 So, my paper presentation is on multi-parametric prostate MRI as a non-invasive investigation in detection of the lesions of the prostate. Under the guidance of Dr. Yogendra Sajdeep, Professor and Head of Department of Retrodiagnosis Pravara Rural Hospital, Dhoni, Carcinoma Prostrate is one of the common cancer in men. Most of the prostate cancer are slow growing and indolent rather than being aggressive in the initial stage and they seldom produce any symptoms until the advanced age. Because it is very important to have an early diagnosis of the prostate cancer which can further lead to improved treatment outcomes. Traditional methods used to diagnose the lesion includes the PSA, the digital rectal examination that does guided biopsy using a 12 core biopsy, however all these methods have their own limitation and disadvantages. Now digital rectal examination is also has a high inter-observerial ability. Moreover, on a study it was found that cross guided biopsy is associated with misdiagnosis of clinically significant prostate cancer in up to 30% of the cases, thus an improvement in diagnostic pathway for the prostate cancer is needed in order to decrease both misdiagnosis of clinically significant prostate cancer and overdiagnosis of clinically insignificant prostate cancer. The inediquity of screening tool to distinguish the subclinical illness from clinically significant prostate cancer always acts as a barrier to the early diagnosis of the prostatic lesion. Multi-parametric MRI is the imaging modality which provides the best anatomic imaging of the prostate gland due to its superior resolution compared with the other imaging techniques. There is introduction of the high field strength magnet, 3 tesla magnet which is a result in higher signal to noise ratio which can be used to increase the resolution, contrast or speed. Currently MRI is the most optimal technique for the evaluation of the prostate and it involves a multi-parametric approach for the diagnosis of the prostatic lesions. Multi-parametric MRI is currently gaining acceptance in detecting and localizing the lesions of the prostate and guiding the targeted biopsy or the focal therapy, stratifying the risk before the treatment, monitoring the patient during the active surveillance, planning and choosing surgery or radiation and accessing the recurrence. So with the help of the multi-parametric MRI imaging we basically diagnose the lesions of the prostate in the early stage which are clinically significant and do a targeted biopsy to prove the lesion and thus we can start the treatment of the patient in the initial stages. The aims and objective of my study is to evaluate the multi-parametric MRI as a non-invasive investigation in detection of the lesions of the prostrate in patients referred to the department of radio diagnosis for the evaluation in pravara instead of medical science. Materials and methodology include the study design which is a descriptive cross-sectional study. The study population was all the patients referred to the department of radio diagnosis of the evaluation of the prostrate were enrolled in this study. The assessment of this patient was done using Philips engineer elation machine which is a three tesla MRI machine. The inclusion criteria include all the patients who are giving consent for the study, all the patients referred to the department of radio diagnosis to the pravara hospital Loni, a symptomatic patient with suspected prostatic lesions and patients with obstructive neuropathy, hesitancy, urinary retention, hemorrhage or pelvic pain. The inclusion criteria include the patient not giving consent for the study and patients with contraindications for MRI such as claustrophobia, metallic implant, aneurysmal clip, pacemakers and prostatic heart valves. The protocol for my study was all the studies were performed on a three tesla Philips MRI machine. The protocol which was used was T1 exel images, T2 sag images, coronal and exel images, T2 fat set exel images, diffusion values were taken at 0, 800, 1400, 2000 B values, ADC images were taken, dynamic contrast study was done and MRI spectroscopy was also performed. The component of the multi-parametric MRI includes the T1 weighted imaging, T2 weighted imaging, diffusion weighted imaging, multi-magnetic resonance spectroscopy and dynamic contrast images. So results were a study was conducted on 18 patients who were referred to the department of radio diagnosis with problems of difficulty in maturation. Out of this 18 patients which were studied, 11 patients proved to have adenocarcinoma, 4 patients had BPH, 1 patient had prostratitis and 2 patients were negative for malignancy. All these patients underwent the multi-parametric MRI prostrate evaluation and following results were obtained in my study. So 68% of the patients with a proved pirate who were given pirate 4, 5 proved to be a case of adenocarcinoma, 29% had BPH, 1% case had prostratitis and 2% were negative. Age-wise distribution of the patient were enrolled in the study includes in this 50 to 68 years I had 3 patients, 60 to 70, 8 years were examined, 70 to 8 years, 4 patients were examined and 80 to 90 years, 3 patients were examined. In my study, PSL level of the patients includes PSL less than 10, 2 patients, PSL 10 to 23 patients, PSL level more than 20 to 100, 10 patients and PSL level more than 100, 3 patients. So out of these patients, the patients with PSL level 100 and 288 had skeletal metastasis. This is a chart that demonstrate the risk of prostrate cancer associated with PSL levels. So if the PSL level is less than 10, there is low risk if the PSL level is 10 to 20, there was intermediate risk, PSL level more than 20 was associated with high risk of prostatic malignancy. On the basis of the lesions which are obtained on MRI images, we can classify the patients according to the risk from very low risk to very high risk that a clinically significant cancer is likely to be present. Here what 5 categories range from pirates 1 to pirates 5. In pirates 1, there is very low risk for the cancer to be present. Pirates 2 has low risk of the clinically significant cancer to be present. Pirates 3 has an intermediate risk, pirates 4 has high risk and pirates 5 has very high risk that a clinically significant cancer is likely to be present. So for the pirates categorization we assign score to the lesions which are obtained on the T2 excel images. These lesions can be obtained in the peripheral zone or the transitional zone. So the scoring system for both of them is different. Now if we get a uniform hyper intense signal which is normal in the prostrate in the peripheral zone then a score of 1 is aside. If we get a linear or wave shape hyper intense signal then a score of 2 is assigned for the lesion. If we get a heterogeneous signal which is non circumscribed rounded then a score of 3 is assigned for the peripheral zone lesion. Now if we get a circumscribed homogenous moderately hyper intense signal with gate test dimension less than 1.5 which is confirmed to the prostrate then we assign a score of 4 for the lesion which is present in the peripheral zone of the prostrate. Now similarly if the greatest dimension of the lesion in the peripheral zone of the prostrate is more than 1.5 or there is evidence of extra prostrate invasion then a score of 5 is assigned. Similarly we have the scoring system for the transitional zone of the prostrate if the score 1 is for the normal appearing nodule of the prostrate. If a nodule is present in the transitional zone which is mostly encapsulated nodule and provides a hyper intense signal then a score of 2 is assigned for that lesion in the transitional zone of the prostrate. If the lesion has heterogeneous signal with presence of obscured margins in the transitional zone of prostrate then the score of 3 was assigned. If the lesion is lenticular shaped and the greatest dimension is less than 1.5 then a score of 4 was assigned. Similarly if the lesion had dimension more than 1.5 centimeter then a score of 5 was assigned. For the peripheral of the transition zone of the prostrate we also categorize the lesion on the basis of the score which are assigned on the diffusion weighted imaging. So if there is no abnormality then a score of 1 is assigned. If there is a linear hyper intense area of diffusion restriction obtained on high B value then we assign a score of 2. If there is focal area of diffusion restriction on high B values on diffusion weighted imaging then a score of 3 is assigned. If there is focal markly hyper intense area of diffusion restriction with greatest dimension less than 1.5 centimeter then a score of 4 is assigned for such lesion. Now if we have the focal and discrete area of diffusion restriction with greatest dimension more than 1.5 centimeter or an evidence of extra prostrate invasion then a score of 5 is assigned for such lesion. Now after categorizing the lesion or the peripheral zone and the transitional zone of the prostrate we can compile our data and assign the pirates category. Now in category 3 so for example if we got a category 3 then if the dynamic contrast enhancement is positive then the lesion gets further classified into pirates 4 category. Now if we assign the score and we get dynamic contrast negative then such lesion is categorized into pirates 3 category of intermediate risk of the prostrate cancer. In my study pirates score 1 and 2 are considered negative whereas the pirate score which were assigned as 3 4 and 5 are considered as intermediate risk high risk and very high suspicious for malignancy. So out of the 18 patients studied 11 patients with pirates score of 4 and 5 had evidence of malignancy on HPR correlation and 7 out of 8 patients with a score of 2 and 3 had evidence of BPH and prostratitis on the HPR report. This is a T2-weighted axial image of the patient in which there is presence of a T2-hypo intense signal which shows corresponding areas of diffusion restriction on DWI images. The T2-hypo intense area showed areas of diffusion restriction on DWI images with low ADC value and shows a positive uptake of contrast on dynamic contrast imaging. So this lesion was categorized as pirate 5 lesion and on the histopathological examination it proved to be a case of adenocarcinoma. The PS level of this patient was more than 100 and patient also had the skeletal myths in the body. The patient had enlargement of the prostrate with symptoms of obstructive uropathy and T2-sadatal images also shows the presence of mucosal irregularities involving the urinary bladder. This is the ultrasound correlation of the same patient. The patient had PS level more than 100 and had skeletal and hepatic and brain parenchymal metastasis. So this is the CT section and corresponding ultrasound section of the patient with the hepatic metastasis. On T2-weighted sagittal images of the spine there are multiple hypo intense areas which are obtained. So CT section was taken and the patient had extensive skeletal metastasis in the whole of the vertebral column also the patient had metastasis in the femoral region. The sensitivity of my study was 91.67% specificity of the study was 87.5% positive predictive value was 91.98% and negative predictive value was 87.4%. So for the conclusion multi-parametric MRI is a non-invasive and useful imaging modality that is emerging as an accurate tool for identifying the clinically relevant tumors. The protocol including T2-weighted imaging, dynamic contrast, NNSEMRI, diffusion-weighted imaging and MR spectroscopy can provide clinically useful information to the urologists for confronting the problem of managing the patient with prostate cancer. It can help in identifying, diagnosing and staging of the prostate cancer and can differentiate clinically significant tumors from benign lesions by combining the anatomical and functional imaging techniques thereby enabling the optimal risk stratification and treatment planning. So these are my references for the study.