PURPOSE: The purpose of this study was to evaluate the usefulness of FLAIR(Fluid Attenuated InversionRecovery) MR imaging in childhood adrenoleukodystrophy by comparing with those of T2-weighted FSE imaging, and tocorrelate MRI finidings with clinical manifestations. MATERIALS AND METHODS: Axial FLAIR images(TR/TE/TI=10004/123/2200) and T2-weighted FSE images(TR/TE=4000/104) of brain in six male patients(age range :6-17 years, mean age : 10.2 years) with biochemically confirmed adrenoleukodystrophy were compared visually by tworadiologists for detection, conspicuity, and the extent of lesion. Quantitatively, we compared lesion/CSFcontrast, lesion/CSF contrast to noise ratio(CNR), lesion/white matter(WM) contrast, and lesion/WM CNR betweenFLAIR and T2 weighted image. We correlated MR findings with clinical manifestations of neurologic symptoms andevaluated whether MRI could detect white matter lesions in neurologically asymptomatic patients. RESULTS: Visualdetection of lesions was better with FLAIR images in 2 of the 6 cases and it was equal in the remainders. Visualconspicuity and detection of the extent of lesion were superior on FLAIR images than T2-weighted images in all 6cases. In the quantitative assessment of lesions, FLAIR was superior to T2-weighted image for lesion/CSF contrastand lesion/CSF CNR, but was inferior to T2 weighted image for lesion/WM contrast and lesion/WM CNR. In one case,FLAIR images distinguished the portion of encephalomalacic change from lesions. MR findings ofadrenoleukodystrophy were correlated with clinical manifestations in symptomatic 4 cases, and also detected whitematter lesions in asymptomatic 2 cases. CONCLUSION: MR imaging with FLAIR sequence provided images that wereequal or superior to T2-weighted images in the evaluation of childhood adrenoleukodystrophy. MRI findings werewell correlated with clinical manifestations and could detect white matter lesions in neurologically asymptomaticadrenoleukodystrophy patients.