 Hello everyone, now my is Dr. Venanta Suryam, post graduate resident second year, studying at KVGMCH Medical College Azulia Karnataka. Today my paper presentation is on the topic Diffusionated Imaging, Effects of Intervascular Contestation on Apparent and Diffusion Coefficient, that is ADC value measures in cases where in new presence. So my guide is Dr. Aishwarya K.C., Professor of Entityology, Department of Radio Diagnosis, KVGMCH College. So coming to the introduction, we all know that organ tumors are the leading indication for gynecological surgery. So characterization of organ masses pre-operatively is very crucial for explaining patients about possible treatment plan, especially the surgical part. So MRI plays an important role and it is of great help in identifying the malignant patients before surgery, particularly when adjacent findings are suboptimal or indeterminate. So MRI can help reveal the morphological characteristics of lesion, including the papillary projections, nodular antiseptic, soluble portions, and signal intensity on T1 and T2 weighted images. But based on these basic sequences, we will not be able to distinguish between the venine and malignant tumors. So there comes a role of division weighted imaging, where it can help us to characterize the lesion, whether it is venine or malignant in nature. So diffusion weighted imaging is sensitive to changes in the micro diffusion of water into both intracellular and extracellular spaces. So ADC values, that is, differences in the upper-end diffusion coefficient of venine and malignant complex adnexal masses have been reported to have certain proven value in certain studies. So typically malignant-oriented tumors demonstrate lower ADC values than venine neopasms, reflecting the higher cellular density. And the effect of gadolinium or contrast studies on ADC measurements is not well understood, and previous studies have shown certain mixed results. And given the mixed results in the current literature, more information is needed to optimize MR protocols by determining whether performing DWI, pre or after the administration of contrast, whether makes it any differences for the evaluation of the tumors. So aims and objectives of my study is to determine whether ADC values of organ tumors measured at 1.5 Tesla MRI, before and after administration gadolinium contrast, this makes any difference, and also to determine ADC values in cases of venine and malignant tumors. So metals and methods I conducted my study at KVC MCH college, and it's a prospective study conducted over a period of 15 months. And study population included women with newly diagnosed organ tumors who underwent contrast MRI to evaluate the nature and extent of the tumor. And the sampling method included universal sampling and 40 patients were included in my study, along with for the final calculation four patients were excluded from the data. So methodology of data collection, inclusion criteria of women from the venicopathy, who refer for the evaluation of organ neoplasms for the contrast in the MRI, and those with a normal RFT, that is normal serum creatinine values. Expression criteria include patients who failed to follow up in our institute with histopathological reports, and also pregnant women were excluded from the study. So methodology, MRI was performed at Phillips 1.5 Tesla machine using the dedicated MRI protocol. So basic sequences, all basic sequences like T1, T2, T1, FATSAT sequences were obtained and a deficient weighted imaging was done before the administration of dynamic contrast. And after nine minutes of administration of dynamic contrast imaging. So data collection performed according to the hospital regulations after the approval by the hospital authority sign. Also consent of the patient was taken. Statistical analysis was done using Microsoft Office Excel 27 and IBSS software version 21. And data will be presented in the form of tables and percentages. Eight meters will be used to assess the statistical significance. So P value less than 0.05 will be considered significant. So results of my study include median age of the patients aged, the people were divided into different groups that is 20 to 40 years, 40 to 60 years and more than 60 years. And we could see that patients were more than age of 60 years were 19 patients and majority of them were the patients who were aged more than 60 years. And over into us were catarys into two types that is benign tumors and malignant tumors. Benign tumors in my study were 21 and malignant tumors were 15 in number. And according to the size, so majority of the tumors were between 10 to 20 centimeters. And some of you tumors were also there, which were which exceeded more than 25 centimeters in size. So coming to the results of my study, so that is basically I took the ADC values before the administration of contrast and after the measured ADC values after the administration of contrast in cases of benign tumors and malignant tumors. So according to the data, so which I collected, so benign tumors, number of lesions for 21 among them serious study number within business is a study number of eight, and others first fiber thick comma sister in fiber mind that tumors one in number. So pre contrast ADC range for different type of tumor was tabulated, and we can see that for Benign tumors, the pre contrast ADC range was 0.48 to 2.21 and average being 0.48. And post contrast ADC range range from 0.20 to 2.32 and post contrast ADC mean was 0.4 plus or minus 0.62. And the difference in the ADC between the of the over in the benign or in tumors pre contrast and post contrast was 0.08 that is 3.4 percent and P value obtained was 0.86. That is it is more than 0.05. So it is not statistically significant. Similarly, we tabulated the findings for ADC values for the malignant tumors. And then in my study 15 malignant tumors per pound among them six for six serious study more business study more were three number two were serious borderline tumor other was business borderline tumors clear cell adenocarcinoma endometroid adenocarcinoma and then also cell tumor. So the main ADC pre contrast ADC value for the malignant tumors raised from 0.912 plus or minus 0.20 and post contrast mean ADC was 0.94 plus or minus 0.23. So difference in ADC was 0.03 plus or minus 0.21 that is 1.6 percent and P value was 0.3. That is it is again more than 0.05. That is it is not again statistically significant. So similarly the ADC values were obtained for solid and cystic components separately for ADC in case of malignant and benign tumors in solid components. We can see that the ADC malignant tumors, the P value before and after contrast administration was also not significant and similar was the case in case of benign tumors and for the cystic components also the statistical significance was not obtained. So for the pre and post contrast image in cases of cystic components of a lesion. So coming to the discussion of my study. So DWI is increasingly being incorporated into MRI protocols due to its potential for improving characterization of ovarian lesions. However, controversy still exits regarding the effects of cadolinium based contrast agents on the measurement of ADC. So in our study ADC values were not significantly different from dynamic contrast imaging MRI sequences in ovarian tumors, that is they were not statistically significant. So which is in agreement with a majority of the previous studies that found no statistically significant change in ADC values after the contrast administration. And several factors for study design may explain why ovarian tumor ADC values were not statistically were not significantly affected by the contrast, because there are some limitations of my study. So this is because we investigated only a single delay post contrast dynamic weighted imaging at a point time of nine minutes after the injection. And one only one type of contrast agent was used that is cadopentated di-glomine other agents may produce different findings and this was not in a tabulated in my study. Furthermore, the number of B values was limited due to the scan time restrictions and we could measure only the ADC values of diffusion weighted imaging of B0 and B800. Only these two diffusion weighted values were included in the study and cadolinium is known to reduce the signal to noise ratio. As a result, the DWI images may have a lower SNR closer to the noise flow and result in an artificially increased or decreased or at higher B values ADC evaluation. So conclusion of my study is that ADC measures using our approach were not statistically significant or they were not significantly changed after the administration of ovarian tumors at 1.5 Tesla MRI. So finding support the possibility that diffusion weighted imaging optimized maybe obtained before or even after the administration contrast MRI without compromising important clinical information. And also we found in our study that benign ovarian tumors at higher ADC values compared to the malignant tumors are consistent with some of the previous studies. So I also tell that further studies are needed to support our study because our study now add a very limited number of samples. So finally to conclude and so two conclusions which were drawn from my studies that one is that the benign tumors ADC are more when compared to that of the malignant tumors and ADC values did not significantly differ. So you can please differ when measured before the contrast administration or after the contrast administration. So these are my references. Thank you. Thank you Anand. I especially thank Hong Kong Update CME 2022 and also HIRIA Masterclass India for giving me this wonderful opportunity for my paper presentation. Thank you.