 Hello everyone, myself Dr. Utsavi Modi, second year PG resident from D.Y. Patil, Kulapur. I would like to thank Indian radiologist for giving me this opportunity and I would also like to thank my guide Dr. Niranjan Sir and the HOD of our department Dr. Niranjan Sir for giving me this opportunity. The topic for my paper is Revolutioning Liver Health Assessment, a novel comparison of MR chemical shift and ultrasonolestrography with C.T. Houndsfield unit for non-alcoholic fatty liver disease in its infancy. So the aim and the objectives of the study are to quantify the degree of fatty infiltration of the liver in patients with asymptomatic non-alcoholic fatty liver disease with MR chemical shift imaging and to compare the diagnostic accuracy of MR chemical shift imaging, USG gray scale and USG shear wave elastrography with C.T. Houndsfield units and early assessment of hepatic stearsuces and hepatic fibrosis. So the introduction with excessive triglyceride accumulation in the liver cells can cause hepatic stearsuces, ultimately progressing to chronic liver disease like non-alcoholic stear to hepatitis and other complications. So roughly if we see 15-5% non-alcoholic stear to hepatitis patients may develop irreversible consequences such as hepatic fibrosis, liver cirrhosis or hepatocellular carcinoma and unfortunately these conditions are often asymptomatic until complications arise or earning them the label of silent liver diseases. So the non-alcoholic fatty liver disease often goes undetected as liver biopsy the gold standard diagnostic procedure is typically performed only on symptomatic patients or those with elevated immunotransferase levels. However, liver biopsy has limitations including invasiveness, discomfort, inability to determine cirrhosis, severity and sampling errors. So the non-invasive imaging modalities could serve as reliable screening tools for the non-alcoholic fatty liver disease offering advantages such as non-invasiveness and better patient compliance thus helping in early diagnosis of non-alcoholic fatty liver disease even in asymptomatic individuals, facilitating timely management. So the materials and methods for the study is that this is a prospective cross-sectional study was conducted in 80 patients and patients were referred to the radiology department for abdominal imaging with the incidental finding of non-alcoholic fatty liver disease were included for the study. These patients were subjected to grayscale imaging, ultrasound point shear wave illustrography, CT imaging and MR chemical shift imaging. So the introduction of the new assessment methods the MR chemical shift imaging is the method that uses ecotime dependent phase inference effects of fat and water to quantify the fat content of the liver by acquiring images at the ecotimes at which water and fat signals are approximately in phase and opposed phase volumetric liver fat detection is possible based on the relative signal loss on out-of-phase images and ultrasound illustrography enables clinically non-invasive evaluation of the liver fibrosis and non-alcoholic fibrosis is thought to function as parent camel framework that adds rigidity therefore estimation of tissue stiffness could reveal whether and how much fibrosis is present. So the point shear wave illustrography staging on the liver fibrosis is as follows normal then mild mild to moderate and moderate to severe. So here we will start with the cases the first case the ultra the gray scale of the ultrasound imaging which shows a diffusely hyper-equic liver parent camera obscuring the periportal ecogenicity but the diaphragmatic ecogenicity is still appreciable so it is the grade 2 fatty liver. So on the ultra ultrasound point shear wave illustrography for one of the samples is detected to be 8.66 plus minor 0.82 and the mean liver parent camel attenuation for the this range of image in the right lobe of the liver and the spleen is being 30.89 HU and 52.21 HU respectively. So the ML chemical shift imaging the in-phase and the out-phase calculating mean is the in-phase is 436.3 and the out-phase is 216.8 so the fat percentage is 25.15. Case 2 the ultrasound gray scale image shows diffusely hyper-equic liver parent camera the diaphragm and the nearby structures are poorly visualized due to scattering of the incident ultrasound waves by the excess of the fat so thus grade 3 fatty liver and the point shear wave illustrography one of the samples is 8.11 and the CT-hounds fill unit for the mean liver parent camel attenuation the range of image in the right lobe of the liver and this spleen is 10.65 and 49.0 respectively. The MR chemical shift imaging the in-phase and the out-phase mean in-phase is 532.3 out phase is 57.99 so the fat percentage turns out to be 44.56 according to the formula. So the results of our study is when the size of the liver is less than 15 centimeters the number of patients with the size of the liver less than 15 centimeters of 22 more than 15 centimeters of 58 so the stiasis which came to be grade 1 the 45 patients grade 2 27 patients and grade 3 27 patients and the ultrasound point shear wave illustrography liver fibrosis staging normal were 14 patients the mild were 28 mild to moderate 38 and moderate to severe was 0 so on analyzing the extent of the fibrosis in the graves of the fatty liver it is observed that the extent of fibrosis strong correlations with the high grade of the fatty liver and on the linear regression between the CT mean hounds fill unit and the USG point wave shear point where point shear wave illustrography it doesn't show a reliable correlation with a slope of the intercept and thus the CT attenuation value is not reliable modality in the assessment of the hepatic fibrosis whereas the the linear regression between CT mean hounds fill units and MRI chemical shift imaging fat estimation showed excellent correlation with the slope of the intercept hence we can apply that MR I chemical shift imaging is a reliable modality for qualitative assessment of fatty liver by providing accurate percentage amount of fat in the liver parent camera so the discussion of the study is that the study found a strong association between fatty liver and the occurrence of fibrosis however it is worth noting that none of the asymptomatic patients fell into the moderate to severe fibrosis category indicating that severe fibrosis unlikely to develop in asymptomatic individuals and non-enhance CT scans were identified as a reliable modality for diagnosing fatty liver with CT attenuation values serving as a non-invasive gold standard and this finding has significant implications for clinical practice as CT scans can provide accurate and accessible diagnostic information. So the linear regression analysis demonstrated good correlations between CT and attenuation values and ultrasound grayscale imaging for fatty liver grading as well as with the MRI chemical shift imaging for fat percentage analysis. These findings support reliability of both ultrasound and MRI as modalities for assessing fatty liver and quantifying fat content. In contrast to the reliable correlations found with the CT and MRI ultrasound point shear wave illustrography did not show a reliable correlation with CT attenuation values for assessing hepatic fibrosis and this suggests that CT harmful units may not be as accurate in detecting fibrosis compared to the other imaging techniques. So these are my references.