 Greetings everyone, I am Dr. H.H. Tiaghi, President of Department of Radiology, J.J. Medical College. Today I will be talking about the Neuroimaging of Leaks Syndrome, a case series and review of literature. Leaks Syndrome is a rare degenerative disease with incidence of 1 to 40,000. Leaks is defined as neurodegenerative disease with variable symptoms is caused by mitochondrial dysfunction from genetic defects accompanied by CNS symptoms. Variable symptoms include psychomotor delay or regression, hypotonia, strabismus, nystagmus and feeding difficulty. There can also be cerebrarytexia and lactate acedemia. Even if there is heterogenicity in clinical, genetic or biochemistry findings, imaging findings are usually identical, which are bilateral, symmetrical, necrotic lesions associated with demyelination, gliosis and basal ganglia, brainstem and cerebellum. Here we review the imaging findings of patients suspected with Leaks Syndrome, which were little confirmed for the same by Ray's Serum and CSF lactate levels. MRS was done with single voxel in basal ganglia or on the lesion. Case 1 is of a 2-year-old male patient which shows corded and putamen T2 flare hyperintensities with diffusion restriction. Also, there were symmetrical T2 flare hyperintensities in bilateral medullary white mother tribes. There was double lactate peak in corded nucleus on MRS. Case 2 is of a 6-month-old patient in which MRI shows symmetrical T2 flare hyperintensities in bilateral corded lentiform nucleus, which also shows diffusion restriction. MRS shows reduced NAA and double lactate peak. In our third case of a 4-year-old male patient shows T2 flare hyperintensity in bilateral putamen, corded, tegmentum and peri-acudactyl region, which shows diffusion restriction and double lactate peak on MRS. Another case of a 3-month-old male patient shows bilateral symmetrical T2 flare hyperintensities in basal ganglia, which is showing diffusion restriction and MRS shows decreased NAA and double lactate peak. A case of a 6-month-old shows diffusion restriction in basal ganglia with similar findings on MRS. This is a case of 2-year-old patient which shows T2 flare hyperintensities in bilateral peri-acudactyl gramata, dorsal pons and the tracts of brain stem. MRS shows double lactate peak on the lesions. This is a case of 5-month-old male patient which shows bilateral symmetrical T2 flare hyperintensities in corded and dorsomedial aspect of thalamus, peri-acudactyl dentate nucleus, which are showing diffusion restriction. There are other MRI findings of HIE also present in our case. On MRS, it shows double lactate peak. Most common location involved in our study is corded and putamen, followed by mid-brain. In all the cases of clinically proven leak syndrome, thalamus was spared in all our cases except the case with HIE. Coming to the discussion, leak syndrome is a clinical phenotype of mitochondrial disorder with the following diagnostic criteria. It is a neurological disease with progressive nature, clinical manifestations of disease of brain stem and basal ganglia, radiologically symmetrical lesions in basal ganglia and brain stem, elevated blood or CSF lactate levels. The most common areas involved are basal ganglia, thalamai and brain stem. In our study, there was significant sparing of thalamai which is not coordinating with the other study staff. A significant of lower brain stem suggests the progression of disease into advanced stage and may lead into occurrence of respiratory failure and sedum death. Environment of cerebrate white pattern is also indicator of progression of disease into late stage. Other lesser common neuroimaging findings may include unifocal or multifocal infarctions, diffuse supratentural eucodystrophy, diffuse of focal cortical atrophy or may also show prominent cerebellar atrophy. So coming to the conclusion, leak syndrome is a rare metabolic disease of newborn. Specific imaging pattern of involvement and specific clinical history can help in prom diagnosis. Involvement of bilateral basal ganglia is most common finding followed by midbrain and sparing of all thalamai in our cases of leak syndrome in our institute. In many Indian institute, due to lack of molecular and higher investigation, clinical feature and neuroimaging remains mainstay method of diagnosis of leak syndrome. These are my references. Thank you.