 Good evening, everyone. I'm Dr. Sarita Sarkar from SCV Medical College and Hospital Cartuck. I'm going to present a case series based on role of ADC in predicting the grade of the brain tumors. So, coming to the introductory part, as we all know, brain tumor can be diagnosed with a conventional MRI sequence that is T1 and T2 weighted images and post-contrast MR, post-contrast T1 weighted images. But those sequences are considered to be inhibition in diagnosing the aggressiveness of the brain tumors. For this purpose, recent studies have shown that there are the need of other imaging modalities like DWI and ADC. DWI or Diffusion Weighted Imaging based on measuring the random Brownian motion of water molecules in the biological tissue and is particularly useful in the tumor characterization. The extent of the tissue celerity and presence of intact cell membrane helps to determine the impedance of water molecule diffusion. Higher the cell content in the tumor or the high grade tumor shows high diffusion restriction and the low ADC value. This is the base of our study. So, aim of aim and objective of our study was to apply the ADC values to quantify the difference between low and high grade tumors and project it with histopathology. So, the data were collected from the patients attending to the department of radio diagnosis being primarily referred from the department of neurosurgery. The study period was 11 months and done on 60 patients. The study design is retrospective study. All patients of brain tumor where performed MR scan using G-sigma HDX machine with 1.5 tesla field strength. We performed the standard MR protocol and then calculated the ADC values of ADC values in the areas of greatest restriction diffusion in the solid tumor components. Then the histopathology reports were correlated individually. The inclusion criteria is the patients having DWI and ADC sequence in MR study. Only collision measuring more than 1 centimeter in diameter were included in the study. The histopathology consistent with high grade tumors and few benign tumors and we included all age group. Exclusion criteria, there were no ADC and DWI sequence in MR study and because histopathological report, patients measuring less than 1 centimeter on MR or artifact in DWI. The study was conducted according with the standard MR protocol using axial coronal and sagittal T1, axial coronal and sagittal T2, axial flare, axial DWI and ADC, axial coronal and sagittal T1 patch set plus contrast. The acquisition parameters were long tier and short T with a flip angle of 90 degree and a soviet 21 centimeter and two V values were taken and ADC maps were automatically calculated using the inbuilt software. The data were analyzed using the SPSS, using the SPSS version pattern. Then we can see, we can see one tumor that is high grade glioma diagnosed histopathologically. We can see the disarray looking cell with cellar atypia that tumor showed high diffusion restriction on DWI and corresponding low ADC value. Another tumor that is histopathologically proven schwannoma, schwannoma no diffusion restriction with high ADC value. So, coming to the result, as we can see there is a slight male pre-reliction and coming to the age distribution including the study included 60 patients, majority belong from the 41 to 70 years age group findings. In the study, 38 percent patient had high grade glioma, 10 percent patient had lymphoma, 4 percent patient had metastasis and 3 percent patient has atypical pterodactyrate tumor and rest of the patients having meningioma, low grade glioma, schwannoma and pituitary macrodenoma. Now coming to the main finding, the 28 patients with high grade tumor had low ADC value where the 4 patients with high grade tumor had high ADC value, whereas the 5 patients with low grade tumor had low ADC value and 28 and 23 patients with low grade tumor had high ADC value. So, we can clearly see 87 percent patients with histopathologically proven high grade tumors at low ADC values and 82 percent patients of low grade tumor had shown high ADC values on MRI. So, now coming to the validity of ADC, high grade tumor with low ADC shown the sensitivity of 87 percent, specificity of 82 percent, positive predictive value of 84 percent and accuracy of 85 percent, whereas low grade tumor with high ADC value had shown sensitivity of 82 percent, specificity of 87.5 percent, positive predictive value of 85 percent and accuracy of 85 percent. So, we can clearly see the sensitivity and specificity in predicting the grade of brain tumor showing significant positive result with good sensitivity and specificity. So, now coming to the discussion part, the study included 60 patients of brain tumor out of them, 32 patients had histologically proven high grade tumor and 28 had histologically proven low grade tumor. So, the findings were the majority of the patients belong from the 41 to 70 years of age group constituted about 73 percent of study population, 57 percent were male and 43 percent were female, 87 percent of patients with 87 percent patients with histologically proven high grade tumors had low ADC and 82 percent patients with low grade tumor had high ADC values. So, WHO3 and 4 were histologically proven, WHO3 and 4 were considered to be high grade tumor and WHO1 and 2 were considered to be low grade tumor. We compared our study with few studies which shown the positive correlation between the ADC, ADC value and brain tumor reading. So, you can see that I have taken the four studies which have shown the positive correlation between the ADC value and brain tumor with an inverse relationship between the ADC value and brain tumor. ADC value, sorry, an inverse relationship between ADC value and high grade tumors. So, to conclude, preoperative accurate brain tumor diagnosis plays an essential role in selection of optimum treatment strategy as their management and prognosis are different. Through this study, we aim to analyze the potential of ADC in predicting the tumor grade by examining DWI and correlating the ADC of the tumor with WHO grade. And we found that our study is consistent with the reference studies. ADCs greater than 800 are predictive of low grade tumor with a sensitivity of 82 percent and ADCs that with less than 800 are predictive of high grade tumor with a sensitivity of 87.5 percent. These are my references. Thank you.