Cervical Spine MRI Reporting Template (Structured Approach)
Category Key Components to Evaluate Pathological Findings & Imaging Features Clinical Significance
1. Alignment - Cervical lordosis. - Loss of lordosis (muscle spasm, trauma). RA, trauma, or inflammatory
- Subluxation/spondylolisthesis. - Retrolisthesis (degenerative instability). arthritis.
- Atlantoaxial interval (>3 mm - AAS (Atlantoaxial subluxation) in RA.
abnormal).
2. Vertebral Bodies - Marrow signal (T1/T2). - Odontoid fracture (Type II most common). Trauma, malignancy, or
- Fractures (burst, compression). - Metastases (T1 hypo, T2 hyper, degenerative.
- Endplate changes (Modic). enhancement).
- Lesions (metastases, hemangiomas). - Modic changes (Type I-III).
3. Intervertebral Discs - Disc hydration (T2 signal). - Central herniation (cord compression). Myelopathy or radiculopathy.
- Bulge/protrusion/extrusion. - Foraminal herniation (radiculopathy).
- Nerve root/spinal cord compression. - Disc osteophyte complex.
4. Spinal Canal & - Canal stenosis (AP diameter <10 mm - Cervical myelopathy (T2 cord Cord compression = surgical
Cord severe). hyperintensity). emergency.
- Cord signal changes (T2 - CSF flow voids (stenosis).
hyperintensity). - Epidural hematoma (T1/T2 variable).
- Syrinx.
5. Neural Foramina - Foraminal narrowing (nerve root - Severe foraminal stenosis (loss of fat). Radiculopathy (C5-C6 most
impingement). - Nerve root compression (protrusion/spur). common).
- Uncovertebral hypertrophy.
6. Facet Joints - Hypertrophy/arthropathy. - Facet OA (sclerosis, osteophytes). Contributes to
- Synovial cysts. - Synovial cyst (T2 hyperintense). central/foraminal stenosis.
- Effusion.
7. Ligaments - Ligamentum flavum hypertrophy. - OPLL (T1/T2 hypointense, canal stenosis). OPLL common in Asians;
- Ossification (OPLL, ALL). - ALL injury (trauma, T2 hyperintense). trauma.
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8. Paraspinal Soft - Prevertebral edema/hematoma. - Prevertebral hematoma (trauma). Trauma or infection.
Tissues - Masses (lymphoma, abscess). - Retropharyngeal abscess (T2 hyper, rim-
enhancing).
9. Congenital/Variants - Chiari malformation. - Chiari I (tonsillar descent >5 mm). Associated with
- Klippel-Feil syndrome. - Fused vertebrae (Klippel-Feil). syringomyelia.
10. Postoperative - Fusion hardware artifacts. - Pseudarthrosis (non-fusion). May require revision surgery.
Changes - Recurrent disc herniation. - Adjacent segment disease.
- Epidural fibrosis.
Lumbar Spine MRI Reporting Template (Structured Approach)
Category Key Components Pathological Findings Imaging Features Clinical Significance
1. Alignment - Lordosis - Degenerative spondylolisthesis - "Step-off" deformity on sagittal Instability may require
- Spondylolisthesis (L4-L5) - Facet tropism flexion-extension views
(Meyerding grading) - Isthmic spondylolisthesis (L5- - Pars defect on axial (T1
- Rotational scoliosis S1 pars defect) hypointense)
- Lateral listhesis
2. Vertebral - Marrow signal - Metastases (T1 hypo, T2/STIR - STIR hyperintensity = acute Pathologic fracture risk
Bodies - Endplates hyper) edema assessment
- Cortical integrity - Multiple myeloma ("pepper - Diffusion restriction in Differentiate benign vs
pot" skull) myeloma malignant
- Modic changes (I-III) - "Fluid sign" in benign fractures
- Hemangioma (T1/T2 hyper,
"polka dot" axial)
3. Discs - Hydration (T2 signal) - HIZ (annular tear) - Diffusion-weighted imaging Radiculopathy correlation
- Contour - Sequestrated fragment for abscess Discogenic pain source
- Annular integrity - "Double rim" sign (migration) - Contrast enhancement for
- Schmorl's nodes postoperative recurrence
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4. Central - AP diameter - "Trefoil" canal (severe - Dynamic stenosis Neurogenic claudication
Canal - Thecal sac compression stenosis) (flexion/extension) Cauda equina risk
- CSF flow void - Redundant nerve roots - "Kissing spinous processes"
- "Pseudomeningocele" post-op (Baastrup)
5. Foramina - Nerve root position - "Far-out" syndrome (L5-S1) - Coronal STIR for foraminal Dermatomal symptom
- Perineural fat - "Up-down" foraminal stenosis assessment correlation
- Uncovertebral changes - Conjoined nerve roots - "Ghost sign" (obliterated fat)
6. Facets - Hypertrophy - "Vacuum phenomenon" - T2* for hemorrhage Pain generator identification
- Fluid - Synovial cysts - Post-contrast synovitis
- Subchondral changes - "Facet edema" (acute
arthropathy)
7. Ligaments - Thickness - Ligamentum flavum - SWI for microhemorrhage Dynamic stenosis
- Signal hypertrophy (>3mm) - CT correlation for ossification contribution
- Calcification - Ossification (OLF)
- "Tram-track" appearance
(OPLL)
8. Paraspinal - Muscle symmetry - Denervation edema (acute) - DTI for nerve integrity Postsurgical outcome
- Fascial planes - Fatty atrophy (chronic) - MRA for AV malformations predictor
- Vascular structures - Psoas abscess
- "Shiny corner" sign (AS)
9. Post-op - Hardware artifacts - "Halo" sign (loosening) - Metal artifact reduction Revision surgery planning
- Recurrent pathology - "Pseudarthrosis" (non-union) sequences
- Fusion status - "Transition syndrome" - Flexion-extension for
instability
10. - Transitional anatomy - "Bertolotti's syndrome" (L5 - Cine MRI for cord motion Surgical approach
Congenital - Neural arch fusion sacralization) - Fat-sat for lipomas modification
- Tethered cord - Spina bifida occulta
- Filum terminale thickness
(>2mm)
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MRI Brain Reporting Template (Structured Approach)
Category Key Components Pathological Findings Imaging Features Clinical Significance
1. Parenchymal - Gray-white - Acute infarct (DWI bright, ADC dark) - "Mismatch" pattern in Stroke window
Signal differentiation - Gliosis (T2/FLAIR hyperintense) stroke assessment
- Symmetry - MS plaques (periventricular, ovoid) - "Dot-dash" appearance Demyelinating disease
- Focal abnormalities of MS activity
- "Tumefactive"
demyelination
2. Ventricles & CSF - Size/shape - Hydrocephalus (transependymal flow) - "Flow void" sign in NPH vs atrophy
- Ependymal lining - Ventriculitis (ependymal aqueduct differentiation
- Flow artifacts enhancement) - "Pulsation" artifacts
- Colloid cyst (T1 hyperintense)
3. Basal Ganglia - Symmetry - Parkinson's (nigrosome-1 loss) - "Swallow tail" sign loss Movement disorder
- Mineralization - Wilson's (T2 BG hyperintensity) - "Face of panda" sign correlation
- Signal changes - Hemochromatosis (T2* hypointense)
4. White Matter - Periventricular - Small vessel disease (Fazekas scale) - "Leukoaraiosis" pattern Vascular dementia risk
- Deep - PRES (posterior predominance) - "String of pearls"
- Subcortical - CADASIL (temporal lobe) (vasculitis)
5. Cortex - Thickness - Cortical dysplasia (transmantle sign) - "Blurred" gray-white Epilepsy focus
- Sulcal pattern - Creutzfeldt-Jakob (cortical ribboning) junction localization
- Signal - PML (subcortical U-fibers) - "Pencil-thin"
enhancement
6. Sella/Suprasellar - Pituitary size - Microadenoma (dynamic - "Snowman" appearance Endocrine dysfunction
- Stalk enhancement) - "Kissing carotids"
- Optic chiasm - Craniopharyngioma (T1 hyperintense)
- Infundibulitis
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7. Cerebellum - Foliation - DNET (cystic with nodule) - "Laminated" appearance Posterior fossa
- Tonsillar position - Hemangioblastoma (cyst with mural - "Light bulb" bright on syndromes
- Signal nodule) T2
- Chiari malformation
8. Vessels - Flow voids - AVM (nidus with flow voids) - "Phase contrast" for Stroke etiology
- Aneurysms - Vasculitis (beaded appearance) flow evaluation
- Stenosis - Thrombosis (empty delta) - "Blooming" on SWI
9. Meninges - Thickness - Carcinomatosis (nodular - "Dural tail" sign Neoplastic vs
- Enhancement enhancement) - "Sugar coating" inflammatory
- Spaces - SDH (crescentic, age-dependent appearance
signal)
- Pachymeningitis
10. Skull/Extra- - Bone marrow - Metastases (T1 hypo, post-contrast - "En plaque" Source identification for
axial - Sinuses enhancement) meningioma lesions
- Orbits - Osteomyelitis (bone edema) - "Hair on end"
- Sinusitis appearance
MRI Knee Reporting Template (Structured Approach)
Category Key Components Pathological Findings Imaging Features Clinical Significance
1. Menisci - Shape/signal - Radial/parrot beak tears - "Ghost meniscus" sign Mechanical symptoms
- Surface integrity - Root tears - "Truncation" sign correlation
- Horn - Discoid meniscus (Watanabe - Meniscal extrusion (>3mm)
proportions classification)
2. Ligaments - Continuity - ACL "mucoid degeneration" - "Empty notch" sign (ACL) Instability assessment
- Signal intensity - PCL "peel-off" lesion - "Kissing contusions" (LCL)
- Fiber pattern - MCL "Stener-like" lesion - "Posterior drawer" sign (PCL)
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3. Cartilage - Thickness - ICRS grading (1-4) - "Double line" sign Surgical planning
- Surface - "Crabmeat" appearance (osteonecrosis)
- Subchondral - Osteochondritis dissecans (OCD) - "T2 mapping" values
bone
4. Bone - Edema pattern - "Bone bruise" (contusion) - "Insufficiency fracture" line Acute vs chronic injury
Marrow - Fracture lines - "Tibial stress syndrome" - "Geographic" edema pattern
- Lesions - SONK (spontaneous osteonecrosis)
5. Tendons - Thickness - "Jumper's knee" (patellar) - "Tooth sign" (quadriceps) Overuse injury patterns
- Signal - "Popliteus tendinopathy" - "Magic angle" artifact
- Insertion - Iliotibial band friction
6. Synovium - Volume - PVNS (nodular, T2 hypointense) - "Blooming" on GRE Inflammatory arthritis
- Enhancement - Synovitis (post-contrast enhancement) - "Rice bodies" appearance
- Composition - Lipoma arborescens
7. Bursae - Size - Prepatellar bursitis ("housemaid's - "Tail sign" (cyst rupture) Infection vs inflammation
- Content knee") - "Fluid-fluid" levels
- Walls - Baker's cyst (with/without rupture)
- Pes anserine bursitis
8. Fat Pads - Signal - Hoffa's syndrome (fibrosis) - "Edema-like" signal Post-surgical changes
- Mass effect - "Cyclops" lesion - "Mass effect" on patella
- Vascularity - Ganglion cysts
9. Nerves - Course - Peroneal nerve compression - "Fascicular" sign Entrapment syndromes
- Size - Intraneural ganglia - "Target" appearance
- Signal - Neuromas
10. Alignment - Patellar tracking - Patellar alta/baja (Insall-Salvati) - "Crossing" sign Maltracking assessment
- Q angle - Trochlear dysplasia (Dejour) - "Supratrochlear spur"
- Trochlear depth - "Squinting" patella
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MRI Shoulder Reporting Template (Structured Approach)
Category Key Components Pathological Findings Imaging Features Clinical
Significance
1. Rotator Cuff - Tendon - Full-thickness tear (retraction, - "High-riding Surgical planning
integrity (supraspinatus, fluid gap) humerus" (cuff (debridement vs.
infraspinatus, subscapularis, teres - Partial-thickness arthropathy) repair)
minor) tear (bursal/articular side) - "Tendon bare
- Muscle quality (fatty - PASTA lesion (articular-side area" (normal thinning)
infiltration) partial tear) - Goutallier staging (fatty
- Footprint insertion - Intrasubstance delamination atrophy)
2. Labrum & - Labral shape/signal - Bankart lesion (anteroinferior - "Peel-back" Instability
Glenohumeral - Bankart/Perthes/SLAP lesions labral tear) sign (SLAP) assessment
Ligaments - Glenoid bone loss - SLAP tear (superior labrum, - "J-sign" (IGHL (traumatic vs.
biceps anchor) disruption) atraumatic)
- HAGL lesion (humeral avulsion) - "Buford
- GLAD lesion (glenolabral complex" (normal variant)
articular disruption)
3. Biceps Tendon - Long head - Medial - "Empty groove" Biceps tenodesis vs.
position (subluxation/dislocation) subluxation (subscapularis tear) sign (dislocation) tenotomy decision
- Tenosynovitis/tear - "Hourglass - "Double biceps"
- Pulley system integrity biceps" (impingement) sign (subluxation)
- Pulley lesion (medial sling
injury)
4. Bones & Joint - Glenoid version - Hill-Sachs - "Trough line" Risk of recurrent
- Hill-Sachs lesion lesion (posterosuperior humerus) sign (chronic dislocation) instability
- AC joint OA - "Engaging" vs. "non-engaging" - "Cystic
- Os acromiale - Osteoarthritis (osteophytes, changes" (rotator cuff tear
cysts) arthropathy)
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5. Subacromial - Acromial shape (Bigliani - Impingement (type II/III - "Spur Need for
Space classification) acromion) formation" (anterior acromioplasty
- Subacromial bursitis - Calcific tendinitis (T1/T2 acromion)
- Coracoacromial ligament hypointense) - "Geyser sign" (massive
- Bursal thickening cuff tear with AC joint
fluid)
6. Paralabral Cysts - Location/size - Spinoglenoid notch - "Fatty atrophy" (chronic Suprascapular
- Nerve cyst (infraspinatus atrophy) denervation) neuropathy
compression (suprascapular, - Ganglion cyst (labral tear - "Mass effect" on nerve
axillary) communication)
7. Muscle Atrophy - Supraspinatus/infraspinatus - Fatty infiltration (Goutallier - "Tangent Prognostic indicator
- Subscapularis grade) sign" (supraspinatus for cuff repair
- Teres minor - Acute denervation edema atrophy)
- "Positive TM
sign" (teres minor atrophy)
8. Post-Surgical - Anchor/repair integrity - Re-tear (fluid signal at repair - "Fluid-filled gap" (failed Need for revision
Changes - Recurrent tears site) repair) surgery
- Capsular thickening - "Cystic anchor" loosening - "Axillary pouch
- Adhesive capsulitis (thickened thickening" (frozen
capsule) shoulder)
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