 Good morning. I am Dr. Kavneet Singh, a junior resident from Krishna Vishwapit Karat and I am going to presenting a scientific paper on MRI staging of rectal cancer and pathological correlation of tumor regression staging. So, rectal cancer is one of the most common malignancy with an incidence of 40 cases in 1 lakh population. The rectum is the most frequently involved site in the large intestine and accounts for one third of all large intestine cancer cases. The patient usually presents to us with complaints of bleeding per rectum, tenismus and morning diarrhea. The risk factors include obesity, diet, smoking, lack of physical exercise and genetic syndromes like lynch, gardeners and phab syndrome. The various radiological modalities that we use to evaluate the rectum are trans rectal ultrasound, CT and MR imaging. High resolution T2 weighted MR and diffusion weighted imaging are used in the staging of rectal cancer both before and after concurrent chemo radiotherapy. Now the patients who require chemo radiotherapy are advised to undergo neo adjuvant treatment before their surgery for 5 to 6 weeks. The follow up MRI is done at 5 to 6 weeks after the therapy and then MR tumor regression staging is done and patients are advised to undergo surgery within 2 to 3 weeks. Later these specimens derived from the surgery are examined to estimate the pathological grading of the tumor regression using Dwarak system. The aim of our study was to estimate the accuracy of MRI tumor regression grade with the histopathological grade in rectal cancer after administration of chemo radiotherapy. So this examination was performed for all patients who were histologically proven to have rectal adenogasinoma, the high resolution T2 sag, T2 oblique agil, T2 oblique coronal, diffusion weighted and large field view T1 pre and post contrast images were acquired using 1.5 Tesla magnetome Avento machine with pelvic faced array surface coils. A total of 21 patients were included in our study in a period of 1 year and 6 months. Out of these 9 cases were excluded from the study which did not meet our inclusion criteria. The purpose of our study was to determine the efficacy of tumor regression staging of rectal cancer in MRI with histopathological staging which was the goal standard criteria. The total of 21 patients included showed the median age of 51 plus minus 13 years, the most common age group between 50 and 259 years. The following was the grading that we used. So grade 1 was assigned to those patients who did not show any sign of regression or had a similar appearance as that was before treatment. Grade 2 is assigned to patients who still have a dominant tumor mass or signal intensity in the rectum with apparent fibrosis chronic inflammation with or without vasculopathy. Grade 3 has been assigned to patients who showed dominant fibrosis changes and signal intensity but still have a substantial tumor load. Grade 4 was assigned to those who have very few tumor cells remaining and have substantial fibrosis or low signal intensity. And grade 5 is assigned to those patients who showed complete response to treatment that is there were no tumor cells or there was absence of any tumor signal on MR imaging. So in our study 8.3% of the tumors were grade 1, 16.7% were grade 2, 41.7% were grade 3, 16.7% belonged to grade 4 and 16.7% landed in the grade 5 MR tumor regression grading stages. The accuracy of MR tumor regression grading system was between 75 to 91%. The maximum number of patients were in grade 3 with sensitivity, specificity, positive and negative predictive values as follows. Now this is the case of a 51-year-old rectal cancer patient, a male patient who showed pre-chemoradiotherapy staging of T4A tumor signal intensity involving the rectum. After the chemoradiotherapy we saw that the patient had regressed to 1 to grade 3 which showed a moderate response that is there were dominant fibrotic changes and there was also visible intermediate signal intensity tumor. In conclusion, there was a high accuracy between the MR and pathological tumor regression grading in rectal cancer. The preoperative assessment using MR can further predict the management and survival rate of the patient. The limitations to our study were that the sample size was small and we had a limited time period. Thank you.