 Good morning, my name is Dr. Neelam, P.G. resident from Wadman Mahavir Medical College and Subdarja Hospital, New Delhi. Topic of my oral paper presentation is Ancestive markers in prediction of hematoma expansion in spontaneous intracellular hemorrhage. Aim is to study the role of incestive markers as predictors of hematoma expansion in spontaneous intracellular hemorrhage. And the objectives are primary objective is to evaluate the incestive density and shape science in predicting hematoma expansion. And the secondary objective is to analyze the diagnostic accuracy of various markers in predicting hematoma expansion. Spontaneous intracellular hemorrhage is the second most common type of stroke and has poor progress as compared to the cerebral infarction. Hematoma expansion is measured determinant of mortality and poor outcome after spontaneous intracellular hemorrhage, which can be targeted in the therapeutic intervention. Hematoma expansion was taken as more than 60% of absolute growth or more than 33% of relative growth. A well-known marker of a sports sign on CT angiography can predict hematoma expansion, but CT angiography has its limitation in terms of contrast administration and non-irrigity in the remote areas. Here's the reliable marker of hematoma expansion on NCCT are the need of the R. Various sensitivity markers investigated, but there is great variability in reported diagnostic accuracy. Therefore, the need of the R is the consensus to define for reliable and objective criteria for prediction of hematoma expansion. Methodology is patients more than 18 years of age with clinical suspicion of spontaneous intracellular hemorrhage and confirmed on NCCT. The consent and detailed clinical history with GCS was taken in secondary ICH, patient with secondary ICH, hemorrhage conversion of cerebral infarction and patients for anti-cogland treatment were excluded from the study. And in the study group, volume of hematoma was measured and signs of hematoma expansion were identified on the baseline scale. After 24 to 48 hours, a repeat NCCT was done and the volume of hematoma was measured again and observed for hematoma expansion is present or not and the statistical analysis was done. The sample size of the study was taken as 75 percent, 75 patients and that is based on studied and by Boilers et al, which observed the sensitivity and specificity for predicting hematoma expansion from hypodensity was 62 percent and 77 percent respectively. The diagnostic tests were used to calculate sensitivity, specificity, negative predictive value and positive predictive value. A p-value of less than 0.05 was considered significant. The sensitivity was assessed for the presence of various signs as defined like hypodensity is any hypodense reason strictly uncapsulated within the hemorrhage with any size, shape or density. Black hole sign was defined as hypotenuating area with a density difference of more than 28 HU compared with the surrounding hematoma and no connection with the surface outside the hematoma should be present. Brand sign was defined as relatively hypotenuating area next to a hypotenuating area of the hematoma with a well-defined margin and a density difference of more than 18 HU between two areas. Island sign is at least three scattered small hematoma, all separate from the main ICH or at least four small hematoma, some or all of which may connect to the ICH. A small hematoma of diameter less than 10 mm, separate from the main hemorrhage in at least one slice or distinct from the main hematoma by 1 to 20 mm separation was considered a significant sign. Brand sign and the swell sign is defined as the round stick ligand irregular reason of hyporisotenuation compared with the benbenchyma and does not have to be uncapsulated in the ICH. Results are taken form of sensitivity, specificity, PPV, NPV and the diagnostic accuracy and found that swell sign and circular sign were the best parameter in terms of specificity, PPV and NPV. And the best parameter in terms of specificity and diagnostic accuracy was the blend sign. In our study, GC's head presentation, midline shift, baseline volume, swell sign, satellite sign and the presence of multiple sign were significantly associated with the hematoma, significant hematoma growth with the P value of less than 0.05. This bar diagram shows the distribution of anxiety-based signs in terms of frequency in our study. In which swell sign and satellite sign were the most frequent sign seen in our study. This double bar graph shows the association between significant hematoma growth and the various sensitivity markers. Represented to cases are 50-year-old male, hypertensive male, presented with loss of consciousness and right-sided hemipiruses for two hours. The baseline necessity was done and shows acute intravenous hematoma in left lentiform nucleus without significant midline shift. And it shows there is a hypodense area within the hypodense hematoma with the attenuation difference of more than 20 attitude was considered as black hole sign. The volume of hematoma was measured by volume of interest method by manually drawing around it. The patient had clinical deterioration and the fall of anxiety scan was done after 18 hours which shows increased size of hematoma and intravenous ventricle extinction. In other case, 48-year-old hypertensive male with right-sided hemipiruses and ultracensurium for six hours. Best line necessity with acute intravenous hematoma in left frontal and pirated lobes with midline shift was seen with the baseline hematoma volume of 49.960. There is a central hypodensity present within the hematoma, indicative of the positive soil sign. In the other section, in this scan, the density difference of more than 18 attitude between two adjacent area was seen and suggestive of the brain sign. And in the same case, there are three or more than three hematoma, all separate from the main hematoma was seen and the positive island sign was considered. In the fall of anxiety, then after 17 hours, hematoma expansion was present taken by the volume of hematoma method. In another case, 56-year-old hypertensive male was presented with headache and right-sided hemipiruses for two hours. And on best line necessity shows the hypodense focus of attenuation with the density difference of more than 28 attitude compared with the surrounding hematoma and was indicative of the black hole sign present. The volume of hematoma was taken by VI method and on the fall of the scan, then after 45 hours, there was no hematoma growth and the static hematoma volume was seen. Spontaneous intracerebral hemorrhage converts the pore prognosis, then the cerebrine function, and the incisity remains the cornerstone imaging modality in its diagnosis as it is widely available. It would be possible to identify individuals who would benefit from therapeutic intervention by identifying those with the highest risk of hematoma expansion, which would help with the prognostications. Hydrogenous density like swell sign, black hole sign, and the blood sign are represent the active bleeding within the hematoma. Shape markers like island sign and the settler sign are likely due to the multifocal hemorrhage. In our study, density and shape markers on the best line necessity were found to be useful tool to predict the hematoma expansion. Swell sign, settler sign in the presence of multiple sign were significantly associated with the significant hematomograph with the p-value of laser 0.05. The sensitivity p-p-v and p-v of swell and settler sign were equal and highest among the five parameter and the blood sign was the best parameter in terms of specificity and the diagnostic accuracy. A good sensitivity of 70% of swell sign and settler sign will help recognize the patients with high chances of hematoma expansion and the high NPV of 84.2% of the blood sign value will be useful to safely exclude the patient not requiring the intensive medical management to prevent the hematoma expansion. Hence, limited availability of CTA and rapid expansion of hematoma in some patients who offer only a narrow window to prevent the hematoma expansion makes the insisting markers as useful parameters to predict the hematoma expansion. It also helps in identifying the patients with no risk of hematoma expansion so precautions from the overtreatment associated with the hematoma expansion can be taken. These are my responses. Thank you.