Structured Reporting Template Library
Copy-pasteable report skeletons with standardised categories and inline pick-lists — for registrars learning to dictate structured reports. Pick-lists show as [option / option]; delete what doesn’t apply.
Educational templates only. These are simplified teaching skeletons, not a substitute for the official lexicons (ACR PI-RADS v2.1, ACR LI-RADS v2018, ACR BI-RADS Atlas, ESGAR rectal consensus) or your department’s approved reporting standards. Always score against the current source document and local protocol.
Prostate mpMRI
PI-RADS v2.1 — Prostate mpMRI
Scoring logic (the core rule): the dominant sequence differs by zone.
• Peripheral zone (PZ) is DWI-driven. Assign the DWI score, then DCE upgrades a DWI-3 → category 4 if there is focal early enhancement (DCE “+”). DCE does not change 1/2/4/5.
• Transition zone (TZ) is T2-driven. Assign the T2 score, then DWI upgrades: T2-score 2 + DWI ≥4 → category 3 (“2+1”); T2-score 3 + DWI 5 → category 4 (“3+1”).
• v2.1: DWI/ADC 2 = linear/wedge; 3 = focal; bilateral symmetric BPH-type TZ nodules = score 1.
• Peripheral zone (PZ) is DWI-driven. Assign the DWI score, then DCE upgrades a DWI-3 → category 4 if there is focal early enhancement (DCE “+”). DCE does not change 1/2/4/5.
• Transition zone (TZ) is T2-driven. Assign the T2 score, then DWI upgrades: T2-score 2 + DWI ≥4 → category 3 (“2+1”); T2-score 3 + DWI 5 → category 4 (“3+1”).
• v2.1: DWI/ADC 2 = linear/wedge; 3 = focal; bilateral symmetric BPH-type TZ nodules = score 1.
| PI-RADS | Likelihood of clinically significant cancer |
|---|---|
| 1 | Very low |
| 2 | Low |
| 3 | Intermediate (equivocal) |
| 4 | High |
| 5 | Very high (≥1.5 cm on dominant sequence, or definite EPE / invasion) |
Skeleton (one block per lesion, up to 4 index lesions):
PROSTATE mpMRI — PI-RADS v2.1 TECHNIQUE: [1.5T / 3T], [endorectal / surface] coil. T2W, DWI (b=[0,100,800-1000] + high-b [1400-2000]) with ADC, DCE. Quality: [diagnostic / degraded by motion/artifact/rectal gas]. CLINICAL: PSA [__] ng/mL. Prior biopsy [none / neg / GG_ ]. [Prior treatment]. GLAND: Volume [__] mL (___ x ___ x ___ x 0.52). PSA density [__]. BPH: [absent / mild / moderate / marked]. Prior findings: [post-biopsy haemorrhage / none]. LESION 1 Location: [right/left], [base/mid/apex], [PZ / TZ / CZ / AFMS], sector [__]. Size: [__] mm (measured on [ADC / T2]). T2 score: [1 / 2 / 3 / 4 / 5] DWI/ADC score: [1 / 2 / 3 / 4 / 5] DCE: [negative (-) / positive (+) focal early enhancement] → PZ: use DWI (DCE upgrades 3→4). TZ: use T2 (DWI upgrades per 2+1 / 3+1). PI-RADS CATEGORY: [1 / 2 / 3 / 4 / 5] LESION 2 (if present): [repeat block] EXTRAPROSTATIC EXTENSION (EPE): [absent / suspected / definite]. EPE grade [0 / 1 / 2]. SEMINAL VESICLES: [normal / invasion, side __]. NEUROVASCULAR BUNDLES: [preserved / involved right / left]. LYMPH NODES: [none suspicious / enlarged — short axis __mm, station __]. BONES / OTHER: [no aggressive marrow lesion / suspicious lesion at __]. IMPRESSION: 1. Index lesion [location], PI-RADS [__] — [recommend targeted biopsy / MDT]. 2. [EPE / SV / nodal status].
Breast MRI
BI-RADS — Breast MRI
Assessment logic: describe background parenchymal enhancement (BPE) and fibroglandular tissue (FGT), then classify each finding as focus / mass / non-mass enhancement (NME) using the ACR MRI lexicon (shape, margin, internal enhancement, distribution), add kinetics, then assign a final BI-RADS category.
| BI-RADS | Assessment | Management |
|---|---|---|
| 0 | Incomplete — need further imaging/priors | Additional workup |
| 1 | Negative | Routine |
| 2 | Benign | Routine |
| 3 | Probably benign (<2% malignant) | Short-interval follow-up (~6 mo) |
| 4 | Suspicious | Tissue diagnosis (biopsy) |
| 5 | Highly suggestive of malignancy (≥95%) | Biopsy |
| 6 | Known biopsy-proven malignancy | Definitive treatment |
BREAST MRI — BI-RADS TECHNIQUE: [1.5T/3T] dynamic contrast-enhanced, [prone, dedicated breast coil]. [__] mL gadolinium. Indication: [high-risk screen / staging / problem-solving / implant / response]. FGT: [almost entirely fatty / scattered / heterogeneous / extreme] BPE: [minimal / mild / moderate / marked], [symmetric / asymmetric] IMPLANTS: [none / intact / rupture — intra/extracapsular] FINDING 1 Type: [focus (<5mm) / MASS / NON-MASS ENHANCEMENT (NME)] Location: [right/left], [clock position], [depth ant/mid/post], size [__]mm — If MASS — Shape: [oval / round / irregular] Margin: [circumscribed / irregular / spiculated] Internal enhancement: [homogeneous / heterogeneous / rim / dark septations] — If NME — Distribution: [focal / linear / segmental / regional / multiregional / diffuse] Internal pattern: [homogeneous / heterogeneous / clumped / clustered ring] T2 signal: [low / iso / high]. DWI/ADC: [no restriction / restricted, ADC __]. Kinetics: initial [slow / medium / fast]; delayed [persistent / plateau / washout] ADDITIONAL: [nodes — axillary/internal mammary; skin/nipple; chest wall/pec]. IMPRESSION: 1. [Finding], [right/left] — BI-RADS [0/1/2/3/4/5/6]. 2. Management: [routine / 6-mo follow-up / biopsy / MDT / surgical planning].
Liver MRI
LI-RADS v2018 — HCC in at-risk patients
Applies only to at-risk patients (cirrhosis, chronic HBV, or prior HCC — not cirrhosis from vascular causes, and not non-cirrhotic non-HBV livers).
Major features: size, non-rim arterial phase hyperenhancement (APHE), non-peripheral washout, enhancing capsule, threshold growth (≥50% in ≤6 months). Combine on the table below.
Major features: size, non-rim arterial phase hyperenhancement (APHE), non-peripheral washout, enhancing capsule, threshold growth (≥50% in ≤6 months). Combine on the table below.
| APHE → | Non-rim APHE present | ||
|---|---|---|---|
| Size / additional features | 0 | 1 | ≥2 |
| <10 mm | LR-3 | LR-4 | LR-4 |
| 10–19 mm | LR-3 | LR-4 | LR-5 |
| ≥20 mm | LR-4 | LR-5 | LR-5 |
(Additional features = washout, capsule, or threshold growth. 10–19 mm with APHE + washout or capsule = LR-5. Without APHE, use column “0”.)
| Category | Meaning |
|---|---|
| LR-1 | Definitely benign |
| LR-2 | Probably benign |
| LR-3 | Intermediate probability of HCC |
| LR-4 | Probably HCC |
| LR-5 | Definitely HCC |
| LR-M | Probably/definitely malignant, not HCC-specific (e.g. iCCA — targetoid, rim APHE, peripheral washout) |
| LR-TIV | Tumour in vein (unequivocal enhancing soft tissue in vein) |
LIVER MRI — LI-RADS v2018 (at-risk patient) TECHNIQUE: [1.5T/3T], [extracellular / hepatobiliary (gadoxetate)] agent, multiphase (pre, late arterial, PV, delayed[, HBP]). DWI. Quality: [adequate / limited by arterial timing / motion]. AT-RISK STATUS: [cirrhosis / chronic HBV / prior HCC]. LIVER: [cirrhotic / steatosis / iron]. Ascites [y/n]. Varices [y/n]. OBSERVATION 1 Segment [__], size [__] mm (measured on [__] phase). Non-rim APHE: [present / absent] Non-peripheral washout: [present / absent] Enhancing capsule: [present / absent] Threshold growth: [present (≥50% ≤6mo) / absent / n.a.] Targetoid features: [none / present → consider LR-M] HBP: [hypointense / iso/hyper]. DWI: [restricted / no]. LI-RADS CATEGORY: [LR-1 / 2 / 3 / 4 / 5 / M / TIV] OBSERVATION 2 (if present): [repeat block] VASCULAR: [patent portal/hepatic veins / tumour in vein → LR-TIV, vessel __]. IMPRESSION: 1. [n] observation(s); dominant = segment [__], [size], LR-[__]. 2. [MDT / follow-up interval / treatment].
Rectal cancer
Rectal Cancer Staging MRI (ESGAR)
Key surgical drivers: the mesorectal fascia (MRF) / CRM — tumour, deposit, or EMVI ≤1 mm from the MRF is mrCRM-involved (threatened). Report EMVI (tumour replacing the vascular flow void beyond muscularis propria). T-stage, N-stage, height and sphincter relationship complete local staging.
| mrT | Definition |
|---|---|
| T1 | Tumour into submucosa (hard to separate from T2 on MRI) |
| T2 | Into but not through muscularis propria |
| T3a–d | Through MP into mesorectal fat: a <1mm, b 1–5mm, c 5–15mm, d >15mm |
| T4a | Invades visceral peritoneum |
| T4b | Invades adjacent organ/structure |
RECTAL CANCER — Staging MRI (ESGAR) TECHNIQUE: High-resolution T2 in 3 planes [oblique axial ⟂ to tumour], [±DWI, ±contrast]. [1.5T/3T]. [±spasmolytic]. TUMOUR LOCATION / HEIGHT: Lower edge [__] cm from anal verge; [low (0-5) / mid (5-10) / high (10-15)]. Craniocaudal length [__] mm. Position: [ant/post/right/left], clock [__]. Relation to anterior peritoneal reflection: [above / at / below]. Morphology: [polypoid / semiannular / annular / mucinous (high T2)]. T STAGE (mrT): [T1/T2 / T3a / T3b / T3c / T3d / T4a / T4b] Extramural depth of spread: [__] mm. MRF / CRM: Shortest tumour-to-MRF distance [__] mm. Status: [CLEAR (>1mm) / THREATENED or INVOLVED (≤1mm)] by [tumour / deposit / EMVI / node]. Quadrant of closest approach: [__]. EMVI: [absent / present] — [vessel/quadrant __], mrEMVI score [0-4]. N STAGE (mrN): Mesorectal nodes: [n] suspicious (short axis, round, irregular, heterogeneous). Extramesorectal (lateral/iliac/obturator): [none / present, side __]. Tumour deposits: [none / present]. mrN: [N0 / N1 / N2] SPHINCTER COMPLEX (low tumours): Internal / intersphincteric plane / external / levator: [intact / involved]. IMPRESSION: 1. [mrT_ N_], MRF [clear/threatened], EMVI [pos/neg]. Height [__]cm. 2. Risk group: [good / intermediate / poor / locally advanced] → [MDT: upfront surgery / neoadjuvant CRT].
Knee MRI
Knee MRI — Structured MSK Template
Systematic checklist: menisci → cruciate & collateral ligaments → cartilage → bone/marrow → extensor mechanism → synovium/effusion. Grade meniscal signal (grade 3 = signal reaching an articular surface = tear) and cartilage (modified Outerbridge/ICRS 0–4).
MRI KNEE — [right / left] TECHNIQUE: [1.5T/3T], [PDFS ax/cor/sag, T1, T2]. Indication: [trauma / pain / internal derangement / post-op]. MENISCI Medial: [normal] or [tear — horizontal/oblique/radial/complex/bucket-handle/root], [ant horn / body / post horn], [displaced y/n]. Extrusion [__]mm. Lateral: [normal] or [tear type, location]. Discoid: [y/n]. LIGAMENTS ACL: [intact / partial / full-thickness tear] — [±secondary signs: pivot-shift oedema, ant tibial translation, Segond]. PCL: [intact / sprain / tear] MCL: [intact / grade I / II / III] LCL / posterolateral corner: [intact / injured] CARTILAGE (ICRS/Outerbridge 0-4) Patellofemoral: [grade __] Medial FT: [grade __] Lateral FT: [grade __] BONE / MARROW Contusion / oedema: [none / location — lateral "kissing" = ACL injury]. Fracture: [none / __]. Osteochondral lesion: [none / __, stable/unstable]. EXTENSOR MECHANISM Quadriceps tendon: [intact / tear]. Patellar tendon: [intact / tendinopathy / tear]. Tracking / trochlea: [normal / dysplasia, TT-TG __mm]. MPFL: [intact / torn]. OTHER: Effusion [none/small/mod/large]. Baker's cyst [y/n]. Plica / loose body [__]. IMPRESSION: 1. [Dominant abnormality]. 2. [Secondary findings].
MS / Brain
MS / Brain — Lesion-Burden Template
McDonald 2017 framework: demonstrate dissemination in space (DIS) — ≥1 T2 lesion in ≥2 of 4 locations: periventricular, cortical/juxtacortical, infratentorial, spinal cord — and dissemination in time (DIT) — simultaneous enhancing + non-enhancing lesions, or a new lesion on follow-up. (Diagnosis is clinical.)
MRI BRAIN — Demyelination protocol TECHNIQUE: [3T preferred], 3D FLAIR, T2, DWI, SWI, 3D T1 [±gad]. [±cord]. Comparison: [none / prior __]. LESION BURDEN (T2/FLAIR) Approx count: [none / few (<10) / moderate (10-30) / numerous (>30) / confluent] DIS — locations involved: Periventricular (ovoid, Dawson's fingers): [y/n, count] Cortical / juxtacortical: [y/n] Infratentorial (pons, peduncle, brainstem): [y/n] Spinal cord (if imaged): [y/n / not imaged] → DIS satisfied if ≥2 of 4 locations. ENHANCEMENT (post-gad) Enhancing lesions: [none / n = __], [nodular / open-ring]. → DIT can be met if enhancing + non-enhancing coexist on one scan. COMPARISON (if priors): New T2/FLAIR [none / n=__]. New enhancing [none / n=__]. OTHER: Central vein sign [__]. Paramagnetic rim lesions [__]. Black holes [__]. Atrophy [none/mild/mod]. Red flags against MS: [none / large confluent, mass effect, restricted diffusion, meningeal enhancement, symmetric deep grey]. IMPRESSION: 1. [n] T2/FLAIR lesions; distribution [__]. DIS: [met / not met]. DIT: [met / not met / n.a.]. 2. [Typical of / non-specific for] demyelination — correlate clinically; McDonald criteria are a clinical diagnosis.
Skeletons are teaching aids — verify every category against the current official lexicon and your local reporting standard before clinical use.
Key references: American College of Radiology — PI-RADS v2.1 (2019); ACR LI-RADS CT/MRI v2018 Core; ACR BI-RADS Atlas (MRI, 5th ed, 2013); ESGAR — Beets-Tan RGH et al., “MRI for clinical management of rectal cancer: updated recommendations from the 2016 ESGAR consensus meeting,” Eur Radiol 2018;28:1465–1475 (doi:10.1007/s00330-017-5026-2); Thompson AJ et al., “Diagnosis of MS: 2017 revisions of the McDonald criteria,” Lancet Neurol 2018;17:162–173. Knee grading: ICRS / modified Outerbridge.