 Hello everyone. My name is Samir Zaman and my topic is the role of readout segmented eco planar that is resolved DWI in the diagnosis of CSI. I am from the department of radio diagnosis from the college. The aim of my study is to evaluate the role of readout segmented. That is RECP also known as the resolve readout segmentation of long variable eco trains, which is the type of multi shot API DWI sequence in detecting the presence of chronic separative or that is media. So we'll start with introduction. The disorders of middle ear are common in Indian population and they cause otorrhea, hearing impairment, ear pain, discharge, and most common as CSI presents with various complications like mastoid abscess, labyrinthitis, facial nerve paralysis and thrombophilitis and most common is colostitoma. Colostitoma is characterized by accumulating keratin debris in the middle ear or other pneumatized areas of the temporal bone. It's locally aggressive. And hence it is very important to diagnose the extent and the presence of colostitoma in patients of CSI. The wide resolution CT that is HR CT is very well known to be the first mentality of choice for colostitoma for detecting the presence of soft tissue density and extent and presence of bone erosion, but it cannot differentiate between colostitoma and inflammatory or granulation tissue or scar tissue. So DWI is an MR sequence used for that which uses the technique of braunian motion to create an image. The water molecules are always not freely flowing but sometimes face to strict restriction which results in high signal density that is diffusion restriction. So it appears hyper intense on DWI. However, granulation tissue will not appear hyper intense on DWI as water molecules are more mobile. So it differentiates colostitoma between inflammatory granulation tissue and scar tissue. So these are the types of DWI that is single shot EPI, non EPI and the one we are using is multi shot EPI that is resolved. So single shot EPI is the single shot of DWI applied. Non EPI also uses single shot. However multi shot uses multiple shots of DWI diffusion restriction. And then, because of multi shot there is the scan time is more and that it is sensitive to motion artifact however the resolution is very good. And it can differentiate colostitomas of two to three m m size and multi shot EPI is a type is a enhancement and a better version of single shot EPI uses that technique. Non EPI is most commonly used for colostitoma nowadays but we have done the study to study about multi shot EPI in detecting colostitoma. So our sample size is 30. And the cases were taken between September 2019 and July 2021. So the sequences used are T1, T2, Axial and Coraline Blaine, T2FS, Resol, DWI and Axial Blaine and these are the sequence. So these are the observation and results. The demography which we have were 13 patients were repeated age group, 17 patients per adults. And amongst the period age group of 13 patients, seven were male and six were female. And out of the 17 adults, nine were male and eight were female. And the clinical features were that 39% had otalgia, 91% had discharge, 32% had associated bleeding, 48% had healing loss, 39% had perforation and 30% had retraction, pocket some autoscopy examination. These are the MRI findings. We saw a diffusion restriction in 28 patients, semi-circular canal invasion in two patients. There was no CVST, unfortunately, and EAC involvement was seen in five patients. And bilateral colostitoma was seen in four patients and unilateral colostitoma was seen in 24 patients and no colostitoma was seen in two patients. So we seen bilateral colostitoma. We had considered two temporal bone studies of each patient. So there were 60 studies in total. And out of the 60 studies, 32 temporal bones showed colostitoma. So these are the findings. This is a chart I made. The number of temporal bones, as we are considering that each patient has two temporal bones, it's a number of temporal bones showing division restriction on MRI and with positive intraop and HP findings were 32, that is true positive. So the number of temporal bones showing division restriction on MRI but were negative on intraop and HP findings were one. The number of temporal bones not showing diffusion restriction on MRI but having a positive HP report and intraop findings was one, that is a false negative. And the number of temporal bones not showing diffusion restriction and also negative on intraop findings were 26, that is too negative. So sensitivity was 97%, specificity was 96%, positive predictive value was 97%, negative predictive value was 96% and accuracy was 97%. Here are some cases. This is one case had a large colostitoma in the left middle here, which appeared predominantly hyper intense on T1 video images with a few hyper intense foci, predominantly hyper intense on T2 axial and showing diffusion restriction and low EDC values. And it was seen that it was the soft tissue was extending into the new stashin tube. And in this case, we see this soft tissue lesion in the right middle here. These are axial images in T1 it appears hyper intense maturing 5 mm, corresponding size on T2 also appearing hyper intense and showing diffusion restriction and low EDC values. So this was the smallest colostitoma we detected that is 5 mm. However, resolve can detect colostitomas of 2 to 3 mm. So this is another case, which we see a soft tissue density, soft tissue lesion, which appeared as a soft tissue density on CT. So colostitoma was one cause. However, MRI showed soft tissue lesion in the left middle here, which showed hyper intensity on T2 showed diffusion restriction and low EDC values. And on intra findings, it would turn out to be malignant otitis external with a mastoid abscess. So this was a false positive. This is another case which had findings of CSM, clinical findings of CSM. However, on MRI, there was no soft tissue lesion in the middle here. And there was no diffusion restriction on low EDC values. However, as this was a case of modified radical mastectomy mastectomy on the left middle here. So we had symptoms of CSM and hence second surgery was performed and it was found that there was a colostitoma in the left middle here. So this is a false negative. So we come to discussion. CSM is a sequelae of acute infection with tympanic membrane perforation. And one of the symptoms of it is a presence as granulation tissue, but sometimes scoma septile may generate and initiate a colostitoma formation, which is the common complication. As we have seen that CT is the best known for detecting colostitoma, DWI MRI is also used to drift. This is used to differentiate between inflammatory and granulation tissue from Scottish. So we have seen that the technique relies on running motion and that a colostitoma consists care and care and debris which shows diffusion restriction. However, granulation tissue and scar tissue does not show. We have a very sample of 30 patients who presented with science and symptoms of CSM 20 patients showed a legion exhibiting diffusion restriction in the left middle here and were correlated with interrupt and HP findings which had confirmed 29 cases in the sample. In all cases predominantly appeared ISO to hypo intense on T1 and hyper intense on T2 showing diffusion restriction low VDC values multiple degrees of diffusion weighted imaging was applied that is the value of 0800 80000 and colostitoma was best seen on B 1000 in 17 patients. There was bilateral colostitoma in few patients and individual temporal bones were assessed each patient which has the sample size was 60 as the sample size. Originally was 30 each patient can consisting of two temporal bones so the some final sample size was 60 and 32 positive temporal bones truly showed a colostitoma that's true positive 26 temporal bones truly showed. Absence of colostitoma colostitoma that is too negative, while one temporal bone was falsely positive which turned out to be a master at that sense. And finally, one colostitoma could not be detected, which was seen in drop and HP on HP, which was a false negative case. So, with regard to DWI non EPI sequences have been the go to detecting small colostitomas and recurrences which is good signal to noise ratio and absence of skull based arguments. However, in this study we evaluate how multi shot DWI resolve DWI phase against non EPI sequences and single shot DWI sequences. So we compared a study with to establish studies. So DWI was by dudow at all, which are compared to resolve DWI with non EPI. And another was by Yamashita, which compared multi shot DWI with single shot EPI DWI. So, it all had the findings of positive predictive value of 93% resolve and negative predictive value of 70% whereas in a study non EPI had the positive predictive predictive value of 92.5% and negative predictive value of 80%. In our study, we got a positive predictive value of 97% and negative predictive value of 96%. So it fared well in comparison to non EPI. And in Yamashita, we got findings of sensitive sensitivity of 97%. Whereas multi shot had 76% and single shot in this we had 46% which was very low. The specificity was 96% in our study 100% in multi shot in their study and 100% single shot in this study, which is comparative to our study. And the accuracy was 97% whereas in multi shot in this study had 87.9% and single shot had 72.4%. Resol DWI detecting cost term and our study showed a sensitivity of 97% specificity of 96% positive predictive value of 97% negative predictive value of 96% and accuracy of 97% The real limitation in our study were sample size was limited and inter-study comparison between other DWI sequences was not done. As compared to the studies of Dudao Iol and Yamashita Iol, Resol DWI holds as a strong DWI technique in the diagnosis of colostatoma comparable with non EPI sequence and comparatively better than single shot effective DWI sequence. In conclusion, Resol DWI which is a type of multi shot DWI is an improved EPI sequence with significantly low skull based artifacts, exceptional resolution and which can be used effectively in diagnosing colostatoma with high accuracy. So these were the references which were helpful in my study. Thank you.