Magnetic resonance imaging brain yield in developmental delay: A developing country perspective

Developmental delay (DD) is an important neuro-morbidity in children affecting the quality of life. MRI plays a crucial role by delineating the underlying structural, metabolic, and genetic abnormalities. To determine the yield of MRI brain in delineating the various underlying abnormalities and etiological factors in children with DD and to correlate these findings with the clinical presentation. This cross-sectional study enrolled 50 children with the developmental delay between 6 months to 6 years of age. The mean age was 31.32 ± 20.56 months. The sensitivity of MRI was 72%. 81.3% of the children with microcephaly had abnormal MRI. The most common underlying etiology was hypoxic-ischemic encephalopathy (42%), followed by congenital/developmental defects and metabolic diseases (10% each). The most commonly involved region of the cerebral cortex was the occipital lobe (44%) because of the high occurrence of coexisting hypoglycemic brain injury, which is extremely common in developing countries and rare in developed countries, with 80% of them having visual abnormalities. Frontal lobe involvement was significantly more in children with abnormal motor findings and behavioral changes. Cortical grey matter abnormalities were significantly more in children with seizures. It is to be emphasized that children with developmental delays should be evaluated with MRI whenever possible. Apart from hypoxic-ischemic encephalopathy, other etiologies should also be looked for. •MRI Brain is a crucial diagnostic tool in developmental delay, with a sensitivity of 72%.•Hypoxic-ischemic encephalopathy is the most common underlying etiology in low and middle-income countries.•Other etiologies contribute to developmental delay in a sizable proportion.•Neuroimaging findings correlate well with the clinical presentation.•Consideration of abnormal clinical findings can further enhance the yield of MRI.•MRI can delineate dual pathology at times, even when the clinical diagnosis is certain.