 Good morning, everyone. I am Dr. Bhavita, postgraduate student first year from department of radio diagnosis. Today's my topic for paper presentation is study of staging of magnetic resonance imaging in avascular necrosis of femoral head. My aim is to study the stages of presentation and prevalence of avascular necrosis of femoral head on magnetic resonance imaging in tertiary care centers. Objectives are to document the results of magnetic resonance imaging in patients having avascular necrosis of femoral head and staging of avascular necrosis of femoral head as per Fikret and Arlet classification. The materials and methods that are being used are the patients with avascular necrosis of femoral head on MRI imaging of two years were included in the study, the hospital record based descriptive study. These patients were subjected to MRI study over three Tesla Philips Achiva MRI machine and T1, T2 and stir sequences were applied. Staging of avascular necrosis of femoral head was done as per Fikret and Arlet classification and distribution was done on the basis of aid, gender and laterality. This is a coronal stir image showing edema which is involving the right femoral head. This can be due to stage one of AVN. This is a coronal stir and T1 weighted images showing crescent sign. There is cleft due to subcondole fracture involving left femoral head. This is seen in stage three AVN. This MRI images shows coronal stir and T1 weighted images showing partial collapse of left femoral head with irregular margins of left hip joint. This is acitabular involvement. This is seen in stage four AVN and the changes of stage two AVN are noted on the right. Coming to the results, out of 100 patients with suspected AVN, 60 patients showed features of AVN of femoral head on MRI. This is the chart that shows the number of patients that have the presentation or stage of presentation. The stage zero, number of patients that were presented with stage zero were 58 patients. In stage one, there were seven patients. In stage two, there were 13 patients. In stage three, there were 26 patients and in stage four, there were 17 patients. Coming to gender distributions, male were more commonly affected than the female. Out of 60, 50 were male and 10 were female who were affected. Coming to the laterality, bilateral AVN are more common than compared to the unilateral AVN. Coming to the conclusion, it was found that the males were more commonly affected with mean age group between 31 to 40 years. Most of the patients had bilateral involvement and the involvement of the left and the right side was nearly equal on both sides. In case of bilateral involvement, the one with higher staging was considered during the distribution and it was found that the most of the patients presented during stage three of the disease. Discussion, avascular necrosis of the femoral head is an increasingly common cause of musculoskeletal disability and it poses a major diagnostic and therapeutic challenge. Although patients are initially asymptomatic, AVN usually progresses to joint destruction, usually before the fifth decade. The avascular necrosis is applied to epiphytial or subarticular involvement whereas bone infarct usually is applied for metaphytial and diaphytial involvement. MRIs become the most sensitive and specific and widely used diagnostic imaging modality for evaluation of AVN of femoral head. This double line sign is a pathognomic image indicator for AVN. On T2W sequences, inner guideline representing granulation tissue and outer dark line suggest you have sclerotic bone. This sign was predominantly seen in stage two diseases. Femoral head collapse and degenerative changes occur in advanced stages of AVN. If you are going to fecate an inlet classification of avascular necrosis of femoral head during stage zero, the plane radiograph and MRI were seen normal. There were no clinical symptoms. In stage one, the plane radiograph was normal or there might be minor osteopenia that can be seen. On MRI, there would be some edema. Bone scan would show increased uptake and clinical symptoms like they would pain typically in the groin. In stage two, the plane radiograph shows mixed osteopenia or sclerosis or subhandral cyst without any subhandral lucency. On MRI, there will be some geographic defect that's double line sign. In the bone scan, there's increased uptake. Patient would present with pain and stiffness. In stage three, the plane radiograph would show crescent sign and eventual cortical collapse. MRI will be same as plane radiograph and the clinical symptoms will pain, stiffness in the presence or absence of radiations to knee and limb. In stage four, the plane radiograph will show in stage with evidence of secondary degenerative changes. On MRI, it shows same as the plane radiograph. Clinical symptoms, there will be pain and limb. Some other classification for avians are Mitchell's classification of avascular necrosis, Steenberg staging of avascular necrosis, Arco classification that's association research, circulation, OCS classification. In the management, early asymptomatic avian do not need any surgical treatment and should be closely monitored with the serial examination. Surgical treatment of avian is aimed to retard the progression of avian in pre-collapse stage that is core decompression. Reconstruction procedure that is arthroplasty is done in collapsed stage. These are my references. Thank you.