MRI Reporting Masterclass
Reporting strategy, lesion description, disease synthesis, impression writing and wording refinement for MRI radiologists — a structured learning system for how expert imagers analyse a case, organise findings, and produce concise, high-value reports.
Read the indication and the last oncology note before the first image.
Look at everything once, silently, before any dictation begins.
Name the disease in your head. If it is characteristic, commit.
Local invasion, vessels, nodes, peritoneum, distant sites.
Pick the most relevant comparison, not simply the most recent.
Obstruction, thrombus, perforation, hemorrhage, hydronephrosis.
Fixed organ order, fixed lesion rhythm, positives before negatives.
Diagnosis + stage + change + complications + important negatives.
Same organ order, every case, every time. Order is what makes a report scannable.
- 1Liver
- 2Gallbladder & bile ducts
- 3Pancreas
- 4Spleen
- 5Adrenals
- 6Kidneys & collecting systems
- 7GI tract
- 8Peritoneum
- 9Lymph nodes
- 10Vasculature
- 11Bones
- 12Other / incidental
Start each organ with the main finding
Liver demonstrates normal size and contour. No biliary dilatation. There is a segment VIII mass…
Liver: Segment VIII mass measuring 3.2 × 2.7 cm… Remainder of the hepatic parenchyma is unremarkable.
Why this works — The reader should never have to scroll past normality to find the cancer.
Positives before negatives
No biliary dilatation. No ascites. There is a pancreatic head mass…
Pancreatic head mass measuring 2.8 cm… No biliary obstruction. No ascites.
Why this works — Clinicians read the first clause of every paragraph and skim the rest.
Biggest clinical issue first in the impression
1. Stable simple renal cysts. 2. Progressive hepatic metastatic disease.
1. Progressive multifocal hepatic metastatic disease. 2. Stable simple renal cysts.
Why this works — Impression order signals clinical priority. Never bury progression under an incidental.
Parallel sentence structure
There is a lesion. It measures 2.3 cm. It enhances arterially. Diffusion restriction is seen.
Segment VIII lesion measuring 2.3 cm demonstrating arterial hyperenhancement, washout, enhancing capsule, and diffusion restriction.
Why this works — One rhythm per lesion — faster to read, faster to dictate, better speech recognition.
Do not repeat the findings in the impression
Findings: segment VI lesion 2 cm. Impression: segment VI lesion measuring 2 cm.
Findings: segment VI lesion 2 cm. Impression: stable segment VI hepatic metastasis.
Why this works — Findings describe anatomy. The impression converts anatomy into meaning.
Do not itemise every metastasis
Lesion 1 measures… lesion 2 measures… lesion 3 measures… (×14)
Overall mild interval progression of multifocal hepatic metastatic disease; dominant segment VIII lesion enlarging to 3.2 cm, previously 2.4 cm.
Why this works — Track a dominant lesion and describe the burden as a whole.
Location
Precise anatomic localisation, in surgical language.
- Segment VIII of the liver
- Pancreatic head, uncinate process
- Left adrenal gland, medial limb
- Upper pole of the right kidney
- Distal common bile duct
- Mid rectum, 7 cm from the anal verge
- Always begin with anatomic localisation — it frames everything that follows.
- Use the language of the person who will operate: segments, levels, clock-face, distance from a landmark.
Enlarging 3.2 × 2.7 cm segment VIII hepatocellular carcinoma (LR-5), previously 2.4 × 2.0 cm, demonstrating arterial hyperenhancement, washout, an enhancing capsule, and restricted diffusion, with tumour thrombus in the adjacent portal venous branch.
Why this works — every descriptor lands in a predictable slot, so the referrer reads one sentence instead of reassembling five.