 Hello, I'm presenting my paper on the role of cardiac MRI in evaluation of primary dialytic cardiomyopathy under the guidance of Professor Dr. Peshawar. So, dialytic cardiomyopathy is a disease of the heart muscle characterized by enlargement of enlargement in dilation of one or both of the ventricles along with impaired contractility. The real idiopathic dialytic cardiomyopathy is when unknown cause cannot be identified. It can be due to a number of factors such as genetic and environmental factors which together cause myocardial injury. Secondly, dialytic cardiomyopathy is due to secondary causes like alcohol abuse and ischemic heart disease, hypertension, drugs, infectious myocarditis, etc. Ischemic heart disease and alcohol abuse are the most common factors. Suriko is generally the initial imaging modality, but cardiac MRI at present is the imaging tour of choice. It has high sensitivity and specificity. It offers high spatial and temporal resolution, provides improved soft tissue contrast, and has excellent myocardial tissue characterization abilities. And the addition is non-invasive and non-ironizing. So the aim of our study is to assess the role of three test the MRI in the assessment of primary dialytic cardiomyopathy. The objectives were to unequivocally diagnose primary dialytic cardiomyopathy in suspected cases and differentiate it from other cardiomyopathy to assess the disease severity and to assess cardiac function for assessment of follow-up and for assessment of other important findings. So this was a descriptive, observational study conducted using 20 patients referred from the Department of Cardiology who were either suspected of having primary dialytic cardiomyopathy or had definite diagnosis of primary dialytic cardiomyopathy and they had no previous history of myocardial infarction. The presence of secondary risk factors like alcohol abuse, ischemic heart disease, infectious myocarditis, and hypertension was an extruding criteria for the study. So a three-plane SSSB localizer was obtained first and for pre-contrast scanning for cardiac morphology we used T2 and T1 dial blood sequences and for cardiac function we used senior sequences. Post-contrast imaging was done using gadolinium and for assessment of delayed enhancement a short-access TI scout image was obtained 10 minutes after the administration of gadolinium and based on the optimal TI value to null the myocardium a delayed 2P high-resolution PSIR sequence was obtained. Retrospective ECG gating was done during the scan to avoid respiratory artifacts. The data analyzed was on the basis of the following parameters and the results were total 20 patients were evaluated out of which 13 were males and 7 were females. The main cases, the main age of cases was 41.5 years which ranged from 25 to 60 years. 19 patients had cardiac symptoms and one patient had no cardiac symptoms. 6 patients had mild cardiomyokali 70% patients that is 14 patients had moderate cardiomyokali no patients showed severe cardiomyokali. 17 patients had dilatation of only the left ventricle whereas 3 patients had dilatation of both left and right ventricles. 17 patients had historic dysfunction with reduced ejection fraction less than 50% out of them 15 patients had severely reduced ejection fraction less than 30% and only 3 patients had normal historic function with preserved ejection fraction more than 50%. Most of the patients had increased endastolic volume more than 140 ml which is consistent with a dilated cardiomyopathy phenotype. Only 3 patients had normal endastolic volume less than 140 ml as you see here. So, 95% of patients had wall motion abnormalities in the form of global left ventricle hypokinesia. Only one patient had no wall motion abnormality. Considering patterns of dilate enhancement, 13 patients had no dilate enhancement which is the most common pattern seen in dilated cardiomyopathy. 3 patients showed patchy mid-myocardial enhancement. 2 patients showed patchy sub-epicardial enhancement and these two are again characteristic patterns seen in dilated cardiomyopathy. One patient showed both patchy mid-myocardial and patchy sub-epicardial enhancement. Only one elderly female showed an unusual territorial sub-endocardial rate gadolinium enhancement pattern. 17 patients had valueless function out of which 12 had only mitral degradation, 5 had both tricuspid and mitral degradation and 3 patients had no valueless function. 10 patients had pericardial effusion, 10 did not. So, our first case is of a 55-year-old female with no secondary risk factors and 2 chambers sine image and C2 dive blood image shows markedly dilated left ventricle and the left ventricle endostatic volume was 256 ml. And this patient had severe psoriasis function with an injection fraction of only 19%. You can see associated mild pericardial effusion here. So, a diagnostic primary dilated cardiomyopathy was suggested. In the same patient, delayed gadolinium contrast enhancement image, short axis and four chamber images show patchy mid-myocardial enhancement in the interventicular septum. Next case of a 40-year-old female with primary dilated cardiomyopathy, he had no secondary risk factors. This is a LVOT SSFB image and a four chamber long axis SSFB image showing markedly dilated left ventricle and the patient had endostatic volume of 339 ml. This patient again had severe psoriasis function with an injection fraction of only 22.5%. But in post fundage imaging, no abnormal delayed enhancement was made. A 45-year-old female again diagnosed with primary dilated cardiomyopathy and she had no secondary risk factors. And you can see on these post contrast images, patchy mid-myocardial enhancement in the interventicular septum. Again, a case of a 46-year-old male with primary dilated cardiomyopathy showing patchy mid-myocardial late enhancement and this is patchy sub-epicardial enhancement in the interventicular septum. So dilated cardiomyopathy is the most common cardiomyopathy and shows enlargement and dilatation of one or both of the ventricles along with impaired systolic function. So findings of MRI include enlargement of cardiac chambers, increased end diastolic and end systolic volumes, systolic dysfunction with depressed ejection factions, wall motion abnormalities in the form of left ventricular hypokinemia and vascular dysfunction can be seen because of chamber enlargement and annular stretching. Complications such as ventricular thrombosis can be seen because of hypokinemia. Now characteristically, seriate contrast imaging in direct cardiomyopathy can either be no abnormal enhancement pattern with a feeling 13 of our cases or patchy mid-myocardial or sub-epicardial contrast enhancement equals feeling 6% of our cases. And this has to be a non territorial enhancement pattern unrelated to our coronary artery distribution. Also cardiac MRI has prognostic importance in directed cardiomyopathy and the presence of late cardiomyopathy enhancement is associated with increased risk of adverse cardiovascular events. Thank you.