Medically reviewed by Dr. Mitesh Chandarana | Last updated: July 2026
If you’ve ever received an MRI report and tried to read it before your follow-up appointment, you’ve likely run into a wall of unfamiliar terms “atrophy,” “hyperintensities,” “signal changes,” “no acute abnormality” written for other doctors, not for you. It’s completely normal to feel more confused after reading the report than before you had the scan.
This guide won’t replace your neurologist’s interpretation – imaging always needs to be read alongside your symptoms and examination findings but it will help you understand the structure of a typical brain MRI report and what some of the most common terms actually mean.
The Basic Structure of an MRI Report
Most radiology reports follow a similar format, regardless of which hospital or scanning center performed the study:
- Clinical History – the reason the scan was ordered (e.g., “tremor, rule out structural cause”)
- Technique – which specific MRI sequences were used (this section is almost entirely for other radiologists/technicians and rarely matters to you directly)
- Findings – the detailed, structure-by-structure description of what was observed
- Impression – a short summary at the end, pulling together the key findings into the radiologist’s overall conclusion
If you only read one section, read the Impression but always discuss the full report with your neurologist, since important details are sometimes in the Findings section that don’t make it into a brief Impression line.
Common Terms and What They Actually Mean
“No Acute Abnormality” or “Unremarkable Study”
This means the radiologist didn’t see anything requiring urgent attention – no bleed, no tumor, no acute stroke. Importantly, this does not rule out conditions like Parkinson’s disease, which often shows a completely normal MRI in its early and even moderate stages. A normal MRI in the context of classic Parkinson’s symptoms is expected, not a sign that something was missed.
“Atrophy”
This refers to shrinkage of brain tissue, which can be a normal part of aging in mild, generalized forms, or can point to a specific pattern relevant to certain conditions. The location and pattern of atrophy matters far more than the word itself for example, atrophy concentrated in the cerebellum can be relevant when evaluating conditions like MSA, while more generalized atrophy is a common, often unremarkable finding in older adults.
“Hyperintensities” or “White Matter Changes”
These appear as bright spots on certain MRI sequences and most commonly reflect small vessel changes related to blood pressure, age, or cardiovascular risk factors – extremely common findings, especially after age 50, and usually not a cause for concern on their own. Your neurologist will interpret their number, location, and pattern in the context of your specific symptoms.
Specific Named Signs
Certain patterns have descriptive nicknames in movement disorder imaging:
- “Hot cross bun sign” – a cross-shaped pattern of signal change in the brainstem, sometimes seen in Multiple System Atrophy (MSA), though not present in all MSA cases and not exclusively specific to it
- “Swallow tail sign” – relates to a specific structure in the midbrain, sometimes referenced in Parkinson’s disease imaging research, though not yet a routine clinical diagnostic tool in most settings
In my practice, I always caution patients against searching these terms online and assuming a diagnosis based on the name alone – these signs are supportive clues within a much larger clinical picture, not standalone diagnostic tests.
“Dopamine Transporter Scan” (DaTscan) – Different from a Standard MRI
If you’ve been told you need a DaTscan rather than (or in addition to) a standard MRI, this is a different, specialized type of scan that measures dopamine transporter activity in the brain used specifically to help distinguish Parkinson’s disease from certain other conditions, rather than looking at brain structure the way a standard MRI does.
Why the Report Alone Isn’t the Full Picture
This is the most important point in this entire guide: an MRI report is one piece of information, interpreted alongside your symptoms, examination findings, and sometimes other tests. Two patients can have very similar MRI findings and receive different diagnosis and treatment plans, because the imaging is only meaningful in the context of everything else.
This is also why it’s genuinely unhelpful and sometimes needlessly anxiety-inducing to search individual terms from your report online before your follow-up appointment. A term that sounds alarming in isolation is often a routine, expected finding once your doctor explains it in context.
Questions Worth Asking Your Neurologist About Your Report
- “Does anything in this report change or confirm what you suspected from my symptoms?”
- “Is there anything here that needs to be monitored with a repeat scan later?”
- “Should I be concerned about any specific finding, or is this within a normal/expected range for my situation?”
Bringing Your Report to Your Appointment
Always bring the physical report (or a digital copy) to your follow-up visit, along with the scan images themselves if provided on a CD or accessible online the radiologist’s written report and the actual images together give your neurologist the most complete picture, which matters especially in complex or borderline cases.
If you’ve recently had an MRI and are waiting to discuss it with your neurologist, try to resist the urge to fully interpret it yourself in the meantime bring your questions to the appointment instead, where the findings can be properly explained in the context of your specific symptoms and history.
Authoritative References
- RadiologyInfo.org (RSNA/ACR) – MRI of the Brain
- Movement Disorder Society – Imaging Biomarkers in Parkinsonian Disorders
- Pocket health- How to read an MRI report
