 Hello everyone, this is Dr. Anavits from the Department of Radiative Diagnosis, M.M. Sierra Mysore. I would like to thank Indian radiologist for giving me this opportunity to present the role of magnetic resonance imaging in diagnosis and staging of patients with CSRVICS. Coming to abstract, the background of this study was we wanted to evaluate the efficacy of MRI in assessment of important diagnostic factors in carcinoma cervix like tumor size, involvement of pyrimatrium, involvement of pelvic sidewall, adjacent organs and nodal status and how we targeted the plan of management and correlate MRI findings with clinical figure staging and CSRVICS. Materials and methods, this was a hospital based cross-sectional study conducted among esophageal and pulmonary cases of CSRVICS presented to the department of radiodiagnosis attached to M.M.C.RI for 18 months from January 2022 to June 2021. Coming to introduction, CSRVICS is the most common gynecological cancers in India and second most common gynecological cancer worldwide. It predominately affects the multiparous woman and is transmitted by HPV. MRI can tell accurately about the urinary bladder and rectal invasion by CSRVICS. Therefore invasive procedures such as gystoscopy and zygmodoscopy can be avoided by using non-invasive diagnostic modalities like MRI. MRI is not only useful for preoperative staging but also it helps in identification of recurrent residual tumors in treated patients. Radiological staging by MRI is better than clinical staging most of the time. These were to evaluate the efficacy of MRI in assessment of important prognostic factors in CSRVICS like tumor size, paramedic involvement, pulmonary sidewall involvement, adjacent organs and auto status and how it utters the panoponism. And the other objective was to correlate the figure staging. Inclusion criteria, histopathal script proven cases of CSRVICS refer to the department for MRI imaging. Exclusion criteria was the patients who were with cardiac pacemakers, new implants, new lips within the body and other contraindications of MRI like lot of those patients were excluded. The third of data collection was HPE proven cases that were referred to our department. Scan was done using 1.5 Tesla G Optima MR3 system machine. Therefore the minimum, after the calculation the minimum sample came around to be 30 due to the availability of cases. The data we took 50 patients who were YPC proven CSRVICS case. In the statistical analysis, categorical data were represented in the form of frequencies and proportions. The CHI score test was used as test of significance for qualitative data. Contest data was represented as mean and standard deviations. An independent T-test was used as a test of significance to identify the mean difference between two quantitative variables. The p-value of LSN 0.05 was counter-statistically significant assuming all the rules of statistical test. MSXL, SPSS version 22 were used to analyze the data. Results of the total of 50 patients who were YPC proven CSRVICS were included in the study. Both newly diagnosed and treated with chemotherapy were included. FICO stage was assigned both clinically and with MRI and the parameters were combined. The two categories of patients were considered for the study that is 18 newly diagnosed patients that forms 36% of the study population and 32 treated cases which formed 64% of the study population. In our study, majority of the patients that is 90% of the study population were married, 10% were unmarried. The age group of patients in the study varied from 36 years to 73 years. In general, majority of the patients belong to this age group of 41 to 50 years that is 38% of the study population. Pollered by 51 to 60 years that is 32% of the population, 11 patients belong to more than 60 years of age, 4 patients belong to less than 40 years of age. Among the newly diagnosed cases, majority of them belong to the age more than 60 years and the age group 41 to 50 years. But among the recurrent cases, the common age group was 41 to 50 years and the 51 to 60 years. The most common presenting symptoms were wide discharge according to the R study seen in about 58% of the population, followed by lower abdomen pain seen in 52% of the patients. In our study, the majority of the patients that is 29, which formed 58% of the study belong to post-maramposal group. 15% belong to pre-maramposal group. 6 patients had undergone total, sub-total hysterectomy. Leather therapy was given to 32 patients totally and most of them, that is 10% 10 patients which formed 31%, were referred for MRA during the follow-up by more than 5 years. Hydrohydro-HIN is an indirect sign of pelvic-side wall invasion and was noted in 7 patients, that is 14% of the cases. Out of these 7 cases, 4 were new cases and 3 were recurrent cases after treatment. In our study, hydrometer was present in 20 cases, that formed 40%. Among these, 10 cases were newly diagnosed and 10 patients were post-treatment cases. Among the 10 post-treatment cases, 9 had a demonstrable massage on MRA. In our study, there were 18 biopsy-prone new cases. Clinically, mass was identified in 16 cases and was not suspected for 2 cases. Out of 16 cases with clinical suspicion of mass, MRA showed presence of mass in 15 cases. MRA was not able to detect one clinically suspected case. MRA showed the presence of mass in 17 cases, including those 2 cases where there were no clinical suspicion. The accuracy sensitivity, positive critical value, thus came around 83%, 88% and 90% respectively. According to the clinical figure staging, the majority of the cases belonged to stage 2B, but according to MRA figure staging, the majority of the cases belonged to stage 4A. No cases were staged as 3C clinically. However, on MRA, 2-3C cases were detected. In our study, significantly, 2 cases were diagnosed as stage 3B clinically and on MRA, they were found to have stage 4B on MRA with bladder rectal emission and distant metastases. One case was diagnosed as 3A. It was found to be 4A on MRA with bladder rectal emission. One case, which was diagnosed as 3B, was found to be 4A on MRA with bladder rectal emission. 2 cases of clinically staged 2 were found to have bladder emission on MRA and hence staged as 4A. One case, which was clinically diagnosed as 1A, showed bladder emission on MRA, just upstage as 4A. One case, which was clinically diagnosed as 4A, with cytoscopy showed bladder emission. Rectal infiltration on Zygmodus came out to be 4A on MRA. Cytoscopy detected bladder emission in only one case. However, on MRA, 7 cases were diagnosed. One patient had both carcinoma of rectum and cervix. Apart from this, one more was identified with rectal infiltration in the Zygmodus scopy. However, MRA showed 3 cases of rectal infiltration. The most common HP type was squamous cell carcinoma, which was present in 94.4% of the newly diagnosed cases and remaining 5.6% constituted by adenosia. In our study, among the 18 newly diagnosed cases, biospeed proven, T2 weighted imaging, diffusion weighted imaging and contrast enhanced imaging showed lesion in 16, 17 and 15 cases respectively. One case did not show T2 hyperintensity or contrast enhancement. However, the lesion was detected in DWI. DWI MRA was able to diagnose 94.4% of the cases. T2 weighted imaging detected 16 cases with form 88%. Contrast images detected 15 cases that form 83.3% cases. A combination of T2 weighted and DWI detected lesion in 16 cases. A combination of T2 weighted and contrast enhancement detected lesion in 15 cases. MRA staging correlated with clinical staging in only 22% of new cases. There was an upstaging in MRA for approximately half of the cases that is 55.5% and downstaging for 22.2% of cases. In our study, considering the 32 post-statement cases, clinically mass was suspected in 24 patients, that is 75% of cases. In 8 cases, there was no clinical suspicion of, but MRA showed the presence of mass in 18 patients out of 24 clinically suspected mass patients. In 8 patients, mass was not suspected clinically, 25% which found 25% of cases. But MRA showed the presence of mass in 2 cases among these 8 cases. The accuracy, sensitivity, specificity, positive and negative predictive values of MRA in recurrent cases were 75, 90, 50, 75, 75% respectively. Squamousal carcinoma was the most common historical type in post-statement cases also, that is in 30%. I don't know if you have seen in 2%. In our study, altogether 20 patients showed lesion on MRA, the number of patients showing lesion on T2, weighted imaging, diffusion weighted imaging and contrast studies were 19, 20, 17 respectively. 3 patients showed T2 hyperneticism and diffusion restriction in the survey. However, in the contrast study, there were no enhancement of tumors in these 3 cases. In one case, imaging was done 2 months after radiotherapy to assess the residual tumor, which was clinically suspected. MRA of the patient showed no obvious lesion on T2, whereas diffusion restriction was noted with earlier RTL phase enhancement in dynamic contrast study. The diagnosis of residual tumor was made for the patient. In our study, the primary group of lymph nodes, that is, parametral obturator, external and internal lymph nodes were involved in 4 patients among the newly diagnosed. A secondary group of lymph nodes was involved in 2 patients. One patient showed involvement of both primary and secondary group of lymph nodes. In the post-statement cases, the primary group of lymph nodes was involved in 6 patients and secondary group was involved in 2 patients. One of the important prognostic indicators is uterine body involvement in patients with CSRX. Of the total 50 cases, uterine body involvement was noted in 21 patients, which found 42% of the studies. More number of cases, 52.3% with stage 4, this was found to have uterine body involvement in our study. 4 cases with stage 3C, 5 cases with stage 2B and only one case with stage 1B showed involvement of lower uterine body. In our study, among the 21 cases with uterine body involvement, 6 showed primary lymph node metastasis and 2 patients showed secondary lymph node metastasis. The mean diameter of the mean size of tumour is another important prognostic pattern. The mean size of the tumour in patients with stage 1B, 2A, 2B was 2.02 cm, 1.6 cm and 4.4 cm respectively. The mean size of the tumour in patients with stage 3C, 4A and 4B was 5.85 cm and 4.5 cm respectively. There was nodal involvement in the mean size of the tumour and it was not seen in cases where mean size of the tumour was 3.4 cm or less. From our study, it was evident that post-radiation complications were more common to develop after 3 years of fetal therapy. The most common post-rarity changes were fatty replacement of bone marrow seen in 7 cases out of 32 RT cases that formed 21.8% of the patients followed by proctitis and cystitis. In new cases, a combination of T2 waiting and DWI detected a lesion in CT cases, a combination of T2 waiting and contrast enhancement detected a lesion in 15 cases. In record cases, a combination of T2 waited imaging, DWI diagnosed 19 cases and a combination of T2 imaging and contrast studies diagnosed 16 cases. For all the newly diagnosed cases, staged with FIGOS system using clinical examination and MRI, the correlation was best for stage 2B disease and a higher staging was given with MRI to clinical stage 1, 2 and 3. Now, critical sensitivity, specificity and positive and negative predictive values of MRI in new cases in our study were 83, 88 and 0%, 93 and 0% respectively. Now, accuracy, sensitivity, specificity, positive and negative predictive value in MRI in recurrent cases in our study were 75%, 90%, 50%, 75% and 75% respectively. Coming to discussion, two categories of patients were considered for study 80 newly diagnosed and 32 treated cases. The most common presenting symptoms was wide discharge seen in 28% followed by low round open. Among the newly diagnosed, majority of them belong to age more than 60 years and between 41 to 50 years but among the recurrent cases, the common age group is 41 to 80 and 50 to 100. These patients must have been diagnosed with disease at an early stage. It is seen that when the life expectancy is more, possibility of recurrence of tumor is also more. The most common histopathic type was SCC, both in newly diagnosed and recurrent cases in our study. It is common cell forming the most majority of the thing correlating with the study done by MITM, LDSE, Nordin et al. 12131 cases of CSRX. In our study, majority of the patients belong to postmanopausal age group. Thus, the disease is more prevalent among postmanopausal men. In our study, totally there were 18 biopsy prone cases. Clinically, most were suspected in 16 cases and not suspected in two cases. However, MRI showed the presence of mass in 17 cases including those cases where there was no suspicion of mass clinically. MRI was not able to diagnose lesion in one case which is there was clinical suspicion. In a study done by Nicolet V, carignanial burden fee of et al shows that stage 1A disease can be staged only at histopathal scale analysis as tumor are not visible at MRI. It was also noted that accurate staging was lacking in cases who underwent histotomy for early stage disease and for benign regions. These patients would be benefited with MRI. Acuracy sensitivity, positive predictive value of MRI in newly diagnosed cases are 83, 88, 93% respectively. The MRI without contrast is reliable in assessing the parametrium and polyxadol invasion. T2 weighting images and diffusion weighted images give good information. Contrast material, contrast analysis T1 imaging has not proved to be more accurate than T2 weighted images in this setting. This is in agreement with the study done by Havigore H et al and Schlider J et al. MRI scores better in delineating the invasion of adjacent organs. In our study three cases were diagnosed as stage 3 clinically and were found to be stage 4A with MRI. Three cases who were staged as 2 were actually found to have bladder invasion. The MRI evolution prevented unnecessary surgical intervention in these patients. Invention of bladder can be ruled out with sufficient confidence with MRI. This was in accordance with study done by Kim et al. For all newly diagnosed cases staged with the FICO system using clinical examination of MRI, correlation was best for stage 2B and higher staging was given with MRI to clinical stage 3. MRI staging correlated with clinical staging in 22%. Upstaging was done in 55% and advanced staging in 22%. This was due to the reason that all these stage 3 disease patients diagnosed clinically had minimal bladder or rectal or invasion, which was missed in clinical cases were misclassified. So MRI is advocated in all advanced cases for proper staging in prognostication. From our study it is evident that there is no definite role for contrast study in all the cases which were newly evaluated. There is no added advantage of contrast over plain study. Among 18 newly diagnosed cases T2W, T2 weighting images, diffusion weighting images, contrast analysis shows lesion 16, 17, 15 cases respectively. DWMRA alone was able to diagnose in 94% cases. T2 weighting in 88% and contrast analysis in 83%. New cases, a combination of T2 weighting images and diffusion weighted images detected lesion in 16 cases. A combination of T2 weighted images and contrast analysis detected in 15 cases. This combination of T2 and DWMRA is better than T2 and contrast study. This was in accordance with study done by Havigost et al. and Shidler et al. who found that there is no added value of contrast in these cases. In our study primary group of lymph nodes was involved in four patients among the newly diagnosed. Secondary was involved in two patients. One patient showed involvement of both primary and secondary group lymph nodes. This is lower than reported by Drescher et al. in this study. From our study involving post-treatment cases, it is clearly evident that there is no added value of routine contrast imaging for all post-treater therapy cases. It has an added value on cases of discrepancies between findings in T2 weighted imaging and diffusion weighted imaging where it serves as a problem solving tool. In our study, although 20 patients showed lesions on MRI, patients showing lesions on T2 images DOEW and contrast studies are 19-20-17 respectively. Diffusion restriction was able to diagnose recurrent lesions. In recurrent cases, combination of T2 weighted imaging and DW is able to diagnose 19 cases. Three patients who showed T2 hyperintensity and diffusion restriction didn't show enhancement of the tumor in cervix. A combination of T2 weighted imaging in contrast study was able to diagnose only 16 cases. Kinkal et al. in his work found that in the first five months after radiotherapy inflammatory chance may be responsible for early enhancement that may mimic recurrence. Thus, there is no added value of routine contrast imaging for all post-treater therapy cases. In our study, MRI helped to exclude the patients with no recurrence of tumor or no residual mass in post-treatment phase so that over treatment of these cases with radiotherapy could be avoided. It also added in the diagnosis of recurrence in two cases which were clinically undiagnosed so that appropriate treatment could be instituted in these cases. One of the patients had pure parameter nodal recurrence with no pelvic mass and MRI helped in diagnosis and staging it as 3C. Procuracy sensitivity, specificity, positive and negative predictive value came around 75-90, 75-75 respectively. In the post-treatment cases, primary group of nodes was involved in six patients, secondary group in two patients. The most important diagnostic indicators are size of the tumor, written body involvement and nodal metastases. More number of cases which stage 4 of the tumor in patients were found to have written body involvement in our study. Thus written body involvement could be directly correlated to the advantage of the disease. Means size of tumor is another important diagnostic pattern as this could be correlated with the stage of disease and nodal involvement. It is also noted that there is nodal involvement if the main size of the tumor crosses 4.4 cm. In our study, hydrometer was current in 20%, among these 10 were newly diagnosed, 10 were post-treatment cases. Among the 10 post-treatment cases, hydrometer was due to cervical stenosis. From our study, it is evident that post-treatment complications are more common to develop after 2-3 years of radiotherapy which also corresponds with the average time of recurrence. Since most of the patients are referred during this time to look for recurrence of tumor, more complications are also diagnosed during this time. The most common post-treatment changes are vital replacement of bone marrow followed by prokaryotes and cystitis. This is the image representation. It is a 55-year-old female, mass is suffix involving lower myometrium hydrometer withening of myometrium metastatic internal iliac lymph nodes and obliteration of fat plane and rectum and bladder infiltration. Stage 3 This is another case. In the non-case of CSRX, post-treatment ill-defined, soft-tastic, solid-cystic mass lesion involving vault, encasing right-terminal lurid, causing proximal hydronephrosis recurrent lesion. Coming to conclusion, MRI is better at demilitating the information of adjacent organs. MRI can replace histoscopy and zygmodoscopy in identifying bladder and rectal imaging. A combination of T2-weighted imaging and diffusion-weighted imaging would be the optimal technique for imaging both new and post-treatment cases. T2 and diffusion-weighted images were the best sequences not only in identifying recurrence but also excluding false positive in already treated patients. The counter-study provides no additional information from our study. The most important prognostic indicator was uterine body involvement in patients with CSRX. Uterine body involvement could be directly correlated with the advanced stage of the disease. These are the references for the study. Thank you.