 Warm greetings to everyone. Today, I, Dr. Tanvi Priyam, will be presenting my scientific paper on magnetic resonance imaging changes of brain in Wilson's disease and its correlation with the clinical features. Wilson's disease is an autosomal recessive disease involving a defect of copper metabolism due to mutation of ATP-7B gene on chromosome 13-Q14.3. Neurologic Wilson's disease is one of the major forms of disease, and the neurologic manifestations include cognitive defect, extra-paramidal and pyramidal features. MRI of brain is a sensitive method to evaluate the neurological involvement in these patients. The terminal involvement is most commonly noted in patients of Wilson's disease, followed by Cerebrin atrophy. Aims of the study were to describe the range of abnormalities in brain magnetic resonance imaging of patients with Wilson's disease having neurological manifestations and its correlation with clinical findings. And to evaluate the sensitivity of different MRI brain sequences in identifying the lesions in these patients, methods, an observational study was conducted on 23 patients with Wilson's disease having neurological manifestations. Inclusion criteria, patients of Wilson's disease having neurological manifestations attending the Neurology or General Medicine Outpatient Department in Neelratan Sarkar Medical College and Hospital and referred to the Department of Radiodiagnosis for brain MRI. The diagnosis of Wilson's disease was based on characteristic clinical findings, presence of KF ringman slit lamp examination, low serum seroloblasmin level, and 24-hour urinary excretion of copper more than 40 microgram per day. Exclusion criteria was set as Wilson's disease patients with incomplete clinical data are not having cranial MRI scans and patients having only hepatic manifestations. After screening the patients according to inclusion criteria, a detailed clinical history and family history was taken, thorough neurological examination was done and all the patients were screened for contraindications to MRI scan before the procedure. Then the patients underwent MRI study of brain on GE sigma HDE 1.5 Tesla MRI scanner. The pulse sequences used were T1 sequence, T2 sequence, T2 weighted flare sequence, and diffusion weighted imaging. The results of the study were as follows, a total of 23 patients of Wilson's disease having neurological manifestations were included, out of which 15 patients were male and eight were female. The median age of patients was 15 years, the main duration of illness was 19.2 months, median age of onset for neurological symptoms was 12 years. Neurological symptoms were present in all patients included in the study. The most common neurological manifestation noted was oromandibular dystonia followed by tremors. Findings for MRI study of brain, MRI study of brain was abnormal in all the 23 patients. The lesions were hyper intense on T2 weighted images and in T2 flare sequences, whereas in T1 weighted images, the lesions appeared hyper intense. The commonest site of involvement noted on MRI study of brain was putamen seen in 20 patients. The other sites involved were caudate region, brainstem, globus pallidus, thalamus, cerebral cortex, subcautical white matter and cerebellum. Cortical atrophy was present in 26% of all the patients. Among all the sequences used in MRI study of brain, T2 and T2 weighted flare sequences were found to be the most sensitive. Among these two sequences, lesions were however more prominent on the flare sequence. T1 sequence had the lowest sensitivity in revealing the abnormalities. The overall sensitivity of different sequences have been tabulated below. The following table shows site of MRI lesions in patients of Wilson's disease with neurological manifestations and the associated movement disorders. The other clinical correlations found were thalamic lesions correlated with choreoethytosis but not with dystonia and tremors. Choreoethytosis also showed correlation with lesions in globus pallidus and putamen. Number of MRI lesions correlated with age at presentation, tremors and choreoethytosis. The following images are representative cranial MRI findings in the patients with Wilson's disease having neurological manifestations. Image A shows basal ganglia hyperintensity on T2 sequence. Image B shows pontine hyperintensity on T2 weighted axial image. In Image C, cortical and sub-cortical hyperintensity on T2 sequence involving bilateral, parito-oxypetal region and the right temporal lobe is seen. Image D is a T1 weighted sequence showing cortical atrophy. The following are sections from MRI brain of a 15-year-old male patient with Wilson's disease having neurological manifestations. Image A shows bilateral putamenal and cortate region hyperintensities in the axial T2 weighted image. This is the flared T2 weighted image showing bilateral putamenal and cortate region hyperintensities. However, in the T1 weighted images, we do not see lesions to be as prominent as seen in T2 and flare sequences. Hyperintensity is also noted in midbrain region in the axial T2 weighted sequence. This is the axial T2 weighted flare sequence showing the hyperintensity in the mid brain region even better than the T2 weighted image. The face of giant panda sign can be very well appreciated here, but the axial T1 weighted image at the similar section doesn't show prominent hyperintensities. The following are sections from the MRI brain of a 24-year-old female patient. Image A and B are T2 weighted axial images showing bilateral hyperintensities in the head of the cortate nucleus, putamen, and thalamic regions. Image C and D are axial T2 weighted flare sequence images showing bilateral hyperintensities in the similar regions as that of T2. The lesions are much more prominent on the flare sequence as compared to the T2 images. In the axial DWI image, only the right thalamic lesion can be appreciated which showed diffusion restriction with a low ADC value. The following are axial T2 rated flare sequence images from the MRI brain scan of a 47-year-old male patient of Wilson's disease with neurological manifestation showing hyperintensities in bilateral cordate region with diffuse enlargement of cortical sulculae. Image B shows pontine hyperintensity with bilateral anterior temporal lobe atrophy and image C shows prominent sulcied and lateral ventricles which are suggestive of brain atrophy and nonspecific focal hyperintensities in the sub-cortical white matter which can be seen bilaterally. The present study revealed abnormalities in the brain MRI of all patients of Wilson's disease with neurological manifestations. The sequences having highest sensitivity for the lesions were T2 and flare. Puterminal involvement was the most common. Lesions in the region of thalamus, plover spallidus and putermen correlated with choreoethytosis. Number of MRI lesions correlated with age at presentation, tremors and choreoethytosis. The findings of the study were similar to the larger study done by Sinha et al. Other study done by Ranjan A, Kim T. J. and Favadol B also showed similar findings. To conclude, neurological symptoms are common for Wilson's disease manifestation. These manifestations are seen as characteristic signal intensity alterations on MRI study of brain especially in basal ganglia region. These signal alterations can be best picked up by T2 and flare sequences and also correlate with clinical features like tremors and choreoethytosis. Therefore, MRI study of brain can be an important tool in studying the neurological involvement in patients of Wilson's disease. These are few of the references used. Thank you very much.