with serum PSA level and repeat MRA without invasive biopsy. Furthermore, there is a highly significant link in our study between the incremental pirates version 2 score and incremental serum PSA level. So the findings were similar to those by those study done by Singh et al. So who found a highly significant association between the pirates version 2 score and the PSA level, T staging and the ADC level. The limited sample size of our study was one of the drawbacks. So another drawback of our study was that we did not use prostatectomy specimen as a reference standard, which underestimates the Gleason score. So coming to conclusion, so screening tools to distinguish subclinical from clinically significant prostate cancer is inadequate and prevents early diagnosis. So the diagnosis of prostate cancer on multi planner MRA is promising. A morphological assessment done using T2 weighted images and functional assessment with diffusion weighted imaging. There was a significant correlation between the pirates version 2 and serum PSA level indicating the value of multi planner MRI in detecting clinically significant prostate cancer. The key diagnostic sequence for prostate cancers where the diffusion weighted and T2 weighted sequences. So these are my references. Thank you.