 Hello everyone, myself Dr. Harshashree, GR2 in the Department of Rady Diagnosis, KVGM Cetsulia. My topic for paper presentation is computer tomography in the assessment of severity of acute pancreatitis using reverse Atlanta classification and comparison with clinical outcome. So coming to AIM to classify acute pancreatitis on CECT using reverse Atlanta classification to define the type of collections and assess the severity grading according to reverse Atlanta classification to compare the reverse Atlanta classification imaging findings with the clinical outcome. So coming to introduction, acute pancreatitis is an acute inflammatory process of the pancreas that can involve peripancreatic tissues or remote organ systems or both. Acute pancreatitis can range from mild self-limiting disease that requires supportive measures to severe disease that life threatening complications. The most common causes of acute pancreatitis are gallstones and binge alcohol consumption. There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and intervention techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. In about 10-20% of instances, the illness is severe and may cause major morbidity and fatality, typically as a result of complications brought out on by multi-system organ failure or septic necrosis. CECT is the primary initial imaging modality in the characterization of acute pancreatitis. Coming to methods, the prospective study was conducted from January 2023 to June 2023 in the department of radio diagnosis, KVGMCH. Study samples that were taken were 30 patients referred from the department of emergency medicine, general surgery, who presented with nausea, vomiting and epigastric pain and CECT abdomen in whom the features were suggestive of acute pancreatitis. These pancreatitis cases were categorized into mild, moderate and severe based on the severity of the condition as determined by reverse Atlanta classification. The outcome parameters were studied and were compared with the reverse Atlanta classification. The outcome parameters that were considered were length of hospital stay, incidence of infection, organ failure and death. So, coming to inclusion and exclusion criteria, inclusion criteria are those patients who were diagnosed with the acute pancreatitis either clinically, laboratory or by ultrasoundographically and patients who give consent for the surgery. Exclusion criteria being patients with a known history of ordinated contrast agent allergies, deranged renal function test, chronic pancreatitis suggested by intraductal calculation, ductal structure and parachemal calcifications, other pancreatic pathologies like pancreatic cancers or cysts and patients with a history of pancreatitis surgery and pregnant women. So, coming to few of the representative images. So, here we have an axial CECT image showing multiple small necrotic collections in the head, body and tail region of the pancreas, consistent with the acute necrotic collection. And here is another image of axial CECT showing a large heterogeneous, particularly enhancing cystic collection in the anterolateral aspect of head of pancreas. And also we can see a residual pancreatic tissue around the middle and the superior aspect of the lesion, consistent with the walled of necrosis. So, next is an axial CECT image showing bulky edematous enhancing pancreas indicated by an arrow with fluid collection in the lesser sac and peri-pancreatic fat stranding. And next is an axial CECT image showing a small fluid collection in the head of the pancreas indicated by an arrow consistent with the pseudo cyst. So, coming to results, the study included 30 patients with acute pancreatitis and they were followed up till the discharge, death or dama. The age group of the patients was 18 to 70 years with the maximum patients being 30 to 40 years. Majority were meals accounting for about 76.7 percentage. And the most common etiology for acute pancreatitis was alcohol and the most common complication encountered was pleural effusion. So, coming to the age distribution, so out of total 30 patients, four patients were aged below 30 years and 14 patients were aged between 31 to 40 years. And nine patients between 41 to 50 years and two patients between 51 to 60 years and one patient more than 60 years. So, here we can see according to this table, majority of the patients that is 46.7 percentage of the patients were aged between 31 to 40 years. Coming to sex distribution, so majority of the patients out of 30 patients, 23 patients were males accounting for 76.7 percent and females accounting for 23.3 percent. And coming to causes of pancreatitis, so majority of the patients were alcoholic accounting for 73.3 percentage. And the cholerythiasis was a cause in about five patients and idiopathic was a cause in about three patients accounting for 10 percentage. So, coming to CT imaging findings according to reverse Atlanta classification. So, coming to acute necrotizing collection, there were total 12 patients out of which three patients had pancreatic collection, two patients had peripancreatic collection and seven patients had pancreatic and peripancreatic collection. Sustaining that majority of the patients had combined both pancreatic and peripancreatic collection. Two patients had world of necrosis and coming to interstitial edematous pancreatitis. Four patients had without fluid collection and seven patients had with fluid collection and five patients had features of pseudosist. So, reverse Atlanta classification severity grading when we have taken, when we have considered the severity grading majority of the patients that is about 18 patients out of total 30 patients fell in the category of mild acute. Seven patients were categorized as moderate with severe and five patients as severe acute. So, coming to the clinical outcome the first factor that we have considered is the duration of the hospital stay. So, majority of the patients that is 17 patients accounting for 56 percentage were hospitalized for less than five days and nine patients were hospitalized for five to 10 days and four patients were hospitalized for more than 10 days. So, coming to revise Atlanta classification versus the duration of the hospital stay when we have compared. So, mild acute cases that were categorized had the duration of hospital stay of 7.3 plus or minus 2.1 days and moderately severe had 22.6 plus or minus 1.90s and severe acute cases had to be hospitalized for 31.1 plus or minus 4.2 days which indicates the duration of the hospital stay increases with the severity grading. So, coming to revise Atlanta classification versus the organ failure. So, cases that were categorized as mild acute organ failure was absent in all of them and in moderately severe cases two cases had persistent organ failure and five cases did not have any persistent organ failure and five cases out of severe acute class had organ failure. So, when we compare it with the infection, so out of 18 cases that were categorized as mild acute two cases presented with infection and it was absent in 16 cases and moderately severe cases in three patients presented with infection and in severe acute cases five patients presented with infection. So, coming to depth no cases that were death cases were reported in mild acute category and one death was reported in moderately severe category and 10 deaths were reported in severe acute category. So, coming to the discussion part of the total 30 patients included in the study 23 were male and 7 were females and most of them were in the age group of 31 to 40 years. And among the study group 22 patients had acute pancreatitis due to alcohol, five patients due to cholelythiasis and in three patients etiology was idiopathic. In our study 18 patients were classified as mild acute, seven patients were moderately severe and five patients were severe acute as per reverse Atlanta classification. Of the total 30 patients only 12 patients had acute necrotizing pancreatitis and among these majority of about seven patients had acute necrotizing pancreatic and peripancreatic collection. And this is in correlation with the study done by M.W. Freeman et al which stated that necrotizing pancreatitis contributed to 15% of all cases of acute pancreatitis. Among these 12 patients four patients had acute severe pancreatitis as per reverse Atlanta classification whereas majority of the patients had moderately severe pancreatitis of about six patients. And this states that grading and grades in severity of acute pancreatitis is higher in patients with necrotizing pancreatitis. So the length of hospital stay organ failure and infection were significantly more associated with severe grade according to reverse Atlanta classification system. And this finding is consistent with the study done by Samuel R. Fernandez et al out of 11 patients who died. Six patients had necrotizing pancreatitis which suggested the higher mortality rate in necrotizing pancreatitis and this is in correlation with the study done by Petro MS et al. So coming to the conclusion part, reverse Atlanta classification is a standardized classification system that uses easily available CT for imaging and facilitates more precise communication between the radiologist and clinicians to allow better treatment planning. Incorporating reverse Atlanta classification system into everyday practice standardizes terminology and facilitates accurate documentation of range of imaging findings in acute pancreatitis. So these are my references. Thank you.