 Greetings, my name is Dr. M. Krishnarajan from Dr. D. Y. Patel Medical College, Pune. And my guide is Dr. Varsha Rangankar. My topic for the paper presentation is the role of MR imaging in the evaluation of children with developmental delay. So the aim of this study is to study the role of MRI in the evaluation of children with developmental delay. Coming to the introduction, development is a complex process and it's continuous of maturity, which begins from the conception and continues up till maturity parallel to the growth of children. However, during this process, a wide range of etiologies including genetic, metabolic, endocrinological, vascular, malformation syndrome, traumatic, infectious, and toxins, and environmental causes can have adverse effects and delay and cause delay in achieving developmental milestones. Clinically, the development can be evaluated using four domains of gross motor, fine motor, and social and language. Developmental delay is defined as a significant delay that involves more than two standard deviations below the mean in one or more developmental domains. It has a significant impact on the quality of the life of the child that is affected. Motor and cognitive development observed in infants 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 except especially the MR imaging. MRI of brain is the modality of choice in investigating infants and children with developmental delay. Many studies have reported significant percentages of abnormal findings in the MRI of brain with significant developmental delay. The abnormalities leading to the development delay can be easily detected on MR imaging in most children. Place of study was Dr. D. Vi Patel Medical College, Amritsar Center. It was a prospective study. The period of study was from September 2019 to July 2021. The period required for data collection was close to two years. The period required for data analysis and reporting was six months. Sample size involves 100 cases. The study design is an observational and a descriptive study. The study was performed on Siemens Magnetum Vita 3 Tesla. Patient positioning was done in supine position with the head pointing towards the magnet. The patient is asked to lie supine and not to move during the study. Head is positioned in the head coil and immobilized with cushions. Laser beam localized center over the glabella. Planes used for axial coronal and sagittal. Sequences used were T1 weighted image in axial and sagittal planes. T2 weighted image in axial and coronal planes. Flare in axial planes. T1 weighted inversion recovery in axial plane. Diffusion weighted sequences in axial plane and susceptibility weighted sequence in axial plane. So on observation coming to the demography. Out of 100 children with development delay 50% were male and 50% were female. And the age group. So there was 62% were below one year of age. 22% were below between one to five years and 16% were between six and 16 years of age. Amongst which the first 62% there were 30 males and 32 females. And in the age group of one to five, the males were 12 and the females were 10. In the age group of six to 16, males were eight and females were also eight. So on seeing the clinical features, most of them presented with these features, which had global development delay in 15 patients, motor delay in 27 patients, cognitive delay in 33 patients, social delay in 41, speech and language delay in 27, seizures in seven, and history of perinatal insert in 56. And these clinical features were overlapping in these patients. Coming to the MRI findings. So out of 100 children, 62% that is 62 children with development delay had abnormal findings on MRI. The findings were hypoxic ischemic encephalopathy, congenital malformations, congenital disorders, isolated atrophic changes, infection associated changes and hydrocephalus. And in hypoxic ischemia encephalopathy, there were perinatal locomalacia and encephalomalacia. There were 21 patients with perinatal locomalacia, 18 patients with encephalomalacia, which respectively gives a percentage of 33 and 29%. In congenital malformations, corpus callus disgenesis were seen in 24%. Early walker spectrum was shown by 8%. And licensee fairly and Pachygaria spectrum was shown by 8%. Amongst the white matter disorders, there was leukodystrophy and delayed malination, out of which leukodystrophy showed we were seen in 19%. And delayed malination was seen in 53%. Isolated atrophic changes were seen in 24%. Infection associated changes were seen in 5%. And hydrocephalus was seen in 46%. Here as well we are seeing the overlap of MRI findings. So this is a case where on image A, we are able to see, image A is a T2, image B is a flare, axial and T2 coronal. We are able to see periventicular T2 hyperintensity predominantly in the peritragonal regions. And few cystic lesions are noted within them. These are suggestive of periventicular leukomalacia. Figure A is a flare, axial image of a case of David of Dijk syndrome, Mason syndrome, which shows left hemiatrophy, left hemiatrophy, and presence of cystic encephalomalacia. Figure B is of the same patient, which is in sagittal T1 image, which shows evidence of corpus callus tini. Figure C is a flare, axial image of the patient, with presence of bilateral periperitral lobe encephalomalacia. So coming to this, image A is a T1 weighted image that shows near symmetrical altarsignal intensity that appears hyperintense on this image A, which is T1 weighted image. And then it appears hyperintense on T2 weighted image and flare. And it is seen predominantly and it is nearly symmetrical in bilateral, in bilateral periventricular white matter regions and in the bilateral subcortical white matter in few places. This is a suggestive of metachromatic leukodystrophy. Coming here, we are seeing a pattern of Pachygeria, where in T2 coronal image, bilateral shallow silvian fishes are seen. And here in the T1 weighted image, or axial image, cerebral hemispheres show an abnormal outline, the simplification of the sulco gyril pattern and reduced number of cerebral sulchi, which appears shallow. There is also thickened cerebral cortex that is seen. These features are suggestive of Pachygeria, which gives a possibility of a torsion infection. Sagittal T1 weighted image shows hypertylarism and facial dysmorphism with hyperplastic and small mandible. And the third ventricle appears dilated. Here we can see the third ventricle appears electric with a normal appearing fourth ventricle with thinning of cow corpus callus. And in the same image, T1 axial image shows dilatation of the bilateral ventricle. This is a case of hydrocephalus secondary to the aqueductal stenosis. Also here in figure A is an image that is a T1 weighted axial image of a patient of dandy walker malformation showing hyperplastic vermis. Figure B is a T1 weighted sagittal image of the same patient showing a cystic dilatation of the fourth ventricle and collection with an enlarged posterior fossa with cephalid rotation of the vermian remnant. So incidental finding was a coratlexus papilloma in this patient. Coming to the discussion, developmental delay was coined to be a descriptive term for impaired adaptive function and sub-average intelligence arising during the developmental age group that is less than 18 years. Children with the developmental delay may demonstrate delay in one or more of the following domains. These children may also tend to exhibit behavioral disturbances such as depression, self-injury, inattentiveness, defiance, sleep disturbances, stereotyping behaviors, difficult temperaments on the neurological and physical front. They can present with microcephaly, microcephaly, seizure disorders, antinatal history of IUGR or postnatal growth retardation, prematurity and congenital anomalies. Apart from the course, the clinical history, physical examination, chromosomal analysis and biochemical testing, neuroimaging plays a vital role in the etiological profiling of these developmental delays. The yield of neuroimaging is highly, highly variable, ranging from 9 to 80%. However, the yield of neuroimaging studies is increased when it is done in presence of specific problems such as microcephaly, seizure disorders of local neurological deficits. The frequency of normal brain MRI was higher in the older age group. This is probably because of the children with develop and delay are identified more frequently when they are younger and probably evaluated earlier. Also, some findings such as delayed malination are recognized in younger children and normalized later in life. After evaluating the MRI findings, we segregated the features and divided them into various etiologies as described. Out of 62 children who presented with GDD, that is global development, 21 children presented with perimental leukomalacia, 18 children presented with encephalomalacia, 15 children presented with corpus callus disgenesis, five presented with dandy vagumal formation, five presented with pachygaria, 12 children presented with leukodystrophy, 33 children presented with delayed malination, 15 presented with isolated atrophic changes, three children presented with infection associated changes and 29 children presented with hydrocephalus. So in conclusion, MR imaging evaluation of brain contributes to the process of diagnosis of etiologies of developmental delay. Development delay has a wide spectrum of etiologies ranging from normal to abnormal. MR study of brain helps the clinician in proper diagnosis leading to appropriate treatment and parent counseling. These are the few references that I've used which was very helpful for my paper presentation. Thank you.