Brain Tumor MRI Reporting Checklist

A brain tumor MRI report does more than suggest a lesion name. It organizes the location, size, infiltrative margin, enhancing component, edema, mass effect, and relationships that influence surgery and oncology. After treatment, comparison is required to assess residual disease, progression, and treatment effect.

The protocol may include T1, T2, FLAIR, diffusion, susceptibility, and postcontrast imaging, with perfusion, spectroscopy, or tractography as needed. Missing sequences and motion should be reported when they lower diagnostic confidence.

Assessment framework

• Localize the lesion as intra-axial or extra-axial.
• State its relationship to lobes, deep nuclei, corpus callosum, and ventricles.
• Measure enhancing tissue separately from nonenhancing T2/FLAIR abnormality.
• Assess restricted diffusion, blood products, necrosis, and mineralization.
• Look for midline shift, herniation, hydrocephalus, and cortical or ependymal spread.

What the report should contain

• Give dimensions in at least two planes and name the comparison date.
• Describe relationships to eloquent cortex, motor pathways, optic pathways, and major vessels when relevant.
• Report perfusion with the method and reference tissue used.
• After surgery, describe new nodular enhancement around the resection cavity.
• In the impression, state the leading tumor class, meaningful alternatives, and level of confidence.

Common errors

• Using edema and infiltrative tumor as synonyms.
• Ignoring steroid use and treatment timing.
• Assigning definite histology from one advanced sequence.

Example report wording

Example impression: A 42 x 36 x 34 mm infiltrative left frontal mass has irregular peripheral enhancement, central necrosis, and increased perfusion in the solid component. T2/FLAIR abnormality extends to the precentral gyrus. There is 5 mm rightward midline shift without hydrocephalus. A high-grade glial neoplasm is favored, with tissue diagnosis required.

Use the general brain MRI reporting checklist for the remainder of the examination.

References

1. American College of Radiology. Practice Parameter for MRI of the Head and Neck. Source (opens in a new tab)
2. American College of Radiology. Practice Parameter for CT of the Head. Source (opens in a new tab)

Clinical note: This material is for radiology education. Do not generate an automatic diagnosis or management decision without checking guideline scope, patient factors, and local policy.