 Good morning to all, I adopt a Sapna Elavath from MGMM by Medical College presenting a paper on the CT evaluation of large bowel bowl thickening. Now the differential diagnosis for thickening of the large bowel bowl include like neoplastic, inflammation, infection or ischemia. In the earlier period standard variant studies of the GI tract were done for the detection of bowel bowl thickening. With the advent of CT has made it possible to demonstrate the true extra luminal extent of pathology and it has been highly valued in the evaluation of bowel bowl thickening. McCardy and the Belters are also suggested that we should carefully analyze the CT parameters like a degree of involvement, pattern of attenuation and enhancement, presence of fat stranding, extent of thickening, symmetry of thickening, associated finding, avoid most of the pitfall as well as provide a diagnosis of primary intestine and lesion or offer a protein and differential diagnosis. The main aim of this study is to evaluate the role of contrast in its computed tomography in the diagnosis and differentiate the malignant and benign large bowel pathologies. In this observational study, data was collected from the patient of suspected large bowel bowl region who were referred to radiology department at MGMM by Medical College. A total of 50 patients were included and the informed consent was taken from each patient prior to enrollment in the study. We include all those patients who presented with the symptoms like altered bowel bowl habit and the patient with positive large bowel bowl finding on colonoscopy or ultrasound. We exclude all those patients in whom the CT was not possible like deranged renal function patient and the pregnant female and who were not willing to give consent excluded from our study. We also followed up to the therapeutic biopsy operative diagnosis histopath report helping that confirmation of provisional diagnosis made on MDCT. Now coming on the observation and result part, overall most of the cases were reported in the ACE group of 41 to 60 year. Now the distribution of the ACE group in the benign bowel bowl pathology, most of the benign cases were reported in the ACE group of 21 to 30 year. We see the 30.8% patient belong to the 21 to 30 year ACE group only followed by the 23.1% patient belong to the 41 to 50 year ACE group. Now the distribution of ACE group in the malignant bowel bowl pathology, most of the malignant cases were found in the ACE group 51 to 60 year followed by 41 to 50 year and none of the cases were reported in early ACE group that is 10 to 30 year. Here we see also 35.3% cases belongs to the 51 to 60 year ACE group followed by 29.4% cases belong to 31 to 40 year ACE group in the malignant bowel pathologies. The majority of the patient in the malignant lesion present with the per rectal bleeding while in the benign condition most common presentation were the loose stool and pain in abdomen. We see here also the bar chart also shows the per rectal bleeding present in 23.5% cases among malignant bowel lesion and the benign bowel lesion majority patient present with the vomiting and the loose stool that is 30.8% present with these symptoms. Let's discuss the location of bowel bowel lesion among all the malignant lesion most of the cases involve the rectum followed by combined location of the sigmoid colon and rectum. Among all the benign lesion most commonly involved segment was long segment extending from the transverse to sigmoid colon. This bar chart shows the same thing in the malignant cases rectum involved in the 52.9% cases while in the benign condition majority of the patient 23% cases involve the transverse segment. Now let's see the attenuation on contrast CT the p value for this is less than 0.05 it means it was statistical significant for the difference in malignant and benign lesion with respect to attenuation majority of benign lesion shows homogeneous attenuation while in the malignant lesion we saw the heterogeneous mix attenuation in this bar chart we see the same thing homogeneous attenuation in the benign patient benign condition while in the malignant lesion we see the heterogeneous mix attenuation. Now let's see the bowel thickening on CT scan the p value was less than 0.05 that is significant for significant for difference in the malignant and benign lesion with respect to mild or marked thickening. Marked thickening was seen in most of the cases belong to the malignant lesion while mild thickening was seen in most of the benign lesion. Only as we see in this bar chart also 88.2% cases among the malignant lesion shows the marked thickening while only we see the mild thickening in 84.6% cases belong to the benign lesion. Symmetric or asymmetric involvement of the large bowel ball thickening the p value was less than 0.05 that is statistical significant for difference in malignant and benign lesion with respect to symmetry of thickening. Most of the malignant lesion were associated with asymmetric thickening while majority of benign lesion involved the symmetrical thickening. As we see here asymmetric thickening in the benign in the malignant cases that is 88.2% patient shows asymmetric involvement while in the benign cases 92.3% cases below shows the symmetric involvement. Now the extent of large bowel ball lesion whether it was focal thickening or there was a segmental thickening or there was diffuse thickening the p value for this is also less than 0.05 that was statistically significant. We see the focal thickening in most of the malignant cases in most of the malignant cases 76.5% cases shows focal thickening that is less than 10 centimeter segment involvement while in the benign cases we see majority of the patient shows diffuse thickening. In this bar chart we also see the malignant cases shows 76.5% cases shows the only focal thickening while in the benign cases 38.5% cases shows the diffuse or segmental thickening. Let's discuss few cases among our study. There is a axial section of the CT in which we see the circumferential bowel ball thickening of the rectum with narrowing of the lumen which came out to be a benign inflammatory lesion on histopath. Let's discuss second case asymmetric mark that innovation or thickening with the heterogeneous attenuation of ascending colon came out to be ascending colon cancer on histopath. Let's see the lymph node involvement and large lymph node involvement seen in both benign and malignant cases and the p value was also more than 0.05 that was not statistically significant. Now we see the malignant and the benign both were shows the enlargement of lymph node and this was not statistically significant in our study and the fat strengthening in the large bowel ball lesion the p value was less than 0.05 and the statistically significant for difference in malignant and benign lesion with respect to fat strengthening. All the benign lesion all the benign lesion were associated with the peripheral fat strengthening among all the entire malignant lesion 70.6% shows presence of surrounding fat strengthening while 29.4% lesion was shows absent fat strengthening. This was the bar this is the bar chart shows the same thing fat strengthening in the large bowel ball lesion. Let's discuss few associated finding most common site of metastasis in the malignant lesion was that of the liver seen in the 17.6% cases followed by lung and bone there were no metastasis seen in 64.7% cases and the obstruction of the bowel was present in 17.6% of the malignant while in 15.4% cases in the benign lesion it was absent in most of both benign and malignant cases. As per the observation of our study among all the malignant lesion the most common location was the rectum in 52.9% cases followed by combined location of sigmoid colon and rectum but CZ et al study done in Gujarat state of India also reported that most common malignant lesion involving large bowel balls adenocarcinoma and recto sigmoid lesion was the most frequent site of involvement noted in 64% patient. Now let's is coming on to the conclusion part from the study we conclude MDCT has a sensitivity of 100% and specificity of 92% and the positive predictive value of 94.4% and negative predictive value of 100%. From the study result it can be stated that MDCT has a high predictive value in the diagnosis and differentiation of benign and malignant lesion of the large bowel. Nature of bowel ball thickening whether it was focal segmental diffuse degree and symmetry of bowel ball thickening pattern attenuation and fat strengthening are among the important parameter which help in diagnosis and differentiation of benign and malignant lesion in the large bowel. These are the references. Thank you.