MRI Lumbar Spine Without Contrast — Dictation, Appropriateness, and Dose for Residents

1. The Never-Ending Lumbar Spine List

It’s 2 PM on a Tuesday. The list is packed with outpatient non-contrast lumbar spine MRIs, all with the same indication: “Low back pain.” Your attending is a stickler for detail. They expect you to comment on alignment, conus position, marrow signal, Modic changes, and then give a precise, level-by-level breakdown of every disc, recess, and foramen. Just dictating “multilevel degenerative change” isn’t going to cut it.

When I was a resident, this was the bread-and-butter study that separated the efficient from the overwhelmed. Getting a system down is key. You need a template that forces you to look at everything, so when the attending asks, “What about the pars at L5?” you have the answer ready. This guide is that system, built from the ground up for trainees. For more tools like this, check out our free residents and fellows resource hub.

2. What an MRI Lumbar Spine Without Contrast Covers and What Attendings Look For

A non-contrast lumbar spine MRI is the workhorse for evaluating degenerative disease and radiculopathy. It’s designed to answer specific questions about the source of a patient’s pain or neurologic symptoms. When your attending co-signs your report, they’re looking for a clear, structured assessment of the following:

• Alignment and Degenerative Changes: Is there spondylolisthesis? How severe is the facet arthropathy? Are the disc heights maintained?
• Spinal Canal and Foraminal Stenosis: A level-by-level analysis of central canal, lateral recess, and neural foraminal narrowing.
• Disc Pathology: Precise description of any disc bulge, protrusion, extrusion, or sequestration, including its effect on the thecal sac and exiting nerve roots.
• Bone Marrow Signal: Is there an acute compression fracture (indicated by marrow edema on STIR)? Are there Modic changes at the endplates? Any suspicious marrow-replacing lesions?
• Conus Medullaris and Cauda Equina: Confirmation of normal conus termination (typically L1-L2) and assessment for any compression or intrinsic signal abnormality of the cauda equina nerve roots.
• Incidental Findings: A check of the paraspinal soft tissues, sacroiliac joints, and visualized portions of the kidneys and iliac wings.

This study is most commonly ordered for low back pain with radiculopathy that has failed conservative management, or for chronic back pain with neurologic deficits or other red flags.

3. Radiology Report Template for MRI Lumbar Spine Without Contrast

This is a solid starting point. Copy it into your dictation system and use it as a checklist. It forces you to be systematic, which is the fastest way to become confident and thorough.

Technique

Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast. Sequences include sagittal T1, T2, and STIR; axial T1 and T2; and coronal T2 HASTE images.

Findings

Alignment and Vertebral Body Height: Lumbar lordosis is [maintained/straightened/reversed]. There is no evidence of spondylolisthesis. Vertebral body heights are maintained. No acute compression fracture is identified. [If present, describe: e.g., Chronic-appearing superior endplate compression fracture at L2.]

Conus Medullaris: The conus medullaris terminates at the [e.g., L1-L2] level, which is normal. The signal intensity of the conus is unremarkable.

Bone Marrow Signal: The bone marrow signal is [normal for age / demonstrates diffuse osteopenia / demonstrates degenerative endplate changes]. [Describe Modic changes, e.g., Type 2 Modic changes are seen at the L4-5 endplates.]

Level-by-Level Analysis:

• T12-L1: The disc is normal in appearance. The central canal, lateral recesses, and neural foramina are patent.
• L1-L2: [e.g., Mild disc bulge without significant stenosis.]
• L2-L3: [e.g., Facet arthropathy contributing to mild bilateral foraminal narrowing.]
• L3-L4: [e.g., Broad-based disc bulge effacing the ventral thecal sac, resulting in mild central canal stenosis.]
• L4-L5: [e.g., Left paracentral disc extrusion contacts and displaces the descending left L5 nerve root. Severe left lateral recess stenosis. Moderate central canal stenosis.]
• L5-S1: [e.g., Disc desiccation and height loss. Bilateral facet arthropathy. Moderate bilateral neural foraminal stenosis.]

Other Findings: The visualized paraspinal soft tissues are unremarkable. The sacroiliac joints are grossly unremarkable. The visualized portions of the kidneys are unremarkable.

Impression

1. Multilevel degenerative disc disease and facet arthropathy, most significant at the following levels:
2. L4-L5: Left paracentral disc extrusion resulting in severe left lateral recess stenosis with contact of the descending left L5 nerve root. Moderate central canal stenosis.
3. L5-S1: Moderate bilateral neural foraminal stenosis secondary to disc height loss and facet arthropathy.
4. Normal termination of the conus medullaris.

4. Free Template Sources for Your Personal Library

Building your own set of macros is a rite of passage. While the template above is a great starting point, two great free repositories exist for finding and comparing templates across different subspecialties and institutions. They are invaluable for seeing how others structure their reports.

• RadReport.org: Curated by the RSNA, this is the most comprehensive library of peer-reviewed templates. It’s an excellent source for standardized, best-practice language.
• Radiology Templates (AU): An Australian-maintained library with a clean interface and practical, clinically-focused templates that are easy to adapt.

5. The Next-Level Move: Free-Form Dictation to Structured Report

Templates are essential, but they can feel rigid. The real goal is to dictate your positive findings naturally, as if you were presenting the case to your attending, and have the report structure itself automatically. This is where AI-powered tools come in.

Instead of clicking through a macro, you can simply dictate, “At L4-5, there’s a large left paracentral disc extrusion causing severe stenosis in the lateral recess and displacing the L5 root.” GigHz Precision AI is designed to take that free-form dictation and generate a clean, structured report. It uses pre-loaded templates from the ACR and SIR, ensuring your terminology is standardized. It also helps surface relevant Clinical Decision Support (CDS) frameworks when needed for more complex studies, guiding you toward the right classification without you having to stop and look it up. It’s about maintaining your natural workflow while producing a report that looks like you spent twice as long on it.

6. When Should You Order an MRI Lumbar Spine Without Contrast? ACR Appropriateness Criteria

Knowing *when* to recommend a study is as important as reading it. The American College of Radiology (ACR) provides evidence-based guidelines. For a non-contrast lumbar spine MRI, the key scenarios fall under the topics of Low Back Pain and Management of Vertebral Compression Fractures.

For a patient with acute low back pain (less than 6 weeks) without red flags (like fever, weight loss, or major neurologic deficit), the ACR rates MRI as “Usually Not Appropriate.” Most of these cases resolve with conservative management. However, for subacute or chronic low back pain, or for patients who are surgical candidates after failing 6 weeks of optimal medical management, an MRI becomes “Usually Appropriate” to identify a surgically correctable cause.

In the context of vertebral compression fractures (VCFs), MRI is critical. For a new, symptomatic VCF seen on a radiograph (with or without a known history of malignancy), an MRI is “Usually Appropriate.” The key sequence is the STIR, which shows bone marrow edema. The presence of edema confirms the fracture is acute and may make the patient a candidate for vertebroplasty or kyphoplasty. The absence of edema suggests a chronic, stable fracture.

7. MRI Lumbar Spine Without Contrast Imaging Protocol — Sequences and Technical Parameters

A standard non-contrast lumbar spine MRI protocol is efficient, typically taking 20-25 minutes. It consists of six core sequences designed to provide a comprehensive look at anatomy, fluid-sensitive pathology, and nerve root impingement. Sagittal images should cover from the lower thoracic spine (T11-T12) through the upper sacrum (S2-S3) to ensure visualization of the conus and facet joints. Axials are typically acquired as a single block from T12-L1 through S1.

The table below outlines the essential sequences.

Common protocol pitfalls: The most common variation is institutional preference for axial coverage. While some sites image the entire lumbar spine axially, others may only acquire axials at specific levels of interest, which can miss pathology. STIR is generally preferred over T2 fat-saturation for its more uniform fat suppression across the large field of view. For patients with marked lordosis, an additional oblique axial T2 sequence angled parallel to the L5-S1 disc can be invaluable for properly evaluating that level.

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

3+ months free for radiology residents and fellows

Look like a rockstar on your reports — dictate positive findings in free form, and the AI generates a structured report using ACR + SIR templates with the appropriate clinical decision support firing automatically. All we ask is feedback so we can keep improving the product for trainees.

Signup is simple. No credit card, no long forms. To get set up, just provide three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
3. Your training program / hospital name

Ready to give it a try? Apply for the residents free-access program.

9. Frequently Asked Questions

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring or storing patient-identifying information (PHI). All data is encrypted in transit and at rest.

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

No. GigHz Precision AI is browser-based and requires no local installation or IT integration to get started. It works on any modern computer, including the PACS workstation or your personal laptop/iPad in the call room.

How does this work with PowerScribe or other dictation systems?

It works alongside your existing system. You can dictate into the GigHz interface, let the AI structure the report, and then copy-paste the final, clean text into your official PACS/RIS dictation window for sign-off. It’s a workflow enhancement, not a replacement.

Can I use my own custom templates?

Yes. While the system comes pre-loaded with ACR and other society-endorsed templates, you can upload and customize your own templates to match your personal or institutional style.

What happens after my residency or fellowship ends?

We have straightforward continuation plans for practicing radiologists. Your access won’t be cut off without notice, and we offer discounts for trainees transitioning to their first attending role.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026