 Hello, everyone, I'm Dr. Andhra La Khartua, post-graduate resident in the Department of Radio Diagnosis, Dr. RML Hospital, New Delhi. The topic of my presentation today is role of MRI in evaluation of pediatric spinal dysraphysm. Introduction, congenital anomalies of spine and spinal cord are collectively termed a spinal dysraphysm. It includes a spectrum of congenital fusion anomalies or one or more dorsal midline structures including skin, subcutaneous tissue, vertebrae, meninges and neural tissue. As a result, there is either absinthe or incomplete fusion of midline spinal enemens. These occur during two to six weeks of gestation. The estimated incidence is about one to three per thousand live birds, however its prevalence has been in decline in the world over the last few decades due to better nutrition for women, folic acid supplementation, improved antenatal care, high-resolution ultrasound for prenatal screening and biochemical markers. Coming to the classification, spinal dysraphysm can be open or closed type based on the presence or absence or absence of overlying skin. In open type, the overlying skin is absent and the nervous tissue and our meninges is exposed to the environment. It is again classified based on the position of the placard. Placard can be beyond the skin surface as in myelomeningosil or hemi myelomeningosil or flushed with the skin surface as in myelosil or hemi myelosil. Closed spinal dysraphysm can be spina bifida cystica where there is a subcutaneous mass or it can be spina bifida occulta where there is no subcutaneous mass. Spina bifida cystica can be fat containing as in lipo myelosil or lipo myelomeningosil or fluid containing as in meningosil or myelosistosil. Spina bifida occulta can be simple as in intradural lipoma, phylo lipoma, tight phylum terminal, persistent terminal ventricle or dermal sinus or it can be a complex dystrophic state which include dorsal enteric fistula, neuroenteric cyst, dastematomyalia, cordal agenesis and segmental spinal dysgenesis. The detection and prompt neurosurgical correction of occult spinal dystrophysm can prevent complications like unirritrack deterioration, infection of dermal sinus and permanent neurological damage. The surgical outcome is better if intervention is carried out before three years of age. Imaging is therefore required to determine the presence or absence of occult spinal dystrophysm so that surgical treatment can be instituted in a timely manner. MRI, due to its multi-planar capabilities, wild field of view, lack of ionizing radiation and superior soft tissue contrast has replaced all other imaging modalities and is necessarily the only investigation required for diagnosis and pre-surgical planning of spinal dystrophysm and its associated syndromes. Ames and objectives of this study was to study the imaging characteristic of spinal dystrophysm on various MRI sequences and to study the spectrum of spinal dystrophysm. The study was conducted in a department in RML Hospital. It is a cross-sectional observational study conducted over a period of 17 months consisting of outpatients and inpatients from the department of neurosurgery and pediatrics with a sample size of 36 cases. Inclusion criteria were children from one day to 18 years with clinical diagnosis of spinal dystrophysm or having cutaneous stigmata such as tuft of hair, hyperpigmentation, dimple on the back, and fatty swelling in the lumbocytril area. Exclusion criteria were post-operative patients and patients who had contraindications to MR like claustrophobic patients or patients with a stroke allergy to intravenous contrast agents. Coming to observation and results, we studied 36 patients. Of the patients ranged from 4 days to 18 years. Most of the patients were below 5 years of age and there was a female predominance in our study with 52.8% of the patients being female. Children with suspected spinal dystrophysm can present with various clinical features such as swelling on the back, skin dimple, hemangioma, focal hypotricosis, skin discharge, lower limb weakness, and bladder bowel disturbances. In our study, swelling in the back was the most common clinical presentation present in 77.8% of the cases. Focal hypotricosis was the most common cutaneous stigmata present in 22.2% of the cases. Myelomeningosil followed by diastematomalia was the commonest dystrophysm in our study. Myelomeningosil accounted for 50% of the cases and diastematomalia accounted for 19.4% of the cases. The other anomalies that we encountered were myelosil, meningosil, lipo-myelomeningosil, lipo-myelosil, myelocystosil, dermal sinus, intradural lipo-ma, hemimylomeningosil, and lipoma of the phylum terminal. Out of 36 patients in our study, 20 were of open spinal dystrophysm. Out of these, 18 were myelomeningosil. One was hemimylomeningosil and the other was myelosil. Among these 20 patients, 15, that is 93.8% were associated with chiary malformation type 2. Our three cases of myelomeningosil were associated with diastematomalia type 2. One was associated with persistent terminal ventricle. Two cases were complicated by ventricleitis. Out of 16 patients of closed spinal dystrophysm, 8 had subcutaneous mass and 8 were without subcutaneous mass, that is, spina bifida occulta. Among the 8 cases with subcutaneous mass, we encountered lipo-myelosil, meningosil, lipo-myelomeningosil, and myelocystosil. Among the 8 cases of spina bifida occulta, we encountered dermal sinus, diastematomalia, intradural lipo-ma, fibro lipo-ma of the phylum terminal, and caudal regression syndrome. One case of dorsal dermal sinus was complicated by epidermal cyst. Coming to the images, this is the first case. This is a T2 weighted axial image showing myelomeningosil sac with nerve roots originating from the neural plecord within. This is a T2 sagittal image showing myelomeningosil sac, a low-lying cot, and a serine formation at dorsal level. This is a T2 sagittal section of the brain of the same patient showing a small posterior fossa slit-shaped fourth ventricle, descent of wormace in medallion to the upper cervical canal, tectil-beaking, a prominent mass intermedia, suggestive of arno-carry malformation. The second case is of a 15-year-old child presenting with low backache and a midline skin dimple. This is a T2 sagittal, T1-T2 axial images showing a T1-T2 hypo-intense fibrosceptum extending from the dorsal thical sac at L5 level through a defect in the posterior spinal elements to the subcutaneous plane, suggestive of a dorsal dermal sinus. The next case, it shows a T2 sagittal section showing a posterior spinal bifida defect with CSF intensity sac containing nerve roots attached to the posterior wall of the sac. In the T2 axial sections, we can see two hemicords lying within the single dueral sac, suggestive of split cord malformation type 2. Each cord is having a dilator-central canal, and the right hemicord is herniating into the CSF intensity, a CSF-filled sac. These findings are consistent with hemimilomeningosil. The next case, T2-T1 and T2-stirred images showing a milomeningosil sac with a cystic expansion of the central ependymal canal suggestive of persistent terminal ventricle. The stirred images, there is no suppression of a signal on stirred images suggesting a fluid content. T2-axial image showing cystic expansion of the central canal with two hemicords lying within the dilated central canal in a single dueral sac, suggestive of persistent terminal ventricle and split cord malformation type 2. The next case is of a 10-year-old child presenting with low backache and lower limb weakness shows a T1-T2 hyper-intense lesion at dorsal umbil level. This is suppressing on T1 fat-set image, suggestive of an intradural lipoma. The T1 and T2-axial sections confirm the intradural and extremity location of the mass. In the next case, it shows a sagittal T1 and T2-wetted image showing a low-lying cord with extrusion of meninges and expansion of ventroceberagnus space. The T2-axial section shows proliferation of subcutaneous fat at this level and the placard lipoma interface is outside the spinal canal, suggestive of a lipomyelomeningosal. The next case is of a 6-year-old child presenting with recurrent pus discharge from swelling in the lower back. The axial T2-wetted image shows a T2-hyper-intense tract extending from subarachnoid space at l1 level to the skin surface with formation of a small subcutaneous collection. More cranial sections show a T2-hypo-intense fibrous septum separating the corda equina nerve roots suggestive of dastematomylea type 2. The last case, it shows a T2- and T1-wetted axial image showing two hemicorps lying within two separate dural sacs separated by a midline oscius purge suggestive of dastematomylea type 1. Now to conclude, imaging of spinal dystrophism is complex as various different conditions are involved in it, having variable imaging appearances and organized approach and MRI with its multiple capabilities and a better soft tissue contrast helps in making an accurate diagnosis. Also, since it doesn't involve any ionizing radiation, MRI is considered safe and advanced modality for assessment of spinal cord in all ages and defining complex spinal dystrophism. Thank you.