 Hello everyone. I am Dr. Manisa Ammar from JJ Medical College, Dhawan Kere, Karnataka. I will be presenting a paper on MRI of brain in children with developmental delay. Introduction Development is a continuous process which begins from conception and continues throughout an individual's life. Developmental delay denotes significant delay in one or more developmental domains. It poses a social stigmata upon the child and family. Developmental delay has an estimated prevalence of 1-3% worldwide. Developmental delay needs careful evaluation to ascertain the etiology which is evident in around 50-70% of cases. MRI has evolved over years as one of the most sensitive modalities in imaging a child with developmental delay. Around 60% of the children with developmental delay have an abnormal MRI. Further, MRI provides detailed anatomical evaluation of the brain and also provides information on the extent of myelination and its associated microstructural changes. Identifying the involved brain structures and associated morphological abnormalities guides the clinician in further evaluation of the child which helps them in arriving at diagnosis and appropriately categorize the patient which has significant impact on patient management. Ames and objectives of our study is to identify the spectrum of abnormalities in brain MRI in children with developmental delay and categorize the morphological abnormalities based on age, brain structures and etiological distribution. Materials and methods used This is a prospective descriptive study involving a sample size of 25 children who presented with developmental delay and were referred to our department for brain MRI. Infants and younger children were sedated, older children when cooperative were imaged and sedated. Infants were placed in supine position and head was placed securely in receiver coil. Brain MRI was done using 1.5 tesla MR unit of Philips achiever using seizure protocol. The sequences used were T2-axel and coronal, T1-3D MPR sequence, flare axel, DW and ADC mapping and GRE sequences. Results of the study Our study involved the evaluation of 25 children between 6 months and 10 years of age who presented with developmental delay. The study revealed a significant number of children who presented with developmental delay were between the age group of 3-5 years. That is 10 children were in the age group of 3-5 years among the total 25 children who were studied. Followed by 6 children were in the age group of 6-8 years and 5 children were in the age group of 1-2 years. The other subgroups were less than number of children that is 4 in the age group less than 1 year and 1 child was between the age group of 9-10 years. Further, the association of positive MRI findings prevailing among the various age groups were studied. It was noted that among the 10 children in the age group of 3-5 years, 7 had abnormal brain MRI findings and among the 6 children in the age group of 6-8 years, 4 had abnormal MRI findings. And it was also noted that among the 4 children among the 5 total in the age group of 1-2 years had abnormal brain MRI findings. It was concluded that there was significant association between the most common age of presentation and abnormal brain findings. That is most common age of presentation was 3-5 years where total of 10 children were present and among which 5 had abnormal brain MRI findings. Sorry, 7 of them had abnormal out of 10, 7 of them had abnormal brain MRI findings. The p-value in that study was less than 0.05 which suggested there was significant association between the most common age of presentation and abnormal brain MRI findings. Next, coming to involved brain structures, the MR images were evaluated in detail with regard to various structures involved in patients presenting with developmental delay. The various structures studied were ventricles, corpus callosum, gray matter, white matter, basal ganglia, limbic system, brainstem, cerebellum and cranial vault. These were evaluated systematically based on the reference study of Vidja et al. Our study revealed abnormalities of white matter in 50% of the patients. Ventricular abnormalities were seen in 37%, corpus callosum was involved in 24%. Gray matter abnormality was seen in 13%. Limic system, basal ganglia, brainstem and cranial vault were involved in 3, 5, 2 and 4% respectively. Other structures like vermus, cerebellar, tonsil, subarachnoid, spaces and systems and coroid prexs were noted in a few other cases that is 10% of other cases. Next, the various MRI findings and the diagnosis were categorized based on the reference study design of William et al. The prevalence of abnormal MRI findings was about 78% among the total evaluated children. Among the children with abnormal brain MRI findings, Leven had non-specific imaging findings. Ideological categorization revealed that there was 78% of the children that is 19 among 25 had abnormal MRI findings and 22% that is 6 cases had normal MRI brain findings. Out of the abnormal, 10 cases that is 50% had findings consistent with neurovascular diseases, most commonly hypoxic, ischemic and cephalopathy. The proportion of children with congenital and developmental disorders was 12%. Neoplastic and cystic lesions was around 3% and non-specific imaging findings were seen in about 11% of cases. One case that is 2% of the total showed combined or multifactorial etiology. These are the images of few representative cases. Axl-T2 weighted MR images of 5-year-old late preterm male child who presented with seizures and developmental delay showed positive bilateral periventricular white matter with chiral thinning that is periventricular leukomalacia in a case of hypoxic ischemic injury. This is a sagittal T1 weighted MR image of 10-year-old preterm male child who presented with developmental delay. There was thinning of the posterior body and spleenium of corpus callosum which was a sequelae of hypoxic ischemic injury. The child also had features of pVL not seen in this section. This is the Axl-T2 weighted MR of 2-year-old preterm male child who was a known case of congenital heart disease who came with complaints of developmental delay. The image shows prominent sulci ventricles and thinning of cerebral hemispheres, thinning of cortex, a case of cerebral atrophy. This is Axl-T2 weighted and T1 weighted MR images of 4-year-old term female child with developmental delay. There is a CSF signal intensity noted in the floor of third ventricles. The lesion showed no evidence of diffusion restriction. It was a case of arachnoid system. Axl-T2 weighted MR image of 1-year-old term child with developmental delay, seizures and hypotonia. The image shows hyperintensity in bilateral lentiform, nucleus antrolateral thalamai and corona radiata feature suggestive of profound hypoxic injury. Hypoxic ischemic injury. Discussion. The study results of our study were compared with reference studies such as the studies by Ali et al, Kaul et al, Vijja et al and women et al. The proportion of children with normal and abnormal brain MRI findings in our study was 22 and 78% respectively. This was compared with the reference studies which I mentioned. The results were comparable to all the studies that is Ali et al, Kaul et al and Vijja et al. However, the study by women et al showed a larger number of children with normal brain MRI findings. That is in our study it was 22% had normal whereas in this study the 41% was normal. This could partly be because of relaxation of the upper age limit in the study of women et al where the reference age group was 2 months to 15 years and larger sample size that is N equals 580 was used in that study. Now, comparison of involved brain structures. Various involved brain structures were compared with the results of other studies which I mentioned earlier. Our study showed abnormalities of white matter in 50% of children. Corpus callosum was involved in 24%, ventricles involved in 37%, grey matter at 13%. In a study by Ali et al white matter was involved in 58% and corpus callosum was involved in 60% which were comparable to the study results of our studies. In another study by Vijja et al the white matter abnormalities was seen in 26% of the children. The corpus callosum was involved in 44% ventricles in 48%. Our study showed increased proportion of children in white matter abnormality. Here only 26% was involved but our study showed 50% involved. This could be because of smaller sample size of our study design. Comparison of various categories is next. The categories based on morphological abnormalities on MRI were compared with the reference studies which I mentioned. In the study by Ali et al most common abnormality encountered was neurovascular diseases because of hypoxic ischemic encephalopathy. Our study also showed most common abnormality being hypoxic ischemic encephalopathy with the percentage of 50%. This percentage and the other categories were comparable in both studies. In study by Momen et al the most common categorical abnormality was again neurovascular disease like hypoxic ischemic encephalopathy which accounted for about 38%. Which was comparable to our study percentage of 50%. Other variables also were comparable to our current study design. In conclusion the current study was undertaken to evaluate the spectrum of abnormality on MRI in children with developmental delay. Out of 25 children evaluated in our study 9 were in the age group of 3 to 5 years. Further these children had an associated abnormal MRI in most cases. Around 78% of the children had an abnormal MRI in our study. The various involved brain structures were also studied systematically. White matter was involved in 50%, ventricles in 37% and corpus callosum in 24% of cases. The various MR abnormalities were categorized and category of neurovascular diseases due to hypoxic ischemic encephalopathy showed the highest proportion of children in our study with 50%. That too with an increased incidence in the age group of 3 to 5 years. Most of the cases were sequelae to, as I mentioned earlier, were sequelae to hypoxic ischemic injuries. MRI has good sensitivity in diagnosing various disorders associated with developmental delay. Careful evaluation of the MRI helps identifying most probable etiology in most, if not of all cases. Additional clinical variables also add on to the diagnostic accuracy of MRI. These are my references. Thank you.