 I'm Dr. Vidhna Gupta of Rohe Khan Medical College in Hospital, Pareli. Today, I'll be presenting my paper on clinical and MRI staging correlation, Carcinoma of Cervix. Introduction. Carcinoma of Cervix is the third most common gynecological malignancy. It arises from the region of cervix. It's typical onset in women is from the age of 45 years. The major risk factors include HPV, multiple sexual partners, history of intercourse at a young age, high parity, and immunosuppression. The patient presents with a history of vaginal bleeding and vaginal discharge. Rarely, the finding is incidental. The major histological types include squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and adenos squamous cell carcinoma of the cervix. Out of the above, squamous cell carcinoma is the most common. And the most common site of presentation is squamous columnar junction. The International Federation of Gynecology and Obstetrics staging system plays an important role in treatment planning. However, it remains inadequate when it comes to assessing the volume of tumor, nodal status, and extent of spread. MRI, with its ability to assess soft tissue in detail, is the preferred modality of imaging when one needs to comment upon the exact volume, shape, direction of spread, local invasion, and nodal invasion status of carcinoma for better treatment plan. In addition, MRI is also capable of assessing the post-operative and post-chimuridation status of the disease, thereby helps in knowing the disease progression. FICO staging, stage 0, carcinoma in C2, stage 1, confined to the cervix. Stage 2 extends beyond uterus, but not to pelvic wall or lower one-third of vagina. Stage 3, extension to lower one-third of vagina or pelvic wall invasion with hydronephrosis. Stage 4, located outside true pelvis. Ames and objectives to compare the accuracy of MRI staging with that of clinical staging in cases of carcinoma of the cervix. Materials, it was a retrospective study with 40 patients who came to radiology department of Royal Khan Medical College in Hospital Vareli. Study duration was from January 2023 to November 2023. Equipment used is sinus magneton, Sembro 1.5 Tesla MRI machine. MRI technique for preparation, patient was kept in queue for three hours prior to imaging to reduce bowel paralysis. Partially distended urinary bladder for better visualization of bladder wall invasion. Supine position, pelvic-phased array multiple. Sequences, T2 weighted images and three orthogonal planes to the long axis of cervix and a coronal view of the cervix, high-resolution matrix, small field of view and slight thickness of 2 to 4 mm. T1 weighted imaging to detect lymphadenopathy, large field of view axial imaging up to the renal hyla. Fat-suppressed images and diffusion weighted images were also acquired. Inclusion criteria is to pathologically conform cases of carcinoma cervix, patients who underwent pre-treatment MRI for carcinoma cervix. Exclusion criteria, a patient who did not undergo pre-treatment MRI for carcinoma cervix. MRI findings, stage 1, 1 is microscopic disease not visible on MRI. There's also peripheral T2 hypo-intense stroma. Stage 2a, involvement of the upper two-fold of vagina appears as segmental loss of the normally visualized T2 hypotense vaginal wall. Stage 2b, tumor destroys the normally seen hypotense peripheral stroma on T2 weighted images and extends to the parametrium. Stage 3a, tumor extends to the lower third of vagina or lateral pelvic wall with associated hydroneous process. Stage 3b, tumor is less than 3mm from the side wall causes a hydrourator infiltrates the obturated internal piriformis and levator anion muscle in cases the iliac vessels and destroys the pelvic bones. 4a, bladder and rectal invasion presents a focal or diffuse disruption of the normally seen T2 low signal intensity wall. A regular nodular wall and intraluminal mass and hyper-intense thickening of the bladder mucus on T2 weighted images. 4b, distance spread to the liver lung bones, peritonium and soft tissue. So in case one, figure A and B show a large heterogeneously hyper-intense lesion on T2 weighted images as indicated involving the cervix and the lower aspect of the uterus. There is discontinuity of the cirrhosis wall indicating bilateral parametrial spread. We can see secondary fluid in the endometrial cavity due to cervical stenosis. On DWI we see hyper-intense signal and on ADC we see hyper-intense signal suggestive of the fusion restriction. In figure E and F which are coronal T2 and T2 fat side images, we can see associated right-sided hydronephrosis. Then in figure G which is a coronal T2 weighted image, there is a dilated right urator. This is due to infiltration of the mass lesion into the lower urator. Case two, we see a large mildly hyper-intense lesion on T2 weighted sagittal and axial images. The lesion shows no parametrial spread. On diffusion weighted image, we see hyper-intense signal with corresponding hyper-intense signal on ADC suggesting diffusion restriction. In case three, we see a large mildly hyper-intense lesion on sagittal T2 weighted image. The lesion is seen to be infiltrating into the body of uterus. The same lesion on T2 weighted axial plane indicates infiltrates shows infiltration into the right posterior lateral parametrium. Mesorectrification, mesorectrified form six o'clock to nine o'clock position. Case four, a large heterogeneously T2 hyper-intense lesion involving both anterior and posterior cervical walls is seen. In figure ENF, there's a heterogeneous tissue with foci of air within it. Figure G shows uniform hyper-intensity on GRE axial images. Plate five shows a well-defined region of hyper-intensity on diffusion weighted image involving the posterior cervical wall. Figure B shows prominent diffusion restriction on ADC in the lesion. Then in figure DENF, which are T1 sagittal, T2 sagittal and T2 axial images respectively, we can see a heterogeneously hyper-intense lesion. Case number six, figure A shows a circumferential T2 hyper-intense mass lesion in the cervix. Figure B shows the same lesion with associated parametral spread. The yellow dots indicate normal cervical margins. In figure C and D, we can see diffusion weighted image showing a hyper-intense signal and ADC image showing hyper-intense signal suggestive of diffusion restriction. In case seven, we can see a large T2 hyper-intense lesion involving the posterior anterior limbs of the cervix. Figure B shows the T2 hyper-intense lesion. In images C and D, we can see there is a presence of diffusion restriction. So the following findings were noted. Hydronephrosis and hydro-eurotonephrosis was seen in 30 patients in MRI and 29 patients clinically. Pelvic sidewall invasion was seen in 35 patients in MRI and 28 patients clinically. Vaginal upper 2-3rd and lower 1-3rd MRI findings were seen in 36 patients and clinically in 38 patients. Parametral spread was seen in 37 patients on MRI and 38 patients clinically. Adjusted pelvic organs spread was seen in zero cases in MRI and 12 cases in clinical findings. Then distant organ like liver, lung and bone spread was seen in zero cases in MRI and on two cases clinically. Result, the correlation between MRI staging and clinical staging was found to be moderate, that is around 70%. The association of MRI findings and clinical findings in the pelvic wall invasion, vaginal invasion and just in pelvic organ invasion and spread to distant organ also showed moderate correlation approximately 65 to 85%. MRI was found to be superior to clinical staging. In conclusion, it was noted that in patients with cervical cancer, MRI is superior to clinical staging as it has highest patient soft tissue resolution which plays an important role in detection of extent of pelvic tumor. It gives a better knowledge of tumor size, parametral invasion, distant organ spread and pelvic sidewall invasion. Therefore MRI has significantly reduced the diagnostic time for the disease and helped in early diagnosis, staging and management. These are my references for the paper. Thank you.