 Good evening to all, I'm Dr. Wasimra, currently a third year post-graduate resident in department of data diagnosis at Sardajam Hospital, New Delhi. I will be presenting my oral paper on the topic multi-parametric MRI features evaluation in prediction of isocyclic dehydrogenous mutational status of diffused low-grade gliomas. Under the guidance of Dr. Yatish Agrawal, who is currently a professor and consultant at the Sardajam Hospital, During the course of my study, an updated WHO classification of brain tumors was released in which adult diffused type gliomas were classified into three categories, namely, astrocytome-IDH mutant, oligodendroglioma-IDH mutant plus one P19Q co-deleted and glioblastoma-IDH wild-type. Diffuse, astrocytoma, IDH wild-type entity has now been removed. All the IDH mutant diffuse astrocytomas are considered as one single entity. And if along with IDH wild-type tumor status, one or more of the three genetic parameters, namely third promoter mutation, EGFR gene amplification and combined gain of entire chromosome 7 and loss of entire chromosome 10 are present, then it is sufficient to label the diffuse astrocytoma as glioblastoma grade 4. The aim of my study was to determine whether MRI characteristics can predict the IDH mutation status of diffuse low-grade gliomas. Low-grade gliomas are primary brain tumors affecting younger people, usually have an indolent course with prolonged survival time just compared to high grade. For diagnosis of gliomas, a combination of imaging histopathology and molecular diagnostic methods are used, among which histopathology is a gold standard, and among the imaging methods MRI is a modality of choice. Lately, genetic characterization has become crucial in the tumor identification and its classification. However, biopsy is the only way to diagnose mutation and which is usually not feasible in all situations and is invasive. So we need more methods to predict the mutational status, which are non-invasive, and MRI has shown potential to non-invasively predict the mutational status in these patients. Gliomas, in comparison to the mutant variant, the wild type exhibit aggressive biology and behaves more like a higher grade glioma, and the outcomes are worse. An improved median overall survival has been demonstrated by various studies in IDH mutant cases as compared to patients with IDH wild type tumors. Along with that, the IDH mutant tumors have shown increased response to alkylating agent therapies, and chemotherapy with alkylating agent is often the mainstay of treatment for recurrent gliomas. Advanced MRI biomarkers for IDH mutational status can provide a non-invasive method for accurately determining and identifying the genetic and molecular characteristics of the glioma, which will have a clinical impact on the diagnosis, prognostic counseling, and therapeutic targeting of the patient. The study was conducted in the department of radio diagnosis and collaboration with the department of neurosurgery and pathology at the Sabdajung Hospital, and a total of 36 patients were taken. The inclusion criteria was the patients with symptoms of space-occupying lesion and features of diffused low-grade glioma and MRI, and the patients with MRI brain features suggesting of lesions other than low-grade gliomas were excluded like glioblastoma, metastasis, tuberculoma, demyelination, along with those people with grade 3, 4 gliomas, pregnant patients, renal disease patients, known history of allergy, paramagnetic substances like pacemakers, metallic clips or claustrophobic patients are also excluded from the study. After written informed consent, patient underwent conventional and functional MR imaging, and the tissues of the operated patients were tested for IDH mutation. The scan was taken on the 3T3 Tesla MR machine with the following conventional sequences, which were 3D plane localizer, axial T1 weighted image, T2 weighted image, flare, sequence and susceptibility weighted imaging. And among the functional MRI imaging, we took DWI images, T2 star DVC perfusion, multi voxel MRS and post gadolinium contrast length 3D SPGR T1 weighted images with the following parameters. The images were analyzed for the following, under the following headings, the tumor location in which we assess the primary lobe of involvement, tumor borders which were categorized into two categories, ill-defined and well-defined borders. And also the images were analyzed for the presence and absence of peritumoral edema, cystic changes, cortical involvement. The contrast enhancement was assessed under the headings volume and pattern in which we assess the tumor with less, and we divide the enhancement volume into two categories, less than 25% and more than 25%, and the pattern as absent mild and heterogeneously enhancing. ADC minimum values were calculated, RCB mean values were calculated by placing the ROI on the solid part of the lesion and in the area with maximum perfusion, MR spectroscopy, under MR spectroscopy, coline criteria and coline NA ratios were assessed in multiple locations and they were calculated from the solid part of the lesion. Out of the 36 patients, the 30 patients were IDH mutant and six patients turned out to be IDH wild type. The age range was 18 to 51 years with mean age of presentation of approximately 37 years in our study and 10 patients were female and 26 patients were male. The quality of the cases in IDH mutant variant lied in the multi-lobar and the frontal location combined. More heterogeneous and more volume of enhancement was seen in the IDH wild type gliomas as compared to the mutant types, which showed none to minimal contrast enhancement and the difference was statistically significant. The wild type tumors found to be significantly associated with lower ADC values and the AURC of the ADC minimum predicting IDH mutant versus wild was 0.928 which demonstrated a fair diagnostic performance according to the study, a cutoff of ADC minimum of more than or equal to 0.76 into 10 to minus three predicts IDH mutant status with sensitivity of 93% and specificity of 83%. The IDH wild type tumors were also found to be significantly associated with the higher RCBV mean values as compared to the mutant variety and AURC of the RCBV mean in predicting the IDH mutant versus wild was 0.76 which also demonstrated fair diagnostic performance, a cutoff of less than 2.9 or less than or equal to 2.9 of RCBV mean value can predict the mutant status with sensitivity of 97% and specificity of 67%. No statistically significant difference was seen in the type of tumor borders and presence or absence of particle involvement peritumoral edema, calcification hemorrhage and cystic changes between the two groups in this study. Higher values of RCBV max and tumor were seen in wild group however the difference was not statistically significant similarly higher values of protein and creatinine were also seen in the wild group but the difference was not statistically significant. These are the representative cases. A 21 year old main presented with complaints of two episodes of GTCS on MRI imaging, a well defined hyper intense lesion was seen in the right insular lobe region and the frontal lobe region with involvement of cortex and mass effect on insulator ganglion capsule region on T1 weighted imaging which was hyper intense on both T2 and flare with no blooming focaccia on the spawn images. There was a focal area of restricted diffusion with no post contrast enhancement. The focal area of increased perfusion was seen on the T2 star perfusion images. This is the MR spectroscopy map the tumor turned out to be IDH positive on the histopathology. Another 31 year old male presented with complaints of headache or the on past two months and episodes of irrelevant talking for 15 days. Indefined and you'll define hyper intense area was seen in the left, right occipital region on T1 image which was hyper intense on T2 and flare with the with a blooming focaccia appearing right on filtered which is just of calcification on post contrast scan the enhancement was mild which was less than 25%. Focal area of restricted diffusion was seen on DWI images with the focal area of increased perfusion the MR spectroscopy graph is the as shown this tumor was also IDH positive. Another case of 40 year old male presented with complaints of headache and seizure for past two months which showed a redefined hyper intense area on T1 weighted image which was hyper intense on T2 and flare with a with a blooming focaccia appearing right on filtered phase suggestive of calcification there was no enhancement on the post contrast scan and with the focal area of restricted diffusion and increased RCB values in focally MR spectroscopy map is as follows this tumor was also IDH positive. This was a 25 years old female with complaints of headache for the past two months, the tumor showed a defined heterogeneously hyper intense lesion in the left and the low with the focal extension to the contralateral site. This lesion appeared heterogeneously hyper intense on T2 and flare on spawn images of blooming focaccia which appeared right as well as dark on filter phase suggested of calcification hemorrhage on post contrast imaging the contrast enhances what was heterogeneous and more than 25% in volume. There was there were areas of restricted diffusion with increased RCB values, the status of the tumor was IDH negative. Knowing the status of the IDH mutation plays an important role in directing the chemotherapy as well as determining the pro prognosis 36 patients are enrolled and mean age of presentation was 37 years. The age of presentation was slightly higher in ideas while type cases, but the difference was not statistically significant which was concordant with the study done in 2018 by Javier E. Will may have met at all. And the study by doing it all in which there was frontal low predominance seen in the IDH mutant variety, however, no such difference was found in the distribution of tumor location in this study. So the majority of the total cases in our study had ill defined borders and no significant correlation was found between the tumor borders in the two groups this was in concordance with the study by Javier E. Will may have met at all. Cystic changes were more common in IDH wild type cases, but the significant difference was not significant, which was also similar to the study done by the Javier E. Will may at all. However, in a study by doing it all cystic changes are found to be more prevalent in Newton cases. This discordance can be due to only four out of 36 oligotendro glioma cases in our study as compared to 20 out of 48 odg cases and above mentioned study and odg cases are more commonly associated with cystic areas. Additionally, we have, we had only six wild type cases in our study, cortical involvement was more common in IDH mutant cases. Again, the difference was not statistically significant. The difference difference was statistically this difference was statistically significant in the study by doing it all this discordance can be due to smaller sample size and less number of wild type cases in our study for comparison. In most cases in IDH wild type tumor showed hemorrhage and more percentage of IDH mutant cases had calcification within, but the difference was not statistically significant IDH. IDH wild type tumors are found to be significantly associated with lower ADC values and higher RCB values comparatively the, the AU ROC of IDC mean predicting the IDH mutant versus why it was 0.9 to it demonstrating a fair diagnostic performance. We have done it all in meta analysis by Sean Hsu lower values of ADC were seen associated with wild type status and multiple other studies are they have also shown that lower ADC values are associated with IDH IDH wild type gliomas. More heterogeneous and more volume of enhancement is seen in IDH wild type gliomas as compared to the mutant types, which showed none to minimal enhancement. Other studies were conducted which showed that IDH mutated LGG showed less degree of internal enhancement. The AU ROC for RCB mean tumor predicting IDH mutants were IDH wild versus wild was 0.761, which had a fair diagnostic performance in our study. And the Colleen creatinine and Colleen NEA ratios were higher in wild type as compared to the mutant type but the difference was not statistically significant in our study. These were my references. Thank you.