 Hello everyone, I am Dr. Shubham Singh, third year radiology resident at Grand Government Medical College and Surgery Group of Hospitals. I am presenting a paper on the role of Diffusion Tensory Imaging in Glamour under the guidance of Dr. Shadat Malavadkar. Glamour is a type of tumor that starts in the gliocytes of the brain or the spine. High-grade gliomas are highly vascular tumors and have a tendency to infiltrate diffusely. They have extensive areas of necrosis and hypoxia. Infiltrated gliomas usually spread in the cores of white matter tracts and DTI is the single non-invasive imaging method which can quantitatively evaluate the white matter tracts for their microstructure integrity. Diffusion Tensory Imaging is an advanced technique that provides information about the diffusivity of water molecules in that issue and that can be used to map fiber tracts in the brain. Within the cerebral white matter, water molecules tend to diffuse more freely along the direction of external fascicles rather than across them. Such directional dependency of diffusivity is termed as an isotropy. Like in this nerve fiber, we can see that the diffusion is greater in the axis parallel to the orientation of the nerve fiber, leading to larger apparent diffusion coefficient ADC along the long axis of exon. However, due to bilipid cell membrane, the diffusion is less in the direction perpendicular to the nerve fiber leading to lower ADC. This map assigns color to voxels based on a combination of an isotropy and direction. The color assignment is arbitrary, but the typical convention that is used is the vector controls the U and fractional and isotropy controls tracts. In fiber tractography imaging, the conventional color coding is as follows. Commissure fibers which run transversely appear red. Association fiber running enteropostally are clean. Projection fibers which run chronically are blue. Fibers that have an oblique orientation are represented with colors originating from the combination of the three primary colors, red and blue form magenta, green and red form yellow, green and blue form cyan. White meter fibers can be classified as commissural association or projection. Commissural fiber example corpus callusum appears red on TTI. Optic radiation running enteropostally is green and corticospinal tract running plenocortally is blue. Using this principle of DTI, we can analyze the effect of tumor on the white matter fibers. Like some tumor can cause displacement of white matter tract leading to there is however in that case is the white matter tracts are intact. And in some cases it can cause edema of the white matter tract. The white matter tracts are intact in that case also however the fractional and isotropy is decreased. Some tumors can infiltrate into the white matter tracts causing reduction in fractional and isotropy. The fiber tracts remain identifiable in that cases. However in extreme cases of hygrid gliomas like glabalus or glabalastoma, multiforman and aplastipestrocytoma, there's complete disruption of white matter tracts and resulting complete reduction in fractional and isotropy and white matter tracts are not identifiable. Now let's go to the cases. Case one, a 35 year old male presented with the complaint of seizure disorder. There was no neurological difficulties on examination. Imaging revealed well defined solid system, layer hyperintense, certainly announcing lesion in the left hyphenylentropyretro. There was reduction in fractional and isotropy. And that lesion caused displacement of white matter fibers. Histopath revealed that it was a logra glaema. Case two, a 70 year old male presented with the complaint of seizure headaches on examination. Rombo test was positive however no other neurological difficulties was found. Imaging revealed an ill defined layer hyperintense, non-enhancing lesion in the superior and middle cerebellar peduncle, left mid-plane and left cerebellar hemisphere. There was mild reduction in the fractional and isotropy in the tumoral region and the white matter for itymatis. This one histopathology revealed a logra glaema in grade two. Case three, a 55 year old female presented with the headache and seizure. There was left side and mild power loss on examination with no other neurological difficulties. Imaging revealed an ill defined layer hyperintense, non-enhancing lesion in the right frontal lobe and basal ganglia. There was reduction in fractional and isotropy. And on tectography, we can see that there is infiltration and displacement of white matter. Histopath revealed that it was a high grade glaema. Case four, a 40 year old male presented with the complain of chronic headache and altered sense volume. Patient was not oriented to time, place or person on examination. Imaging revealed an ill defined layer hyperintense, vocally enhancing lesion involving the pawns upper half of middle oglongata and bilateral cerebellar peduncles. And on tectography, we can see that there is complete infiltration of the white matter. Histopath revealed it was a high grade glaema. Case five, a 36 year old male presented with complain of severe headache and multiple episodes of convulsions. Patient was not oriented to time, place or person. And imaging revealed an ill defined solid stick layer hyperintense ring enhancing lesion in the left temporal lobe. There was reduction in fractional and isotropy. And we can see that is complete destruction of the white matter test. Histopath revealed a high grade glaema. Case four, the preoperative identification of the extent of malignant cell infiltration within the white matter test constitute a significant challenge. Tumor cells can invade and change the white matter fiber structure by widening, displacing and or disrupting the fiber bundle. The surgical treatment for brain tumor is aimed at achieving the maximum possible reception while minimizing the neurological deficit resulting from surgical injury to the intact functional brain not affected by the tumor. This requires pre-interoperative mapping of the tumor as well as the definition of its relationship with functional structures so that such structures can be preserved during surgical section. Conclusion, DTI provides better assessment of the effect of cerebral tumor on white matter tracks compared to the conventional MRI. This effect may take form of one or more of the whole patterns that were discussed previously. The preoperative pattern of white matter track involvement was significantly associated with postoperative DTI changes which may be reflected in better clinical neurological outcome. Hence, this technique is gaining support as a preoperative MRI method for evaluating brain tumors closely related to the eloquent areas optimizing the surgical strategies. These were my references. Thank you.