Background: White matter diseases, also known as leukoencephalopathies, encompass a broad spectrum of disorders prevalent in the pediatric population. Magnetic Resonance Imaging (MRI) is the modality of choice for assessing patients with white matter signal abnormalities; however, diagnosing pediatric white matter disorders poses significant challenges for radiologists. The study aims to assess the role of MRI in defining different patterns of white matter lesions in the pediatric age group.Methods: This cross-sectional observational study was held in the MRI unit at the Radiology Department at Suez Canal University Hospital. The study included 72 eligible infants and children, with MRI evidence of white matter abnormality. Results: Seventy-two infants and children, 35 (48.6%) males and 37 (51.4%) females, showing MRI white matter signal abnormalities, were included in our study. Cases were classified based on MRI white matter signal changes in T1WI and T2WI into two main categories: hypomyelination (21%) and dys/demyelination pattern (74%) with 4 cases (5%) displayed as other different patterns. The sensitivity and specificity of MRI to accurately detect hypomyelination patterns in patients with hypomyelination disorders were 92.3% and 94.9% respectively, yielding an overall accuracy of 94.4%. For dys/demyelination patterns in patients with known dysmyelinating or demyelinating disorders, sensitivity was 88.1% and specificity was 92.3%, resulting in an accuracy of 88.9%. Notably, the classification of dys/demyelination patterns into confluent and multifocal types showed statistical significance; two-thirds of cases with a confluent pattern were ultimately diagnosed as dysmyelinating disorders, whereas two-thirds of those with a multifocal pattern were diagnosed as demyelinating disorders.Conclusion: A thorough assessment of various MRI sequences to determine the pattern and distribution of white matter abnormalities, along with evaluation for associated findings such as basal ganglia, brainstem or cerebellar abnormalities, and cortical malformations, is essential. This comprehensive approach aids in narrowing down the differential diagnosis, establishing a definitive diagnosis, or directing further investigations necessary for accurate diagnosis.

white matter; hypomyelination; dys/demyelination; MRI.