 Good morning, everyone. My name is Dr. Manisha Uchandani. I'm second year post-graduate resident at Maharshi Mukundeshwar Institute of Medical Science, Mulana. So the topic of my paper that I will be presenting today is Diagnostic Accuracy of Ultrasound and Computed Tomography in Detection of Pancreatic Tumors. So the solid lesion of pancreas represent a heterogeneous group of entities that can be broadly classified as either neoplastic or non-neoplastic. Neoplastic lesion include pancreatic adenocarcinoma, pancreatic neuroendocrine tumor, solid pseudo papillary tumor, pancreatoblastoma, pancreatic lymphoma or the metastasis to the pancreas and rare miscellaneous neoplasm. Non-neoplastic lesion include focal pancreatitis, fatty infiltration replacement, intra-pancreatic esicere spleen, congenital anomalies such as prominent pancreatic lobulation and bifid pancreatic tail. So the variety of imaging modalities are available for assisting these solid lesion including ultrasonography, computed tomography, MRI and hybrid nuclear imaging such as single photon emission computed tomography and positron emission computed tomography. So the aim of my study is to assess the accuracy of ultrasound and CT in evaluation of pancreatic tumor and in determining the receptability and prognosis of various pancreatic tumors. So the methods we have gone through is this is a prospective study of 50 patients with a pancreatic lesion to evaluate the efficiency of ultrasound and CT in detecting and diagnosing the pancreatic neoplasm. So the all the CT examination were performed on 28 slides MD city out of total 50 cases. The cases with a high suspicious of pancreatic neoplasm based on clinical and laboratory finding positive on CT were 40 and the patient which were positive on ultrasound were 35. So the CT is the most versatile technique for imaging pancreas. It is high diagnostic accuracy for determining the nature of neoplasm. CT has an advantage over ultrasound in evaluation of pancreas as pancreas being a retroperitoneal may be obscured by a bowel gases which make it difficult to visualize on ultrasound. But CT has no such limitation. The entire anatomy of pancreas and pathologies can be well delineated by CT. So here is the coronal post contrast portal phase CT scan shows an iso adiabatic tumor in the pancreatic head causing proximal dilatation of CVD and abrupt cutoff. Then we have an another Excel post contrast portal phase CT scan shows a double duct sign the dilatation of CVD and MPD is seen and we can also see that IHBRD is our prison intrahepatic ductal dilatation is also present. So here is another Excel post contrast portal phase CT scan shows a unresectable adenocarcinoma with vascular invasion and liver metastasis in 72 year old man present with abdominal pain, weight loss and jaundice. So here is an Excel contrast enhanced CT image demonstrate a small cyst conjured in a honeycomb pattern in the pancreatic head and neck so we can think of cirrhosis adenoma. Then we have Excel contrast enhanced CT shows a large complicated cystic lesion in a 54 old woman so we can think of malignant mucinous system. So here is the post contrast portal phase CT scan shows a large tumor in the ancinate process with extrinsic cystic necrotic degeneration and thick enhancing ball. So we can think of malignant neuro endocrine tumor with cystic necrotic degeneration. Then we have another case of 53 year old man present with a general malaise. We can see that the post contrast arterial phase CT scan shows a heterogeneously hypo attenuated tumor in the pancreatic head containing punctate foci of calcification and we can also see that a large hypervascular ring enhancing metastasis is seen in segment 6 of the level. Then a 54 year old man present with abdominal pain this is a coronal oblique post contrast arterial phase shows the local invasion of pancreatic tail from the lymphomaid's infiltration of the spleen and we can also see that retroperitoneal lymphodylopathy. So this is the second case of secondary lymphoma. Then this is a pathologically proved metastasis to the pancreas from renal cell carcinoma in asymptomatic 68 year old woman who had undergone the left nephrectomy. So the post contrast portal phase CT scan shows a large hypervascular tumor with cystic necrotic degeneration in the pancreatic tail and these are the vessels indicate the intratumoral vessels. So in the prison study out of 40 cases 31 cases were diagnosed as ductile adenocarcinoma, 6 were diagnosed as cystic neoplasm, 1 with neuroendocrine tumor, 1 with lymphoma and 1 with metastasis and rest of the 10 patients were normal on city and ultra. So out of 40 cases 31 cases were non-receptible due to the local or distance spread of the tumor and 9 cases were recyclable. So the sensitivity and specificity of contrast enhanced computed tomography in diagnostic of pancreatic tumor is 88.3% and 71.43% respectively. But in case of ultrasound it's a bit low. The sensitivity is 76% and specificity is 62.5%. So the image finding on ultrasound and city have a favorable result also. The use of ultrasound is non-invasive, non-ionizing, taking only few minutes easy to perform and integrity, cost effective with good repeatability and reliability. But in USG was less sensitivity and specific in detection of pancreatic neoplasm when compared to city. It was not able to diagnose the small iso-equic solid masses which were diagnosed on contrast enhanced city. There was also difficulty in accurate assessment of the local extension and small sized liver mitts. In case of contrast enhanced city it emerged as a better and superior modality in detecting various pancreatic neoplasm and it is more specific and sensitive when compared to ultrasound. Thank you.