 Hello everyone, this is Dr. Vashita, postgraduate from Department of Radio Diagnosis, Shri Devrajara's Medical College, Kholar. Today I'll be doing oral paper presentation on role of diffusion weighted MRI and ADC values in differentiating benign from malignant breast lations. Purpose of this study was to assess the utility of diffusion weighted MRI along with its corresponding ADC values in differentiating benign from malignant breast lations versus sensitivity and specificity of diffusion weighted MRI for confirming the diagnosis of lations on extreme mammography and sonome mammography in patients with tense breast by using diffusion weighted MRI and ADC values as a supplementary tool. Objectives of this study was to assess restricted diffusion of breast lations on diffusion weighted MRI to calculate corresponding ADC values and to derive a cutoff value in differentiating benign and malignant breast lations to correlate diffusion weighted MRI findings with pathological findings. Diffusion weighted MRI measures the mobility of water molecules within tissue, thereby reflecting the cellular micro environment. It represents the tumor cellularity and cell membrane integrity. Breast cancers typically exhibit reduced diffusivity and appear hyper intense to surrounding tissues. Upper end diffusion coefficient is a quantitative measurement of restricted diffusion seen in the lations. Diffusion weighted MRI helps in distinguishing benign and malignant lations in the diagnostic setting. Diffusion weighted MRI and ADC values could also serve as a part of non-contrast enhanced MRI approach for screening. However, the sensitivity is lower than that of dynamic contrast enhanced MRI but superior to that of X-ray mammography and solar mammography. It helps in improving image quality and sensitivity in cancer detection. This study was a hospital based observational study performed in 50 patients. It was performed on 1.5 tesla MR machine using dedicated double breast coil. DWI sequences were taken at B value of 50, 400 and 800 seconds per millimeter square and ADC mapping was done. All the patients with breast lesions were included in the study. Patients who had undergone FNAC or biopsy within the last three weeks or the patients undergoing chemotherapy or radiotherapy for carcinoma breast were excluded in this study. The mean age of all the patients was 47.7 plus or minus 14 years where the youngest patient was 16 years and the oldest being 85 years of age. Most of the patients that is 16 patients were between the range of 40 to 49 years and followed by 15 patients being between the range of 50 to 59 years suggested that breast lesions are more common in the perimenopause followed by postmenopausal age. DWI and ADC sequences were taken in patients are having breast lesions and the lesions from which FNAC was taken was selected for analyzing on DWI and ADC sequences. The lesions which showed restricted diffusion were constant to be malignant lesions and the lesions which showed no restricted diffusion were benign lesions. This is a DWI image and it's corresponding ADC image of a benign lesion showing no restricted diffusion. This is a DWI and it's corresponding ADC image where the breast lesion in the right breast shows restricted diffusion which is suggestive of a malignant etiology. ADC value for benign lesions was calculated by drawing multiple ROIs where each ROI was approximately 25 mm square and multiple ROIs were drawn throughout the breast lesion and may day ADC value was calculated. In case of malignant breast lesion multiple ROIs each ROI being approximately 25 mm square was drawn in the areas of restricted diffusion within the lesion and mean ADC value was calculated. The mean ADC values for benign breast lesions was found to be more than 1.3 into 10 to the power minus 3 and that of malignant lesions it was found to be less than 1.3 into 10 to the power minus 3. 18 patients out of 50 showed breast lesions with no restricted diffusion and they had an ADC value more than 1.3 into 10 to the power minus 3 which is suggestive of benign etiology whereas one patient had a breast lesion which showed no restricted diffusion its ADC value was less than 1.3 into 10 to the power minus 3 and on histopathology this turned out to be benign ferrots tumor. So benign ferrots tumor showed no restricted diffusion however its ADC value was that of malignant wherein this patient it was found to be 1.1 into 10 to the power minus 3 and hence this lesion was a mismatch in our study. 29 out of 50 patients had breast lesions which showed restricted diffusion and they had an ADC value of less than 1.3 into 10 to the power minus 3 which is suggestive of malignant lesion whereas two patients had breast lesions which showed no restricted diffusion and its ADC value was more than 1.3 into 10 to the power minus 3. These two patients morphologically showed had a lesion which had malignant features but showed no restricted diffusion and had an ADC value of 1.8 into 10 to the power minus 3 which is suggestive of benign etiology and on histopathology this both patients had musinus carcinoma therefore musinus carcinoma is a mismatch and can be false negative in diagnosing to be malignant lesions. The cause can be because of abundant musin and low cellularity in cases of musinus carcinoma. The sensitivity of diffusion weighted MRI and its corresponding ADC values in differentiating benign from malignant breast lesions was 93.5 percent and specificity was 94.7 percent where one patient has a false positive to be a malignant lesion on ADC values that was benign ferrots tumor and two patients were false negative to be malignant that was musinus carcinoma. Concluding diffusion weighted MRI can be used as a fast unenhanced screening modality sensitivity superior to that of mammography and ultrasound the ability of diffusion weighted MRI to detect cancer may further be enhanced using the ADC values. ADC values can be used as a supplemental MRI technique for an incorporation into breast MRI protocols. These were my references.