 So, welcome everyone. I'm Dr. Shubhamsa and I'm a junior resident and from department of radio diagnosis from IBG. And today I'm going to present our paper that is MRI and multi-director CT evaluation of craniovertebral junction abnormalities in short CVJ abnormalities. As we all know that the craniovertebral junction being the transit zone between the cranium and spine, it is one of the most complex and dynamic region of the spine and the anatomy of the CV junction is also a little bit complicated. Both the congenital as well as acquired disease process can affect the CV junction and they are common in all the age groups and almost equal in both the sexes. What are the objectives of a study? First is to establish the role of imaging for pre-treatment evaluation of the CV junction abnormality. Second is to outline the normal anatomy as well as the variance which is commonly seen in the CV junction. And third, we'll also try to systematically classify the frequently detected CVJ abnormalities. One point to note here that when you did literature review, we did not find that amount of material above our study. So our study will add a value in the literature as well as we can also get an idea about the demographic, socio-demographic profile of the patient, hence we're getting affected by CV junction abnormalities. Coming to the material and method, it is a single institution with prospective type of descriptive study and the sample size was 55 and it occurred between January 2019 to August 2020. And we used the treatise for MR and Philly's six inch slice machine. About the inclusion criteria, all the suspected patients who are having a suspicion of CV junction abnormalities of both the sexes and all the ages were included in our study. Only exclusion criteria was if the patient has any contradiction to MR like the patient having any metallic implant or the patient at discostrophobic or if the patient is post-operative, then we exclude those patients. In from consents were taken from all the patients before including the study. These are the results, our total sample size was 55 out of each 35 patients was male, so male patients were predominant. Second, although the congenital as well as traumatic as well as genetic patients were there, the predominant age of presentation was between the 40 to 49 years, that is the fifth decade. Third is that the congenital abnormalities were the predominant in the CV junction abnormalities followed by genetic changes. One point to note here that in our study, one patient may have one or two disorder. For example, the patient may have any segmentation abnormalities as a congenital part as well as patient had age related genetic changes that is affected in the CV junction. So one patient may have one or more disease process simultaneously. Next, as you can see that the congenital abnormalities were predominant in our study. Among the congenital abnormality, the OS-Odontium followed by the Prenio-Oxpital-Atlanto-Oxpital assimilation and the rachiscus was predominantly affected congenital abnormality in our study. Coming to the Atlanto-XL instability, which is one of the most dreaded complication and which is affecting the CV junction, OS-Odontium was responsible for 14 of the patients or majority of the patients who had Atlanto-XL instability had Os-Odontium followed by due to the trauma. Also, a significant number of patients were affected by genetic changes has also had Atlanto-XL instability. In the trauma patients specifically, the most common bone which is get involved was dense. Next, as you can see that this is the age distribution of the congenital abnormalities at the CVJ and 4th to 5th decay that was the predominant in this age group. 4th to 5th decay was the age group that was presenting with the symptom of the CVJ abnormalities. One point just I want to mention here, all the patients suppose in our general population and the patient may have the CV junction, but it is usually not symptomatic. The symptomatic age group in our study was between the 4th to 5th decay. Coming to the trauma, you can see that the 3rd decay is the common age group was presenting with the trauma. Coming to the degenerative patient, as it is expected that the old age group that is the 5th to 6th decay, that is the 5th to 6th decay, that is the 5th to 6th decay were common in the degenerative changes. When we compare the age group distribution between the congenital abnormalities and the degenerative changes, we found that the 4th to 5th decay, 4th to 5th decay, was the common age group where the congenital as well as degenerative changes were predominant. definitely the age-related changes predominantly that is the fifth or sixth decade after that. So the point is that even though general population may have city junction abnormalities, it is not usually always symptomatic. The symptomatic age group in our study was presented in between the fourth to fifth decade. Coming to the Atlanta Accident Instability, it is well known fact that if the patient has increased ADI interval, he or she may have Atlanta Accident Instability. But one point to note that even after having normal Atlanta interval, the patient may have Atlanta Accident Instability. In our case, the number was 30. So in summary, the most common abnormality is what gives the congenital abnormality followed by genetic. Among congenital abnormalities, the most common among chroma patients type 2 urinary tractors was the most common. About 67% of the patients who have congenital anomalies also had degenerative changes. And 55% of the patients who had degenerative changes had Atlanta Accident Instability also. So, degenerative changes is one of the most common cause of the Atlanta Accident Instability patient in patients having the segmentation anomaly. Also, the 100% patients of U-matter arteritis patients had Atlanta Accident Instability. But the number of the U-matter patients in our study was only 2. So that significant, it was not that much of significant. Coming to the discussion that congenital abnormalities was the most common abnormality and congenital abnormalities was although common in all the age group's model this and trauma was prevalent in the third decade and vaginal impregnation and platinomusia are not that much common compared to OZ Orontium. And Atlanta Accident Instability is the most dreaded complication always to look for CVJ naughty and most common cause was OZ Orontium followed by degenerative followed by trauma cases. This is the anatomy of the Atlanta Accident region that is a CV junction. The most important ligament was the transverse ligament, which is a part of the Cushiate ligament. As you can see, this is the transverse ligament. Other ligament involved Atlanta anterior longitudinal ligament, which is continuing as Atlanta occipital membrane. So this is the base. This is that representing images of our study. This is from the first is the congenital. As you can see, this is the vaginal imagination. This is the three lines actually here. This is the chamber line line. One is the McGregor line and the MAC race line. As you all see that this is the posterior part of the heart pellet and to the occipital port two buttons. If this is approximately greater than five millimeter above the Mac, above the chamber line lines or four millimeter above the McGregor line, it is definitely the basilar in imagination. This is the OZ Orontium. This is the most common congenital abnormality. It is well-quarticated head bone and it is well-quarticated. This is the OZ Orontium, which is well-quarticated bone. This is the well-quarticated bone, which is from the type two fracture of the dates. Okay. This is the OZ terminally. This is the OZ terminally. As you can see that this is due to the failure of the fusion between the terminal ocicle with the rest of the odontoid. This is the congenital one of the patient. This is the mercury patient. This is the mechopolysaccharosis. As you can see, the dense is severely high plastic. Please also note the beating of the vertebra is present. This is the trauma. This is the trauma. This is the patients having the trauma into the dense, the type two dense fracture. That is the base of the odontoid was the most common in our study. Coming to the Atlanta axial subluxation, the ADI interval in CT if it is greater than 2 millimeter. This is indicator of Atlanta dental increase interval for Atlanta dental subluxation. This is the degenerative changes. As you can see that the Atlanta dental interval is reduced and there is chlorosis, there is osteophytes, which are indicative of degenerative changes. This is the inflammatory conditions. This is one of the one patients, two patients for all the rheumatoid arthritis. You can see the panacea formation, which is enhancing on the contrast study also. And this is the paedontal bonus. There is erosion of the dense vertebra also. Coming to the infecting conditions, only one patients are there. This is the tuberculosis. As you can see that this is the paedontal vertebral absence, which is enhancing, remanancing with occipital bone extension. This is a new plastic condition. This was not common in our study. This is one of the examples of osteochondroma of the C2 arch. Atlanta axial subluxation. This is the rotatory subluxation. As you can see, this is the 3D image and there is asymmetry between the dens and with the lateral masses of the atlas vertebra. Whether CT or MR, this is both CT and MR should be equally used in conjunction as CT gives us the bony architecture well, whereas MRI gives us the soft tissue architecture well. So, we should use CT and MR both simultaneously. So, these are my references. Thank you.