Thoracic Spine MRI Report Template: Normal and Level-by-Level Examples

Complete normal thoracic spine MRI report

This example assumes a routine thoracic spine MRI without intravenous contrast. State the actual coverage, sequences, contrast protocol, comparison, and any limitation. Review every included vertebral level and the spinal cord before using normal wording.

Clinical note: This is an examination-specific framework, not a substitute for image interpretation. A thoracic MRI does not evaluate the entire spine or every cause of back pain unless those regions and structures are included.

Examination: MRI of the thoracic spine without intravenous contrast.

Technique: Multiplanar, multisequence images of the thoracic spine were obtained.

Comparison: [Date and examination / None available].

Findings: Thoracic alignment and vertebral body heights are maintained. Marrow signal is within expected limits. Intervertebral disc heights and signal are preserved. No focal disc herniation, significant spinal canal stenosis, or neural foraminal narrowing is identified at the evaluated levels. The thoracic spinal cord is normal in caliber and signal. No significant abnormality is identified in the included paraspinal soft tissues.

Impression: No significant abnormality of the thoracic spine on MRI.

Only state that the conus medullaris is normal when it is included and adequately assessed. Do not describe partially imaged organs or spine segments as fully normal.

Thoracic-specific review sequence

1. Coverage and vertebral numbering

Confirm the superior and inferior coverage, sequence quality, motion, and comparison studies. Count levels using the localizer and available whole-spine images when present. Rib-bearing vertebrae and transitional anatomy can complicate numbering. If the study does not establish a reliable reference, state how levels were assigned or that numbering is limited.

2. Alignment, vertebral bodies, and marrow

Assess thoracic kyphosis, scoliosis, translation, vertebral body height, endplates, posterior elements, and marrow signal. Look for focal lesion, edema, fracture, or deformity. If vertebral height loss is present, identify the level and describe its configuration and extent. For a suspected compression fracture, include marrow edema, posterior wall involvement, retropulsion, canal effect, and associated soft-tissue or posterior-element findings when visible.

3. Discs, canal, and neural foramina

Review disc height and signal at each level. Describe focal protrusion or extrusion, its direction, and any effect on the ventral thecal sac, spinal cord, or exiting roots. State the severity and side of canal or foraminal narrowing where present. The thoracic levels should be reviewed separately rather than inferred from a lumbar template.

4. Spinal cord and surrounding tissues

Assess cord caliber and signal throughout the included region. Note a focal lesion, edema, compression, or syrinx if present. Review the epidural space and visible paraspinal tissues. When the clinical question concerns infection, tumor, or postoperative change, a tailored protocol, often including contrast, may be needed.

Level-by-level worksheet

Use a level-by-level worksheet to make sure the entire imaged thoracic spine is covered. It is a review aid; a report can group normal levels when that remains clear.

T1-T2: Disc / canal / right foramen / left foramen.
T2-T3: Disc / canal / right foramen / left foramen.
T3-T4: Disc / canal / right foramen / left foramen.
T4-T5: Disc / canal / right foramen / left foramen.
T5-T6: Disc / canal / right foramen / left foramen.
T6-T7: Disc / canal / right foramen / left foramen.
T7-T8: Disc / canal / right foramen / left foramen.
T8-T9: Disc / canal / right foramen / left foramen.
T9-T10: Disc / canal / right foramen / left foramen.
T10-T11: Disc / canal / right foramen / left foramen.
T11-T12: Disc / canal / right foramen / left foramen.
T12-L1: Disc / canal / right foramen / left foramen.

When level numbering is uncertain, do not silently adopt the worksheet labels. Verify with a reliable localizer or describe the limitation and use an agreed local convention.

Selected compression and deformity wording

Vertebral compression deformity

There is mild anterior height loss of the T8 vertebral body, without marrow edema or posterior wall retropulsion. No associated spinal canal narrowing is identified. Correlation with prior imaging and clinical history is advised to assess chronicity.

Absence of marrow edema may make a recent fracture less likely, but MRI should not be used to assign an exact fracture date from one signal feature alone.

Compression fracture with marrow edema

The T8 vertebral body demonstrates approximately 25% anterior height loss with marrow edema. There is no posterior wall retropulsion, significant canal narrowing, or posterior-element edema. The appearance is compatible with a recent compression fracture in the appropriate clinical context.

State the actual height-loss estimate only when it can be measured reliably. If there is posterior wall involvement, retropulsion, epidural abnormality, or cord compression, make that explicit in the findings and impression.

Fictional worked example

This fictional example demonstrates a thoracic MRI report for a suspected recent compression injury. The degree of height loss and all other details are illustrative.

Examination: MRI of the thoracic spine without intravenous contrast.

Technique: Multiplanar, multisequence images were obtained, including fluid-sensitive sequences.

Comparison: Thoracic radiographs dated [date].

Findings: Thoracic kyphosis is maintained. The T8 vertebral body has approximately 20% anterior height loss with diffuse marrow edema. The posterior wall is intact, without retropulsion or significant spinal canal narrowing. No edema is seen in the posterior elements. The remaining vertebral body heights are maintained. No focal marrow-replacing lesion is identified. Thoracic disc heights are preserved without significant disc herniation or neural foraminal narrowing. The spinal cord is normal in caliber and signal.

Impression:
1. T8 vertebral body compression fracture with approximately 20% anterior height loss and marrow edema. No retropulsion or canal compromise.
2. No thoracic cord signal abnormality.

The case is labeled as fictional because its measurements and clinical context are illustrative. In a real report, verify the level, compare prior studies, and describe any feature that changes stability or neural risk.

Reporting checklist and common pitfalls

• Coverage, image quality, contrast use, and comparison
• Reliable thoracic level numbering, especially near T1 and T12-L1
• Alignment, vertebral height, marrow, endplates, and posterior elements
• Disc, canal, and right/left neural foramina at every imaged level
• Cord caliber and signal across the included region
• For a compression deformity: level, shape, estimated height loss, edema, posterior wall, retropulsion, and canal effect
• Included conus or adjacent structures described only if adequately shown
• Impression prioritizes fracture, neural compression, or other finding relevant to the question

Do not use lumbar level labels or a lumbar-only checklist for a thoracic study. Do not call a vertebral deformity acute or chronic from shape alone. If the vertebral level is uncertain, communicate the numbering limitation before the finding is used for a procedure or follow-up. CT may better define cortical fracture morphology; MRI and CT answer different questions and may be complementary.

For imaging selection and scenario-specific recommendations, consult the ACR Appropriateness Criteria® for Thoracic Back Pain (opens in a new tab) and the ACR criteria for Management of Vertebral Compression Fractures (opens in a new tab). A related but anatomically distinct framework is the normal lumbar spine MRI report.

References

• American College of Radiology. ACR–ASNR–SABI–SSR Practice Parameter for the Performance of MRI of the Adult Spine (opens in a new tab).
• American College of Radiology. ACR Appropriateness Criteria®: Thoracic Back Pain (opens in a new tab), revised 2024.
• Khan MA, et al. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update (opens in a new tab). Journal of the American College of Radiology. 2023;20(5S):S102–S124. doi:10.1016/j.jacr.2023.02.015.
• American College of Radiology. Practice Parameter for Communication of Diagnostic Imaging Findings (opens in a new tab).

This educational framework does not replace patient-specific interpretation, the current local protocol, or clinical judgment.