Conventional MRI Brain Imaging Findings in Children with Attention-deficit/Hyperactivity Disorder (ADHD): A Retrospective Analysis

Background and Objectives: Attention-deficit/hyperactivity disorder (ADHD) is coupled with subtle variations in fronto-striato-cerebellar brain circuits. Although advanced neuroimaging supports these findings, conventional MRI—being broadly accessible and cost-effective—has constrained proven utility in ADHD. This study was done with the objective of describing the frequency and nature of structural brain abnormalities detected on conventional MRI among children diagnosed with ADHD. Materials and Methods: A retrospective study of 154 children aged 1–12 years diagnosed with ADHD (Diagnostic and Statistical Manual of Mental Disorders-5 criteria) at a tertiary care centre in Chennai between January and December 2024 was conducted. MRI (3T, T1-weighted, T2-weighted, and FLAIR sequences) was assessed. Children with comorbid psychiatric or neurological conditions, TBI, metallic implants, or incomplete imaging were excluded. MRI findings were evaluated qualitatively with a focus on the frontal lobe, basal ganglia, and cerebellum. Results: The cohort (mean age 6.29 ± 3 years) was primarily male (83.8%). Comorbidities included autism spectrum disorder (66.2%), speech delay (12.3%), and seizures (3.9%). MRI was reported as normal in 94.8% of cases. Frontal lobe hyperintensities were seen in 3.3%, cerebellar anomalies in 1.9%, and no basal ganglia abnormalities were observed. Only 2.6% of scans showed potentially ADHD-related findings. Incidental observations (e.g., cavum septum pellucidum/vergae) were rare and statistically unrelated to comorbidities. Conclusion: Conventional MRI notices structural brain changes in a small proportion of children with ADHD. Routine use in typical ADHD cases may have limited clinical value unless atypical features are present.