 Title of my paper is Role of MR Imaging in the Evaluation of Children with Developmental Delay. AM was to study the role of magnetic resonance imaging in the evaluation of children with developmental delay. Development is a complex and continuous process of maturity, which begins from conception and continues up till maturity, parallel to growth of children. However, during this process, a wide range of etiologies, including genetic, metabolic, endocrinal, vascular, malformation syndrome, traumatic, infectious, toxins and environmental causes can have adverse effects and cause delay in achieving developmental milestones. Clinically, development can be evaluated using four domains, which are gross motor, fine motor, social and language skills. Developmental delay is defined as a significant delay that is more than two standard deviations below the mean in one or more developmental domains. It has significant impact on the quality of life of the child affected. Motor and cognitive development observed in infants and children are considered a rumination of postnatal brain development. Myelination and synaptogenesis are thought to have correlation with the process of postnatal development. The biological correlation can be very well studied using various neuroimaging techniques, especially magnetic resonance imaging, magnetic resonance imaging of brain is the modality of choice in investigating infants and children with developmental delay. Many studies have reported significant percentage of abnormal findings on MRI brain in children with developmental delay. The abnormalities leading to developmental delay can be easily detected on MRI imaging in most children. So ours was a prospective study conducted over a period of two years from September 2019 to July 2021 with a sample size of 100 cases. Patient was positioned in a supine position with head pointing towards the magnet. The patient is asked to lie supine and not to move during the study. Patient was positioned in a head coil and immobilized with cushion. Laser beam was, localizer was entered over glabella. Planes used were axial, coronal and societal. And the sequences used were T1 weighted imaging in axial and societal planes, T2 weighted imaging in axial and coronal planes, flare imaging in axial plane, T1 weighted inversion recovery sequences in axial plane, diffusion weighted sequence in axial plane and susceptibility weighted imaging in axial plane. Out of 100 children with developmental delay, 50 were female and 50 were male. Out of which, 62% were in the less than one year age group, out of which 30 were male and 32 female, 22% were in the 1 to 5 years age group, of which 12 were male and 10 were female, 16% were in the 6 to 16 years age group, out of which 8 were male and 8 were female. So coming to clinical features, 15% of the children had global developmental delay, 27% had motor delay, 33% had cognitive delay, 41% had social delay, 23% had speech or language delay, 7% had seizures and 56% of them had perinatal insult. About 62% of the children with developmental delay had abnormal findings on MRI, 33% of the children had perimentricular leukomalasia, 29% had encephalomalasia, 24% had corpus callosal disigenesis, 8% had dandee walker spectrum, 8% had lichen kephali pachygyria, 19% had lucidistrophy, 53% had delayed myelidation, 24% had isolated atrophic changes, 5% had infection associated changes and 46% had hydrocephalus. Here we can see figure A, B and C showing T2 axial, flare axial and T2 coronal images with perimentricular T2 hyperintensities predominantly in the peritragonal regions and few cystic lesions were also noted within them. These findings are suggestive of perimentricular leukomalasia. Here we can see a flare axial image of a case of diabetes dyke-mesin syndrome which shows left hemiatrophy and the presence of cystic encephalomalasia. Figure B is of the same patient and it is a little T1 image which shows evidence of corpus callosal thinning and figure C is a flare image of a patient with presence of bilateral parietal lob encephalomalasia. Here neosymmetrical altered signal intensities appearing hyperintens on T1 weighted imaging, hyperintens on T2 weighted imaging and flare imaging, predominantly in the bilateral perimentricular white matter and in bilateral subcortical white matter in certain areas and features with resistive of metachromatic leukodystrophy. Here we can see T2 coronal image which shows bilateral shallow sylvanes fissures and axial T1 image where cerebrals hemisphere show abnormal outline with simplification of the sulco-guerral pattern and reduced number of cerebrals sulchi which appear shallow. There was also thickened cerebral cortex and finding the resistive of pachygeria with possibility of torsion infection. Here we can see a sagittal T1 weighted imaging which shows a dilated thyroid ventricle with a normal appearing fourth ventricle and thinning of the corpus callosum. Axial T1 image shows dilatation of the bilateral lateral ventricles and diagnosis was hydrocephalus which was secondary to acudactyl stenosis. Here we can see a T1 axial image of a patient with dandy walker malformation showing hypoplastic vermus and figure B is a T1 serratal image of the same patient showing cystic dilatation of the fourth ventricle with the connection between the fourth ventricle and the enlarged posterior fossa with capillate rotation of the remnant of the vermus. So development delay was going to be a descriptive term for impaired adaptive functioning and sub-average intelligence arising during developmental age group that is less than 18 years of age. Children with developmental delay may demonstrate delay in one or more of the following domains which includes language delay, gross motor delay, fine motor delay or social delay. These children may also tend to exhibit behavioral disturbances such as aggression, self-injury, inattentiveness, defiant sleep disturbances, stereotypic behaviors or difficult temperaments. For neurological and physical friend, they can present with micro or macrocephaly, seizure disorders, antigenital history of IUGR or postnatal growth retardation, prematurity and congenital anomalies. Apart from clinical history, physical examination, chromosomal analysis and biochemical testing, neuroimaging also plays a vital role in the etiological profiling of these developmentally delayed children. The yield of neuroimaging is highly variable ranging from 9 to 80 percent. However, the yield of neuroimaging study increases when it is done in the presence of specific problems such as microcephaly, seizure disorder or focal neurological deficit. The frequency of normal MR brain was higher in older age group. This is probably because the children with developmental delay are identified more frequently when they are younger and probably evaluated earlier. Also some findings such as delayed myelination are recognized in younger children and normalizes later on in life. After evaluating the MRI findings, we segregated the features and divided them into various ethologies as described. Out of 62 who clinically presented with global development delay, 21 children presented with periventricular leukomalasia, 18 children presented with encephalomalasia, 15 children presented with corpus callosum decision assist, 5 children presented with that debokker malformation, 5 children presented with pachygyria, 12 children presented with eukodystrophy, 33 children presented with delayed myelination, 15 children presented with isolated atrophic changes, 3 children presented with infection associated changes and 29 children presented with hydrocephalus. In conclusion, MRI evaluation of brain contributes to the process of diagnosis of etiologies of developmental delay. Developmental delay has wide spectrum of etiology ranging from normal to abnormal. MRI study of brain helps the clinician in proper diagnosis leading to appropriate treatment and also helps in pain in counseling. Thank you.