Brain MRI Recognition Pattern

Systematic approach to interpreting brain MRI with sequences, anatomical landmarks, and key pathological patterns

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1. MRI Sequences

A. Standard Sequences

• • T1-weighted:
  - Anatomical detail
  - Hypointense CSF, gray/white matter differentiation
  - Contrast-enhancing lesions (post-gadolinium)
• • T2-weighted:
  - Pathological changes
  - Hyperintense CSF, edema, tumors
  - White matter lesions
• • FLAIR:
  - Suppresses CSF signal
  - Highlights periventricular lesions
  - MS plaques, infarcts
• • DWI/ADC:
  - Acute ischemia (bright on DWI, dark on ADC)
  - Abscesses, cytotoxic edema
• • SWI/GRE:
  - Blood products, calcifications
  - Microbleeds, cavernomas

B. Advanced Sequences

• • MRA:
  - Vascular anatomy
  - Aneurysms, stenoses
• • MRV:
  - Venous sinuses
  - Thrombosis
• • Perfusion:
  - rCBV maps
  - Tumor grading, penumbra
• • Spectroscopy:
  - Metabolic profiles
  - Choline/NAA ratio for tumors

2. ABCDEF Systematic Approach

Step

Assessment

Key Elements

A

Alignment/Atrophy

Midline shift, sulcal prominence

B

Blood/Bones

Hemorrhage, fractures

C

Cisterns/Ventricles

Hydrocephalus, SAH

D

Densities

Signal abnormalities

E

Enhancement

Patterns (nodular/ring)

F

Fossa/Foramina

Posterior fossa lesions

3. Pathological Patterns

A. White Matter Lesions

Condition

Pattern

Key Features

MS

Periventricular ovoid

Dawson's fingers, callosal involvement

Vasculitis

Multifocal

Juxtacortical, deep gray matter

CJD

Cortical ribboning

Basal ganglia DWI restriction

ADEM

Ill-defined

Post-infectious, large lesions

B. Mass Lesions

• • Glioblastoma:
  - Irregular ring enhancement
  - Central necrosis
  - Surrounding FLAIR hyperintensity
• • Meningioma:
  - Dural-based
  - Homogeneous enhancement
  - Dural tail
• • Metastasis:
  - Multiple
  - Gray-white junction
  - Vasogenic edema

4. Vascular Patterns

A. Stroke

• • Acute:
  - DWI bright (minutes)
  - ADC dark (1-7 days)
  - T2/FLAIR positive (6-12 hrs)
• • Subacute:
  - T1 shortening (3-7 days)
  - Gyral enhancement (days-weeks)
• • Chronic:
  - Encephalomalacia
  - Hemosiderin (GRE hypointense)

B. Hemorrhage Evolution

Stage

T1

T2

Hyperacute

Iso

Hyper

Acute

Iso

Hypo

Early subacute

Hyper

Hypo

Late subacute

Hyper

Hyper

Chronic

Hypo

Hypo

5. Key Anatomical Landmarks

Structure

Location

Significance

Internal capsule

Between thalamus and basal ganglia

Motor/sensory pathways

Corpus callosum

Midline

Interhemispheric connections

Optic radiation

Temporal lobe to occipital

Visual pathway

Circle of Willis

Brain base

Vascular supply

6. Brain MRI Reporting Template

• 1. Technique: Sequences, contrast use
• 2. Parenchyma:
  - Gray/white differentiation
  - Focal abnormalities
• 3. Ventricles/Cisterns:
  - Size
  - Symmetry
• 4. Vascular:
  - Flow voids
  - Abnormal enhancement
• 5. Bones/Sinuses:
  - Fractures
  - Sinus disease
• 6. Impression:
  - Key findings
  - Differential diagnosis

Always correlate with clinical history and prior imaging. Review all sequences systematically. For stroke protocols, check DWI immediately. In trauma, review SWI for microbleeds. For tumors, assess perfusion and spectroscopy when available. Document incidental findings (e.g., aneurysms, empty sella) with appropriate follow-up recommendations. Compare with prior studies for interval changes when possible.

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