 Good morning, members of faculty and delegates. My name is Dr. Dhruv Narayan, and I'm a second year radiology resident at Maharishi Markandeswar Institute of Medical Sciences and Research. I'm gonna be presenting my paper today on the role of MRI in differentiating benign from malignant breast lesions using dynamic contrast enhanced MR and diffusion-weighted imaging. So breast cancer accounts for about, is the second most common cancer in Indian women and is a significant cause of worldwide morbidity and mortality. Majority of lesions are benign, and therefore it is important to distinguish the benign from the malignant lesions. Conventional mammography and ultrasound with the cornerstones and diagnosis, however, they have been shown to have a high false positive rate in the detection of breast malignancies and therefore causing unwarranted biopsies. MRI techniques have been shown to have a higher diagnostic accuracy and therefore they can help reduce the number of unwarranted biopsies. Dynamic contrast enhanced images as well as diffusion-weighted images have been used as an adjunct to ultrasound and mammography to increase the diagnostic accuracy as well as monitor the response to all two treatment. The aims and objectives of the study were to evaluate the role of diffusion-weighted imaging and dynamic contrast enhanced imaging in differentiating between benign from malignant lesions and comparison of our findings with the histopathological diagnosis. A total of 30 patients who conducted work included in the study who presented with the palpable breast lump with either positive or negative ultrasound or mammographic findings. The MRI machine used in my study was the Multiva 1.5 Tesla machine with a dedicated breast erectile. Even T2 spare or FATSAT T2-weighted images were obtained in diffusion-weighted images using P values of 0 to 1,000 and ADC were calculated. Dynamic contrast enhanced images were performed with IV gadolinium, a single pre-contrast scan and four post-constructional contrast scans over a period of four minutes and 24 seconds was performed and our findings were compared with histopathological findings. So the results of my study have been tabulated which I'm going to discuss with you. So according to the pathological final diagnosis, out of 30 lesions, 10 were benign and 20 were malignant. Amongst the benign lesions, fibroadenoma was the most common benign pathology while intraducal carcinoma was the most common malignant lesion. All patients with benign lesions were less than 40 years of age while 13 out of 20 patients with malignant lesions were more than 30 years of age. The mammographic findings revealed that majority of the benign lesions were single and unilateral. All the malignant lesions in the study were unilateral. However, four out of 20 were multiple. Most common shape in the study was either round or oval accounting for six out of 10 benign breast lesions, four out of 10 breast lesions, benign breast lesions had irregular shape with cannulomatous mastitis accounting for two of such lesions. In my study, 18 out of 20 malignant breast lesions had an irregular shape on mammography with 11 shrinks back speculations. On mammography, architectural distortion and calcification were uncommonly seen with benign lesions whereas there were far more common with malignant lesions. Similarly, skin thickening and axillary lymphadenopathy also were far more common with malignant lesions as compared to benign lesions. None of the benign lesions showed temperature attraction whereas it was present in eight out of 20 malignant lesions. So mammography correctly characterized six out of 10 benign breast lesions as biolats two and three. However, one case of benanulomatous mastitis, two fibroadenomas and one intraductal papilloma were falsely characterized as malignant by mammography. Mammography correctly characterized 17 out of 20 lesions as malignant, which is biolats four of five. However, three cases of intraductal carcinoma were falsely characterized as benign. Moving on to the MR findings of my study, majority of the benign lesions were in the size range of two to five centimeters while 11 out of 20 lesions were more than five centimeters in size. The most common shape again was either round or oval and accounting for six out of 10 benign breast lesions. Four out of 10 benign breast lesions had an irregular shape with granulomatous mastitis accounting for two out of such cases. In my study, 17 out of 20 malignant breast lesions had an irregular shape with 13 of them showing speculations. So majority of the breast lesions were either hypo intense or heterogenense on T1, which proved to be benign, while 18 out of 20 malignant breast lesions were hypo intense on T1. Six benign cases showed hyper intense signal on T2 while 16 out of 20 malignant cases showed hypo intense signal on T2. On MRI again, architectural distortion and skin thickening was more commonly seen with malignant lesions as compared to benign lesions. However, in one case of granulomatous mastitis, skin thickening was present. One benign lesion also showed nipple retraction, whereas it was present in about half of the malignant lesions. Moving on to the enhancement patterns, six out of 10 benign lesions showed homogenous enhancement out of which three of them were fibrodenomas. Two cases of granulomatous mastitis showed rim enhancement. All the malignant lesions showed heterogeneous enhancement pattern on dynamic contrast images. Only two out of 10 benign preslations showed non-mass enhancement, both of which showed granulomatous mastitis. Two out of 20 malignant lesions showed non-mass enhancement with one case each of intraductal carcinoma and intradobidotarsinoma. The dynamic curve pattern of my lesions over seven out of 10 benign preslations showed a type one curve and the rest showed a type two dynamic curve. 15 out of 20 malignant lesions showed a type three dynamic curve. Four out of 20 malignant lesions showed a type two dynamic curve. One case of intraductal carcinoma showed a type one curve. Eight out of 10 benign lesions did not show restricted diffusion on DWI, whereas two cases of granulomatous mastitis did restrict. All the malignant lesions also showed restricted diffusion on DWI. Now I'm going to be presenting two cases which I have included in my study. This is a case of a 37-year-old female presenting with a lump in the left breast. In this, we can see that left breast shows multiple closely placed lesions in the lower inner quadrant at the seven to eight o'clock position. The masses of your hypointense on T1 and hyperintense on stir images, they also appear hyperintense on T2. The lesion shows slight speculation however no skin thickening, pectoral muscle invasion or chest wall invasion is seen. Slight nipple retraction was observed. On diffusion restriction, on diffusion weighted images, diffusion restriction was noted and a type three dynamic time intensity curve was obtained. This is the second case of an intraductal carcinoma. This is a 35-year-old female who complained of lump in the left breast. Here again we can see that there is a large irregularly shaped lesion with speculated margins in the left retroalular region which appears hyperintense on T1 and T2 images and hyperintense on stir, on spur. The lesion is seen extending superiorly to skin causing skin thickening and nipple retraction. However, no gross invasion of the pectoral muscles of the chest wall could be seen. It restricted on diffusion weighted images and showed a type three dynamic time intensity curve. So several conclusions were drawn from my study which were as follows. Among the benign lesions, fibroadenoma was the most common benign pathology and intraductal carcinoma was the most known malignant pathology. Mammography correctly characterized six out of 10 lesions as benign and 17 out of 20 lesions as malignant. However, three cases of intraductal carcinoma were falsely characterized as benign. MRI of the breast was far more accurate than mammography in differentiating between benign and breast lesions. MRI correctly characterized nine out of 10 lesions as benign and all malignant lesions as barats five. The sensitivity of DWI and dynamic contrast images was calculated as 95 and 95% respectively which remained 95% when a positive result from either of them was accepted as malignant. The specificity of DWI and dynamic contrast was calculated as 95 and 70% which increased to 80% when a positive result from either of them was accepted as a malignancy. Thank you for your time.