 Good morning to all. I'm Dr. Suji, paging resident from Srimugambige Institute of Medical Sciences, Kulashegram from Tamil Nadu. Thank you for the opportunity to present my study on this forum. My study name was correlative MRI study of acromial morphology and associated rotator cuff tear. In this study, we evaluated acromial morphologies and their relationship to rotator cuff tear and subacromial impeachment. Yes, MRI for the rescue. MRI has proven to be a single solution for characterizing acromial morphology and for evaluating rotator cuff tears and subacromial impeachment. Ames and objectives of the study was to identify the morphological properties of the acromion, which was based on acromial type, lateral acromial ankle, acromial humoral interval and acromial index. And association to the supraspinosterous tear and impeachment syndrome. Next slide is materials and methods. Seymons magnetum essence are 1.5 Tesla with a dedicated 8 channel shoulder coil was used. Here patient were put in a supine position with their arms on their sides of their bodies in partial external rotation. Following the localizer images, coronal oblique, sagittal oblique and axial images are obtained. The sequences we have used are T2 weighted image and proton density fat saturated image sequences of axial, coronal and sagittal. Next slide is procedure. In procedure, the step one is sample selection, which was evaluated in three groups as follows. That is group one, which consists of 15 patient with supraspinosterous tear and group two, which consists of 15 patients with subacromial impeachment and group three, which consists of 10 controls without subacromial impeachment pathology and supraspinosterous tear pathology. All participants who had a shoulder MRI were included in this study. Patients having previous shoulder surgery, fractures or dislocations, infections, malignancy were all excluded from this study. Next step two is classify the acromial shapes. There are four acromial shapes that is type one, type two, type three and type four. Then step three is additional measurements. Acromial humeral interval, acromial index, lateral acromial ankle was measured. Next slide is observation. According to distribution by age, experiment sample is well distributed based on age. Distribution by acromial type two was the most encountered acromial shape in both group one and group two. That is with supraspinosterous pathology and subacromial impeachment pathology. Type four was not found in any of the experimental groups and control group didn't have any patients with type three acromial. Then according to distribution by acromial index, group one and group two has higher acromial index that is 0.6 greater than 0.6. For the control group, there is a low acromial index that is less than 0.6. According to distribution by acromial humeral interval, group one and group two has acromial humeral interval of less than 6 mm. And lateral acromial ankle of less than 70 degree was found only in group one. That is rotator cuff pathology especially supraspinosterous. Next slide is result. Morphological properties of the acromion is associated to the supraspinosterous and impeachment syndrome and MRI based acromial pathologies can be used as preventive diagnosis of supraspinosterous and subacromial impeachment. Next slide is discussions. Acromial type, this acromial type was calculated on sagittal oblique MR image. I repeat it was calculated it was the analyzed to analyze the morphology of acromion sagittal oblique MR image was preferred. Type on is flat and type two is curved parallely humeral head and type three is anterior hooked and type four is convex under surface. This is distribution by acromial type. This is the graph distribution by acromial type. Next is acromial lateral ankle. Here it was calculated on coronal oblique MR image. How to measure the acromial lateral angle is first to draw a straight line along the superior and inferior most later part of the glenoid and another straight line which was drawn parallel on the underside of the acromion. Then the lateral angle was calculated was defined, which is the ankle formed by these two lines. So lower limit of normal lateral angle acromial ankle with cutoff of around 70 to 75 degrees. This is a lateral acromial angle distribution graph and ankle of less than 70 degree which occurred in patients with rotator cuff tears. Then acromion index here it was also calculated on coronal oblique image. Here first we have to draw a line for parallel to the which has a lateral aspect of the humorous and another line which is drawn along lateral aspect of the glenoid. Then GA is calculated which is distance from the plane of the glenoid cavity to the lateral edge of the acromion. And GU is distance from the plane of the glenoid cavity to the lateral edge of the humeral head. So acromion index is ratio of GA GA by GU. Normal value was less than 0.7 if it is greater than 0.7 then it was clinically important. This is the graph distribution of acromial index. So acromial index of more than 0.6 occurred in rotator cuff tears and subacromial impingement. Next is acromial humeral interval. This also it was calculated in coronal oblique image. How to measure the acromial humeral interval is the shortest distance in millimeter between the under surface of the acromion and the superior surface of the humeral head. So less than 6 mm indicates a supra supra spin at a stack. This is the graph distribution of acromial humeral interval. Acromial humeral interval of lesser 6 mm according group one and group two patients. That is supra spinatus pathology and subacromial impingement pathology patients. Conclusion. That is take home messages. Low lateral acromial ankle higher acromial index and lesser acromial humeral interval are associated with higher prevalence of subacromial impingement and rotator cuff tears and can be measured using MRI. I repeat low lateral acromial ankle high acromial index and lesser acromial humeral interval are associated with higher prevalence of subacromial impingement and rotator cuff tears. These parameters which plays an important role in pre surgical assessment for acromial plastic and extremely hooked anterior acromion with lateral acromial ankle of less than 70 degree had significant association with rotator cuff tears. Thank you.