 Good day everyone, today I am presenting a paper on 3-T MRI and EWI in evaluation of uterine and end-excel lesions under the guidance of Dr. Pratik Shah Yadav Maham in Department of Radio Diagnosis, D.Y. Patil Medical College, Pune. In females, uterine and end-excel pathologies have been the common cause of morbidity, although most of them are benign, malignant ones are associated with significant risk of mortality. Hence, accurate diagnosis is of utmost importance for timely intervention, which can be done with a good accuracy by magnetic resonance imaging. At nexal masses, whose origin and nature, which can be either cystic or solid, is difficult to be detected in sonography and are better evaluated by MRA because of its precision in characterizing the lesion and defining the tissue of origin. MRA is therefore a critical imaging method for detecting uterine and end-excel lesions and also separating them from the benign from malignant ones. DWI imaging is a functional imaging sequence which works on the principle of random mobility of water molecules within the tissues. Different tissues have variable water diffusion, which provides a good image contrast and the exogenous contrast administration, we can see the tissues better. Obtained DWI image is analyzed qualitatively by using different strands of diffusion, sensitizing gradient, nothing but the B values and quantitatively using the apparent diffusion coefficient, nothing called as ADC maps. MRA with DWI imaging emerged as an optimistic tool in detection and characterization of the various uterine and end-excel tumors, their anatomical extension, understanding the pathophysiology by ADC values, which is further helps in differentiating benign from malignant lesions. The aim of this study is the utility of the structural MRA and DWI in evaluation of uterine and end-excel lesions and its role in differentiating between various uterine and end-excel lesions into malignant and benign ones. The study is a cross-sectional study where 100 subjects of all the age groups were taken and the variables like lesions of uterus, cervix, vagina, ovaries, fallopian tubes, broad ligament and parovirin sister included, and the duration of the study is done between September 2020 to December 2021. The technique we used, all the patients are subjected to the 3 Tesla MRA in Magnetum Vida machine and following sequences are used. T1 weighted imaging sequence is done in axial and coronal planes, T2 weighted imaging in axial, coronal and sagittal planes, diffusion weighted sequence in axial plane, stress sequence in axial, coronal and sagittal plane, T1 fat suppressed in axial plane, gradient echo in coronal and axial planes and contrast is used whenever it is required. Anatomy of the uterus and end-excel on MRA, coming to the anatomy, the uterus is divided into two segments, namely corpus, curled body and the cervix. On T1 weighted imaging, the entire uterus is iso intense to the muscle and it is very difficult to distinguish from the separate anatomical areas. On T2 weighted imaging, the corpus shows three different zones. Endometrium is a central high signal intensity region measuring 3 to 6 millimeters during the pyrroliferative phase and 5 to 13 millimeters during the security phase. Junctional zone is the one seen in between the endometrium and myometrium, the low signal intensity area measuring 2 to 8 millimeters. Junctional zone shows variable trend based on the myometrical contractions and uterine peristalsis which sometimes may be confused with the uterine fibroids or adenomyosis. Myometrium is the zone seen immediately external to the junctional zone and it shows intermediate signal intensity. The uterus normally lies in a position of anti-version and anti-version and anti-flection. The body of the uterus is bent forward on the cervix approximately at the level of the internal horse and this forward inclination of the body of the uterus constitutes anti-flection. The direction of the axis of cervix depends upon the position of the uterus. In anti-version the external horse is directed downwards and backwards. When the uterus is retroverted the cervix is directed downwards and forwards and the lowest part of the cervix is either external horse or the posterior tip. Here we can see the sagittal T2 weighted MRA image demonstrating the anatomy of the uterus where the one is represented by the endometrium which is a high signal intensity area. Following is the junctional zone represented by number two and next to it is an intermediate signal intensity zone represented by the number three. So whereas coming to the MRA anatomy of EDNEXA, ovaries are better visualized in premenopausal women. They show high signal intensity follicles on T1 weighted images and medulla appears as an intermediate signal intensity area. Ovaries gradually etrophene size with age in postmenopausal women. They are gradually enlarged during the proliferative phase and during the pre-ovulation phase reach their maximum size and have an enlarged dominant follicle. During the peri-ovulation phase the medulla has a high signal intensity on T2 due to edematous vascularized troma and even show may show high signal intensity on DWA images likely which is called as a T2 shine through. The fallopian tubes are approximately 10 centimeters long within the superior portion of the broad ligament and normal tubes are not routinely visualized. Coming next are the uterine and adnexal lesions. The following I have listed the lesions which can be both of benign and malignant type. The list goes as follows which can uterine and adnexal lesions can be of uterine endometrial hyperplasia, endometrial polyps, uterine gliomaoma, adenomaiosis, endopsyvercal polyps, endometrial carcinoma, cervical carcinoma, benign ovarian cysts, endometriosis, endometrioma, hemorrhagic cyst, metuocystic teratoma and dermaid cyst, benign cystic neoplasms and cysts, adenomas which can be of two types, serious and musinous type, benign solid tumors like banners, tumor fibroma, ticoma and fibroticoma, inflammatory masses like tuovirinapsis which are of benign etiology and malignant ovarian neoplasm. Coming to the study characteristics of these lesions on MRA, the composition of these lesions can be of simple fluid which shows T1 hypointensity and T2 hyperintensity without any enhancement on post contrast studies and the common causes can be functional ovarian cysts, benign cystic neoplasm, inclusion cyst, hydrosalpans and epidermoid cysts. It can be a blood also and the blood appears hyperintense on T1 weighted images, variable on T2 and no contrast enhancement and the common causes of accumulation of blood is hematoma, hemorrhagic cysts in ovary, endometriosis and hematosalpans. When there is a lipid composition it appears T1 hyperintensity and as T2 intermediate signal without any enhancement on post contrast study and the common causes would be teratoma, lipoma, liposarcoma and lipolyomyoma. When it is a mixoid composition it appears a hypointense on T1, hyperintense on T2 without any contrast enhancement and or every type of enhancement. It can the common causes will be angiomixoma, mixoma, neurogenic tumor, mixoid degeneration of liomyoma. When the composition is a fibroid tissue, fibros tissue, it appears isointense to hypointense on T1 weighted images, hypointense on T2 and shows mild progressive enhancement and the composition would be fibroma, fibrothecoma, Brenna's tumor and sister no fibroma. When the composition is of smooth muzzle it appears isointense on T1, hypointense on T2 weighted images with moderate enhancement on post contrast studies and the diagnosis would lead to liomyoma. In case if it is the composition suspected as lymphoid tissue, it appears isointense on T1 and mildly hyperintense on T2 weighted images with mild homogenous enhancement and the common causes would be lymphoma. When the differential diagnosis based on these imaging characteristics, if the lesion is a uterine fibroid which has a composition of smooth muzzle, it appears isointense on T1 weighted image, hypointense on T2 and hypointense on steric images without any post contrast enhancement. If it is adenomyosis or adenomyoma which is of epithelial in composition, it appears isointense on T1 weighted image, hyperintense on T2 weighted image, hypointense on steric image without any contrast enhancement and without any diffusion restriction. In case of endometrial carcinoma and carcinoma cervix where it is a epithelial in composition again, it appears isointense on T1, hyperintense on T2 and steric images with heterogeneous post contrast enhancement and with positive diffusion restriction can be seen. In case of endometrioma where blood is the composition, it appears either hypo or hyper on T1 weighted images and T2 weighted images, heterogeneous appearance in steric sequence showing no post contrast enhancement, but showing diffusion restriction on DWI and hyperintense on GRE sequences. In case of serocystidinoma where the and mucinous isstidinoma where the composition is purely fluid, it appears hypointense on T1 weighted images, hyperintense on T2 weighted and steric sequences showing peripheral and septal contrast enhancement and showing no diffusion restriction on DWI sequence. In case of hemorrhagic where again blood is the composition, it appears heterogeneous enhancement and appears heterogeneous on both T1 and T2 weighted images and steric sequences, but showing positive diffusion restriction. And the list goes on, in case of simple cysts, parovariensis and hydrosalphans where the fluid is the composition, it appears hypointense on T1 weighted images, hyperintense on T2 weighted images and steric sequence, but not showing any diffusion restriction. In case of mature teratoma with fat as a composition, it appears hyperintense on T2 weighted images with heterogeneous appearance of steric sequence and shows hyperintensity in GRE sequences, but no diffusion restriction on DWI. In case of tuboevarian masses which are benign in etiology with fluid as composition, if they appear hypointense on T1 weighted images, hyperintense on T2 weighted and appears heterogeneous on steric images, it shows peripheral enhancement and post-contrast studies. In case of ovarian torsion, the torsion appearance of ovarie can be seen as hyperintensity in both T1 and T2 weighted images and steric sequences with peripheral contrast enhancement and diffusion restriction can also be seen on DWI images. In case of the tumours like fibroticoma where the fibrous tissue is seen as a composition, we can see them as iso intense on T1 weighted images, heterogeneous appearance on T2 weighted images showing hyperintensity on steric sequences and heterogeneous post-contrast enhancement and positive diffusion restriction. In case of ovarian torsionoma where epithelial in origin, it appears hyperintense on T1 weighted images, heterogeneous appearance on T2 weighted images showing heterogeneous appearance on steric images, positive diffusion restriction on DWI and heterogeneous post-contrast enhancement and hyperintensity on GRE. These are the uterine and adnexal lesions. I have included the images. First is the axial T1 weighted image showing the heterogeneously hypointense lesion in the uterus and the below image is a diffusion restricted image showing no diffusion restriction. This is a uterine fibroid. Coming next is the axial T1 weighted image of the uterus which is seen as a bulky uterus with an ill-defined lesion in the endometrium showing central hypointensity and peripheral hyperintense signal. Few area of signal loss can be seen in these images which could be likely calcific fork and the image below it is a diffusion weighted image showing peripheral diffusion restriction and the next image is a carcinoma cervix. It can be seen in the axial T1 weighted image showing bulky cervix with ill-defined hyperintense lesion and the below image is a diffusion weighted image showing peripheral diffusion restriction and the fourth image is an axial T1 weighted image showing a large multi-loculated heterogeneously hypointense solid cystic lesion in the right adnexa showing thick septae and peripheral projection on diffusion restriction showing on DW image showing diffusion restriction. Coming next is a tubo ovarian mass of benign utiology. We can see this is an MRA pelvis image showing tubo ovarian mass in the right adnexa. On axial T2 weighted image a large retort shaped lesion is seen in the right adnexa showing peripheral hyperintense signal and central low intensity content. On axial T1 weighted image the lesion appears hypointense and instead images it appears hyperintense. On post contrast images this lesion shows a peripheral enhancement. Coming next is a endometrioma. Here is the image showing bilateral ovarian endometriotic cyst on axial T2 weighted image which is seen as a two well-defined hyperintensistic lesions in both ovaries showing T2 shading sign. Axial T1 weighted images appears these appears hyperintense. On T1 fat set images these lesions appear hypointense and I have included the diffusion restricted DW images with also the ADC maps. The lesion is showing diffusion restriction with corresponding low ADC values. So, the observation in our study included out of 100 patients we have taken 54 patients were seen to have uterine lesions and 46 patients have the adnexal lesions of the total uterine and adnexal lesions 77 were observed to be benign and 23 were observed to be malignant and all the findings were correlated 100% in our MRA using the diffusion restriction. So, the conclusion of our study in our study out of the 39 benign uterine lesions 0 lesions showed diffusion restriction and out of 15 malignant uterine lesions 15 all the 15 showed the diffusion restriction and out of the benign no no lesion showed the diffusion So, DW has a significant role in differentiating benign from malignant uterine lesions. On the other hand the DW sequence with ADC cut off value was not very significant in differentiating benign and malignant adnexal lesions because DW alone cannot differentiate endometriosis and tubo ovarian masses which are of benign utiology from that of the malignant lesions. So, in the adnexal pathologies additional sequences like T1 weighted image, T2 weighted images, T1 post contrast images are required for the complete evaluation and differentiation. These are the references I have taken for my study. Thank you. Thank you Indian Radiologist team for giving me this opportunity.