 Good morning to all of you and a very warm welcome myself Dr. Prathamesh Vijay Kothorekar. First year PG Dereo Diagnosis resident of Dr. Diby Patil Medical College Hospital Kolhapur. Today we are going to discuss about the topic of preparation presentation on evaluation of osteoarthritis using magnetic resonance imaging. First we will see what is arthritis. Arthritis is nothing but it is inflammation of joint and osteoarthritis is commonly known as wear and tear arthritis. It is the most common type of arthritis. It is associated with breakdown of cartilage in the joints. Now the preferred locations for osteoarthritis are mainly the weight bearing joints such as hips, knees, spine. It affects the finger, thumb, neck and last also. Other joints can also be affected but it requires a predisposing condition such as previous injury, excessive stress or an underlying disorder of cartilage. Osteoarthritis it can be managed symptomatically but the damage caused it is irreversible. So staying active, maintaining a healthy weight and receiving certain treatments might slow down the progression of disease and help improve the pain and joint dysfunction. Now what are the risk factors involved in osteoarthritis? First is the old age. As age increases the risk of osteoarthritis increases. It is more commonly seen in women but the it is not cause is not known. The obesity is also a factor because it increases the weight on the mainly the weight bearing joints and certain other factors such as joint injuries while playing sports or accidents. Then there can be repeated stress on the joint. Other factors such as it can be genetic, it can be because of the bone deformities. There are certain metabolic disorders which are associated with osteoarthritis such as diabetes, hemoconrosis when there is too much iron deposition in the joints. Now which are the imaging tests used? So we use X-ray as primary modality but the cartilage does not show up on the X-ray. So for this we use better modality which is MRI which provides a detailed image of the soft tissue including the bone, the cartilage. So MRI overall provides a better information even in complex cases. Now what are the different imaging features which we need to see during this imaging modality evaluation? So first on plain X-ray radiof we use telegram and Lorentz grading scale wherein we can see eight points essential points such as asymmetric distribution, non-uniform loss of joint space, osteophytes, subcontral sclerosis, subcontral cysts, intra-articular loose bodies, intra-articular deformity and joint supplication. So we can see this all on X-ray. Now for MRI Higgs et al studied MR grading system of osteoarthritis he gave it according to which there are four grades of and grade zero which is normal. Now the grade one it is inhomogeneous high signal intensity in cartilage on T2 wave image. Grade two is grade one plus indistinct trabeculae or signal intensity loss in femoral head and neck on T1 wave image. Grade three is criteria of stage one and two plus indistinct zone between the femoral head and acetabulum and subcontral signal loss due to bone sclerosis. The grade four it includes above criteria up to grade three plus femoral head deformity. Now there are several scoring system using MR assessment of osteoarthritis of knee have also been proposed such as whole organ magnetic resonance imaging score, new osteoarthritis scoring system and Boston leads osteoarthritis knee score. Now we will see what is the aim of the study. The aim of the study is to establish a diagnosis of osteoarthritis in adult hip disorders using magnetic resonance imaging. So what are the objectives? The objective firstly is to identify the osteoarthritic lesions on MRI then to diagnose or accurate pathological environment on MRI and staging of osteoarthritis and finally to establish diagnosis of osteoarthritis in adult hip disorders using magnetic resonance imaging. Now what were the different material and methods followed? The source of this data was the patients presenting to Dr. Diva Patil Medical College Hospital Kolhapur. The type of study was cross-sectional observational study sample size was 50 patients. Now the in inclusion criteria all patients they were aged greater than equal to 18 they were both male as well as female and suspected to have unilateral or bilateral disorders of hip and referred to the department of radio diagnosis. Now in exclusion criteria we see the patients presenting with dislocation of hip fracture head and neck of hemorrhoids or the fracture of acetablam, contraindications to MRI such as ferromagnetic implant, claustrophobic patients, contraindications to use of contra agents and patients less than 18 years of age were excluded they were not included in this study. The technique used was with the help of Philipps Achiva 3 Tesla machine MRI machine. Further we will see the results and observations of this study. So out of 50 patients which were selected for the study 40 were diagnosed with osteoarthritis that amounts to about 80% and the remaining 10 the 10 patients were normal they had normal hip then we will see the different thermographics first the age. So amongst the 40 patients who were presented with osteoarthritis it was seen that the mean age of distribution was 55.5 years and the maximum age of presentation was in between 40 to 49 and 60 to 69 years as we can see rightly in the graph and bar diagram plotted in the image. Secondly we see gender now it was seen that among the 40 patients which were diagnosed with osteoarthritis 24 were male whereas 16 were females. So 60% males were affected and 40% females so in our study males were more affected. Now the grading of osteoarthritis on MRI as we had seen Higgs et al. MRI grading of osteoarthritis it had 4 grades with grade 0 normal. So in our study we saw that the grade 2 patients were more as compared to the other grades various parameters assessed so various MRI findings were assessed in osteoarthritis patients which are tabulated in the table below. We can see certain features were seen characteristics on MRI such as high signal intensity on T2 weighted image in intraarticular cartilage indistinct trapecular or signal loss of femoral head and neck on T1 weighted image indistinct zone between femoral head and acetabulum, bone sclerosis, subcontral signal loss and femoral head deformity. So in this table there are total this table is plotted for total 50 patients which shows these characteristics of which the indistinct trapecular signal loss of femoral head and neck on T1 weighted image was maximum. Now this table only focuses on the 40 patients which were diagnosed with osteoarthritis the same characteristics were observed in these patients and it was found that the commonest MRI abnormality which was seen in these patients was indistinct trapecular or signal loss in the femoral head and neck on T1 weighted image which amounted to about 87.5% which was maximum. Now we will see what is the the plane radiograph versus the MRI so in the 40 cases diagnosed they were detected both on as well as MRI but MRI it revealed accurate pathological involvement and also it was helpful in staging the osteoarthritis and was helpful for further appropriate management. Also we saw that the commonest MRI abnormality in osteoarthritis patient was signal loss in the femoral head and neck on T1 weighted image which was found in 87.5% in this study. Now we will see certain cases of which this is the first case which we have selected between maximum preferring range of 60 to 69 so this patient is of 62 year old male patient which presented with right hip pain and limb. In this we can see that on T2 weighted image coronal section there is inhomogeneity with areas of high signal intensity in the articular cartilage whereas in coronal T1 weighted image we can see indistinct trabeculae or signal intensity loss on femoral head and neck on T1 weighted image. So this is the case of osteoarthritis. Now this is the second case which was chosen between the preferred range of 40 to 49 years so this patient is 47 year old patient which presented with left hip pain. In this we can see on x-ray on the left head of femur we can see there is in the joint left joint hip joint we can see a symmetrical distribution then there is non-uniform loss of joint space then there is subchondral sclerosis a little bit and intraarticular deformity thus can be seen in the left side left hip joint. The other image is proton density fat saturation image on the left side which shows loss of articular cartilage with subchondral bone marrow edema little bit. So this is diagnosed with osteoarthritis. So finally the conclusion so in our study 50 patients were selected of aged above 18 years who underwent evaluation of hip using MRI. We found that elderly patients they presented with degenerative joint diseases and most of them had grade 2 osteoarthritis which showed signal loss in femoral head and neck on T1 weighted image on MRI. Secondly we saw that there was a male preponderance in our study and the unilateral hip involvement was more common. The early hip lesions were missed on the plane radiographies so MRI it was useful to identify these various hip lesions in early stages. So MRI was useful in early diagnosis as well as accurate staging of osteoarthritis hip in elderly. Thus we can say that MRI is beta investigation tool and should be included in evaluation protocol of patient with clinically suspected osteoarthritis. MRI offers several advantages in terms of sensitivity soft tissue contrast cartilage evaluation, evaluation of signing well chlorophyllations, bone marrow edema and assessment of joint effusion of osteoarthritis which can be missed on the plane radiographs. So MRI must be made available and utilized for osteoarthritis evaluation in adults so that early diagnosis can be made with appropriate treatment initiation in the early stages of disease and hence preventing the further appropriation of diseases. These are the certain references that I looked in for. Once again thank you to all. Thanks a lot.