 Hello everybody, my name is Dr. Savad Shetty and I am a second year post-graduate resident in the Department of Radiology of K.S.A.G. Medical Academy, Mangalore. My topic for Sonobas 2024 paper presentation is the comparison of bone tumors on radiography and MRI with histopathology. So coming to the background, either soft tissue inside the bones or a barren growth of bone-leg tissue can result in bone tumors. Dr. and secondary tumors are divided into benign and malignant categories. There are two age ranges in which malignant bone visions can occur, that is, the range of 10 to 20 years of age and 42 to 80 years of age. Additionally, there is a gender preference for them. Males are more likely than females to experience them by about 1.5%. Information from patients' medical history, that is, age, gender, malignancies, pain history, injuries, lesion examination, radiographic examination of the margins, degree of cortical expansion, periostal reaction and prior imaging are all considered in the diagnostic evaluation of focal bone lesions. Hematological malignancies and malesthetic cancers like Casanoma cast a larger shadow than primary bone tumors. Now MRI will aid in separating benign from malignant bone lesions. This aims to emphasize the value of MRI and plane radiography while maintaining histopathology as the gold standard for the diagnosis of bone tumors and to improve treatment outcomes with regards to accurate and rapid diagnosis. Introduction When it comes to small lesions, magnetic lesions imaging, that is, MRI, is useful because these lesions can be detected on diffusion-weighted imaging, that is, the DWI sequence, where the diffusion restriction is more indicative of malignancy. The diagnosis of bone tumors is greatly aided by conventional radiography. X-rays are specifically used in imaging diagnostic procedures. The best method for local staging is thought to be MRI. Age, tumor location, pattern of destruction or the margins, aggressiveness, growth rate, matrix formation, periostal reaction, cortical involvement, size, number and appearance on MRI imaging are necessary for an accurate diagnosis. Benign tumors are frequently seen in clinical practice and have a variety of shared physical characteristics. In order to avoid making the mistaken diagnosis, it is crucial for our clinicians to assess the patient's presentation, symptoms and radiographic appearance, coming to the materials and methods. Now retrospectively, MRI and radiographs of patients who are underwent imaging at the Department of Radiology at KSACD Medical Academy in Mangalore were used and they were obtained using standard imaging protocols with Philips 1.5 Tesla MRI between the dates of January 2021 and September 2023. The inclusion criteria of the study were patients of all ages with mass lesions planned for an MRI scan. The exclusion criteria of the study are patients with a history of surgeries or known for any other malignancies or people who are already undergoing chemotherapy. X-ray radiographs were taken with at least two projections that was antiviroposterior and lateral rios. Once the imaging was completed, X-ray findings were interpreted and looked for the presence or absence of a bone lesion. Now X-ray findings were then compared with MRI findings. Coming to the observation and results, 64 participants were enrolled in the study. Their main age was 54 years. There was a minimum age of 14 years and a maximum age of 81 years. Of the 64 participants, 34 of them were males that accounted to about 53.12% and the rest 30 were females, so about 46.8%. Now, primary symptoms of the 64 patients, 43 of them complained of pain that accounted to about 67%. 27 of them complained about swelling of joints that attributed to 42%, 20 of them complained about weight loss that was 31.2% and 24 of them complained about restricted movement that was again about 37%. In addition to the primary symptoms, the location of the lesion was also considered. So MRI revealed that the location of the lesion, 22 of them had bone lesions in the diaphysis that was 34% and about 16 of them had it in the metaphysis that is 25%. 7 of them had it in the metadiafysis and 19 of them in the metaphyseal lesion, so that attributed to about 10.9% and 29.6% respectively. Also, the type of lesion was also described. Out of the 64 people examined on X-ray, 38 of them had leitic lesions, 21 of them were sclerotic and 5 of them were metastatic. When it was finally sent to histopathology, 56 of them were found to be malignant bone tumors and 8 of them were found to be benign. Coming to some images, we can see an altered signal density lesion in the lateral aspect of the distal, metadiafysil region of the right femur with some cortical disruption, so you can see both the axial and the coronal images of the femur. Now based on the periostal reaction, the soft tissue component, the soft tissue involvement and the cortical disruption, this was a case of osteosarcoma, which was confirmed on MRI and eventually histopathological examination. This is basically a series of first two X-rays that was in the AP analytical view followed by MRI in SAG and axial and coronal sections as well. So this was basically an altered signal intensity lesion in the proximal epimetrificial region of the right tibia with some cortical disruption, interrupted periostal reaction and a soft tissue component. Now these features were again of an osteosarcoma. When the patient first came with the swelling at the knee joint, an X-ray was taken, so the X-ray was the first step which helped us pick up that there was something sinister that was going on in this knee joint. So based on that, an MRI was done and our final diagnosis was confirmed on histopathology. So this is just one example that why histopath and MRI and radiography go hand in hand. Now coming to the discussion part, the gold standard for diagnosis in our study was histopathology and we assessed the diagnostic accuracy of MRI and X-rays for bone tumors. Using histology as the gold standard, we discovered that MRI and X-ray have very good bone tumor diagnostic precision and malignant bone tumors primarily affect the spine of the long bones. The purpose of the study was to emphasise the value of MRI and play a radiography in the diagnosis of bone tumors. The diagnosis of any bone neoplasm might be limited by several factors including lesions in the complex anatomy, evaluation of the bone marrow and soft tissue resolution, all of which are important for staging. While both have a high diagnostic accuracy, MRI is more accurate in assessing soft tissues and estimating the growing area of tumors. MRI and X-rays have almost equal diagnostic accuracy. So X-ray imaging, osteoporosis, periostal reaction, sclerotization of the lesions, calcification and ossification of the bone can be evaluated. Noninvasive imaging techniques such as MRI and X-rays are dependable and very accurate in diagnosing bone tumors. In order to rule out malignancy and minimise errors and the necessity for fine needle aspiration cytology or biopsy with high diagnostic accuracy, measures such as division restriction, local invasion, soft tissue characterization, periolesial alterations and X-ray evaluation of bone and soft tissue calcifications are used. These are the references. Thank you.