 Good evening, everyone. Today I'm presenting on the topic low MRI mammographic kinetic parameters for clinical prognostication in female breast cancers. As we all know contrast enhanced MRI is the most sensitive method for female breast cancer diagnosis and is routinely used for pre-operative evaluation of newly diagnosed cases. In recent years, DC MRI has been utilized to enhance the specificity of MRI in identifying the breast lesions on imaging, morphological characteristics and patterns of contrast enhancement provide invaluable information. Not only about the cancer histology, but also about the prognosis of the survivor multiple methods exist for evaluating the kinetic enhancement pattern for breast tumor. For automatically analyzing the kinetic data and performing volumetric analysis of breast cancer, CAD systems have the benefit of being user friendly and widely available in clinical settings. CAD technologies reduce the need for time consuming activities such as technician for radiologists during the ROI manually. The relationship between kinetic parameters on CAD and histological characteristics of breast cancers have been investigated in our study. And furthermore, these kinetic features derived from CAD can be utilized to identify tumor aggressiveness including hormone receptor status and histological weight. The aim of our study is to determine if breast dynamic contrast enhanced MRI imaging, kinetic characteristics can predict tumor aggressiveness and survival outcomes in invasive breast cancer. Evaluating the relationship between various kinetic measures and histopathological traits and associating them with disease recurrence. The study was conducted in the Department of Diary Diagnosis at Rajivanji Cancer Institute and our study was retrospective one which included 130 patients. And patients who underwent DC MRI imaging at our institute were subjected and then further subjected to surgery and subsequently proved medignant after the HP confirmation. And as well, their molecular subtypes known were included in our study. Patients who could not be followed up for even a year were excluded from our study. The first MRI imaging was performed using a 1.5 Tesla Simons Evento Minneton machine with a dedicated bilateral phase array, this quite with the patient in turn position and the MRI imaging examination consists of T1, T2, STIR sequences BWI and DC sequences at 1, 2, 3, 5 and 7 minutes. The DC MRI images were transferred to a CAD system that is Z-Vista that analyze the signal intensities within each voxel, the FOV, obtained during the dynamic sequences. According to ACR biologists, MRI lexicon, kinetic patterns are defined as they're basically divided into two, the early enhancement patterns and the delayed enhancement patterns. In the early enhancement patterns, we have rapid as well as medium uptake. Rapid uptake means relative enhancement increase was more than 100% of the contrasting age and medium uptake when it was 50 to 100%. In delayed kinetic, we have persistent, plateau and washout. Persistence means continuous increase in signal over time. Plateau means a signal intensity that does not change over time after initialize and washout when the signal intensity decreased by more than 10%. It's initial highest point of rise. So, in a study of Inclusion 130 patient and out of which 25 cases show reoccurrence and the rest of 125 shows no reoccurrence. The CAD reports included the following three kinetic curve patterns type 1, which is delayed persistent enhancement pattern type 2, which is delayed plateau enhancement pattern and type 3, which is delayed washout enhancement pattern. The interpreting radiologists wrote the CAD reports prospectively and when operators selected the engaged slice with the biggest diameter, a square alloy of the entire tumor was automatically segmented. In the study among subjects in reoccurrence 100% of them had rapidly early enhancement pattern and among subjects without reoccurrence only 85.7% patient had rapid enhancement patterns and there was a significant association between reoccurrence and early enhancement patterns. As we can also see in this chart. In the study among subjects with reoccurrence 100% of them had washout and among subjects without reoccurrence 85.7% had washout 12.4% persistent and 1.9% plateau pattern on delayed imaging. There was significant association between delayed enhancement patterns and reoccurrence as well. A higher washout component may be caused by the higher vascular permeability due to increased expression of vascular and othelial growth factors, which is frequently found in epitlegal tumors, as we can also see in this chart. These tumors that tested negative for ER, that is estrogen receptor, PR, progesterone receptor and HER2NEW were categorized as triple negative. Triple negative tumors are more frequently presented with usually present at advanced stage at diagnosis as the aggressive tumor. In the study among subjects reoccurrence of breast cancer, 66% had TNBC and among subjects with no reoccurrence, 4.8% had TNBC. There was significant association with TNBC and reoccurrence with p-value of less than 0.005. In above study, comparison was also done between TNBC and kinetic patterns. However, no significant association was found between these variables. Now, coming to the cases. As a case study one shows, contrast enhanced MR in a 50-year-old female, non-circumstant irregular shaped heterogeneously enhancing lesion in light breast upper quadrant. Using CAD software, first of all, we generated the overlay maps in which we can see the red color, which represented the washout pattern being the highest pattern in this lesion, and putting the ROI on this lesion, we can see a rapid enhancement curve with washout. And moreover, follow up at 24 months, this patient presented with new node in the axilla, which was proven to be the occurrence. Now shown here is the homogeneously enhancing circumstabilization in light breast with ROI applied on the most suspicious area. And we can see the rapid initially peak enhancement, how a delayed kinetic persistent patterns is seen. Now, another case of a 46-year-old female presented with left breast lung in 2017, proven to be IDC. On DCE MR, an irregular shaped heterogeneously enhancing lesion is seen in outer upper quadrant of left breast, which shows rapid early enhancement and washout on delayed kinetics. On further scan, done in 2018, post-op changes are seen with no enhancing lesion, but on further follow-up into the 19th, we can see another heterogeneously enhancing lesion, which was proven to be the occurrence. So, as I have already told, the pre-op scans shows the type 3 kinetic patterns is rapid rise and delayed washout pattern. So, we have seen that DCE MR in pre-op breast cancer patients are not only utilized to assess the local extent of disease and assist in surgical and treatment planning. But these kinetic characteristics can also broaden the ability to use DCE MRI to non-invisibly describe the underlying tumor architecture, biology and function in the breast cancer patient undergoing pre-operative evaluation. Since the study is retrospective type conducted in single institute, it may have introduced selection biases. However, this is one of the novel and major studies which has quoted kinetic curve pattern on DCE MRI with DCE Z occurrence. Simply studied done can be supplemented with other variables in future. Thank you.