MRI Brain Routine (Without Contrast) — Dictation, Appropriateness, and Dose for Residents

1. The Non-Contrast Brain MRI: Your On-Call Workhorse

It’s a Tuesday afternoon. The neurology service sends over an order for an outpatient MRI Brain on a 75-year-old with progressive memory loss. The indication just says “dementia workup.” You know your attending is going to expect you to comment on atrophy, white matter disease, and any evidence of old infarcts or microhemorrhages. This isn’t a stat read, but getting it right the first time—with a clean, structured report—saves you from a dozen painful edits later. This is where a solid template for the routine non-contrast brain MRI becomes your best friend on the rotation. It’s one of the most common studies you’ll read, and mastering it is a core skill. (For more high-yield guides and tools, check out the residents and fellows resource hub.)

2. What a Routine MRI Brain (Without Contrast) Covers and What Attendings Look For

The routine non-contrast brain MRI is the foundational neuroimaging study. It’s designed to provide a comprehensive structural overview of the brain parenchyma, ventricles, and surrounding spaces without ionizing radiation. It’s the go-to for a wide range of non-acute neurologic complaints, from chronic headaches to cognitive decline.

When I’m reviewing your report, I’m looking for a systematic evaluation that answers the key clinical questions:

• Infarct: Is there evidence of acute, subacute, or chronic stroke? The Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) map are your first stop.
• White Matter Disease: Are there FLAIR hyperintensities suggesting demyelination (like in multiple sclerosis) or chronic microvascular ischemic changes?
• Hemorrhage: Are there signs of old microhemorrhages on the T2*/SWI sequence? Their pattern (lobar vs. deep) can suggest the underlying cause.
• Atrophy & Volume Loss: Is there generalized or focal atrophy? Pay special attention to the hippocampi in a dementia workup.
• Masses & Edema: Is there a space-occupying lesion, mass effect, or surrounding edema?
• Structural Integrity: Are the ventricles dilated? Are the cerebellar tonsils in the correct position?

Common indications include dementia/memory loss workup, multiple sclerosis evaluation, subacute or chronic stroke assessment, seizure workup, and characterizing hydrocephalus.

3. Radiology Report Template for MRI Brain Routine (Without Contrast)

This template provides a solid starting point. Dictate the positive findings, and let the normal placeholders fill in the rest. Remember to tailor the findings and impression to the specific clinical history.

Technique

Multiplanar, multisequence magnetic resonance imaging of the brain was performed without the administration of intravenous contrast. Sequences include sagittal T1, axial T1, axial T2, axial FLAIR, axial diffusion-weighted imaging with ADC mapping, and axial susceptibility-weighted imaging (or T2* gradient echo).

Findings

Diffusion-Weighted Imaging: No evidence of restricted diffusion to suggest acute or early subacute infarct.
Parenchyma: No evidence of intracranial mass, hemorrhage, or extra-axial fluid collection. The gray-white matter differentiation is preserved. The basal ganglia, thalami, and brainstem appear unremarkable.
White Matter: [Describe any white matter T2/FLAIR hyperintensities, specifying location (periventricular, subcortical, deep) and pattern. E.g., “Mild deep white matter FLAIR hyperintensities consistent with chronic microvascular ischemic change.” or “Multiple ovoid periventricular FLAIR hyperintensities perpendicular to the ventricles, suspicious for demyelinating plaques.”]
Ventricles and Extra-Axial Spaces: The ventricular system and sulci are [normal in size for age / prominent, suggesting generalized volume loss]. No hydrocephalus. Basal cisterns are patent.
Susceptibility-Weighted Imaging: [No evidence of susceptibility artifact to suggest hemorrhage or calcification. / Scattered foci of susceptibility artifact in the [lobar distribution / deep gray nuclei] consistent with microhemorrhages.]
Cerebellum and Brainstem: The cerebellar tonsils are in normal position. The brainstem is unremarkable.
Visualized Sinuses and Mastoids: The paranasal sinuses and mastoid air cells are clear.
Orbits: The globes and orbits are grossly unremarkable.
Calvarium and Skull Base: The calvarium and skull base are intact.

Impression

1. No evidence of acute intracranial hemorrhage, mass, or infarct.
2. [e.g., Mild cerebral volume loss, slightly greater than expected for age.]
3. [e.g., Mild deep white matter FLAIR hyperintensities, consistent with chronic microvascular ischemic disease.]
4. [e.g., No other significant intracranial abnormality.]

4. Free Template Sources for Your Personal Library

Building your own set of macros in your dictation system is a rite of passage. But you don’t have to start from scratch. Beyond your own institution’s templates, two great free repositories exist that are worth bookmarking. They are maintained by radiologists for radiologists.

• RadReport.org: Curated by the Radiological Society of North America (RSNA), this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty. (https://radreport.org/)
• Radiology Templates (AU): An excellent, user-friendly site maintained by Australian radiologists with a clean interface and practical, easy-to-adapt templates. (https://www.radiologytemplates.com.au/home-page/)

5. The Next-Level Move: AI-Assisted Structured Reporting

A static template is a great start, but the real friction comes from manually editing it for every positive finding. You see three old lacunar infarcts and some microbleeds, and suddenly you’re deleting normal clauses and typing out descriptions, locations, and measurements. This is where modern tools can streamline your workflow.

Instead of starting with a rigid template, you can dictate the positive findings in free form—”multiple chronic lacunar infarcts in the left basal ganglia and scattered deep white matter microhemorrhages”—and let an AI tool structure them for you. The GigHz Precision AI reporting assistant is designed for this. It takes your free-form dictation of abnormalities and generates a complete, structured report using pre-loaded templates from the American College of Radiology (ACR) and Society of Interventional Radiology (SIR). It also helps surface relevant Clinical Decision Support (CDS) criteria when findings like a liver or kidney lesion are described, ensuring your report contains the necessary classifications without you having to look them up.

6. When Should You Order a Routine MRI Brain? ACR Appropriateness Criteria

The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right test for the right reason. For the non-contrast brain MRI, the indications are broad, particularly in the workup of cognitive decline and suspected demyelinating disease.

For a patient presenting with dementia or cognitive impairment, a non-contrast brain MRI is almost always the first-line imaging test. The ACR rates it as “Usually Appropriate” for nearly every common scenario, including initial imaging for mild cognitive impairment, suspected Alzheimer disease (both typical and atypical presentations), frontotemporal dementia, dementia with Lewy bodies, and suspected vascular dementia. It is also the preferred study for evaluating patients before and after starting anti-amyloid monoclonal antibody therapy for Alzheimer disease, as it can detect treatment-related complications like ARIA-E and ARIA-H.

Similarly, for suspected demyelinating diseases like multiple sclerosis, the non-contrast brain MRI is a cornerstone of diagnosis. For an adult with symptoms suggesting a first demyelinating event, an MRI of the brain is rated “Usually Appropriate.” While an MRI with and without contrast is often preferred to assess for active inflammation, the non-contrast portion with its FLAIR sequence is critical for identifying the characteristic white matter lesions.

This study is generally not the first choice for acute head trauma or suspected acute hemorrhage, where a non-contrast head CT is much faster and more sensitive for fresh blood. For detailed evaluation of tumors, infection, or vascular pathology, contrast-enhanced MRI or MRA/CTA are the appropriate next steps.

7. MRI Brain Routine (Without Contrast) Imaging Protocol — Sequences and Parameters

A standard non-contrast brain MRI protocol is highly conserved across institutions and takes about 20-25 minutes of scanner time. The goal is to acquire a core set of sequences that provide a comprehensive look at brain anatomy, fluid, diffusion, and susceptibility.

The six core sequences are the foundation of the exam. The sagittal T1 provides a survey and look at midline structures. DWI/ADC is the first place you should look for acute stroke. FLAIR is the workhorse for white matter pathology. The T2 and axial T1 provide complementary anatomical and fluid-sensitive information, and the T2*/SWI is essential for detecting microhemorrhages and calcium.

Common protocol pitfalls: Motion is the biggest enemy; even small head movements can degrade image quality, particularly on the high-resolution FLAIR and DWI sequences. Ensure the patient is properly cushioned in the head coil. While T2* GRE is acceptable, Susceptibility-Weighted Imaging (SWI) is strongly preferred if available, as it has superior sensitivity for detecting microhemorrhages, a key finding in hypertensive arteriopathy and cerebral amyloid angiopathy.

8. The 3-Months-Free Offer for Residents and Fellows

3+ months free for radiology residents and fellows.

We want to help you look like a rockstar on your reports. The GigHz Precision AI assistant lets you dictate your positive findings in free form, and the AI generates a complete, structured report using ACR and SIR templates. The appropriate Clinical Decision Support (CDS) for things like liver and renal lesions fires automatically, so you can add the right classification to your impression without stopping to look it up.

All we ask in return is your feedback so we can keep improving the product for trainees. The signup is simple—no credit card, no long forms. To get started, just provide these three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or fellowship specialty)
3. Your training program / hospital name

We’ll get you set up with a free account that lasts for the duration of your training block. To get access, apply for the residents free-access program.

9. Frequently Asked Questions

Is this tool HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. No Protected Health Information (PHI) is required to generate a report, and any incidental PHI is automatically filtered and scrubbed before processing.

Do I need our hospital’s IT department to set this up?

No. GigHz Precision AI is a secure, browser-based tool. There is no software to install. It works on any modern web browser, including the one on your call-room workstation or personal iPad.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside any existing dictation system. You dictate your findings as you normally would, and then you can use the AI-generated structured text to quickly build your final report. Most residents copy-paste the structured findings or impression directly into their PACS/RIS.

Can I use this on my phone or iPad?

Yes, the tool is fully responsive and works on mobile devices and tablets, making it useful for reviewing report structure or preparing for a case when you’re away from a workstation.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and SIR templates, you can create, save, and share your own custom templates for specific attendings or institutional preferences.

What happens after I finish residency or fellowship?

The free access program is designed for trainees. After you graduate, you can transition to a standard attending-level plan. We offer discounts for recent graduates to help you get started in your new practice.