Table 2.
Adapted VASARI imaging features.
| Features and scoring | Definition |
|---|---|
| Major axis size 1. 0.5-5.0 cm; 2. > 5.0 cm |
The diameter of the tumor on its longest axis |
| Tumor location 1. Lobar*; 2. Other locations† |
Location of the geographic epicenter
of the lesion * Frontal, temporal, parietal, occipital, insular;† basal ganglia, brainstem, cerebellum, thalamus |
| Side of tumor epicenter 1. Right or left; 2. Bilateral/central |
Laterality of the lesion epicenter |
| Eloquent brain area*
involvement 1. Yes; 2. No |
Does the geographic epicenter or the
enhancing component involve an eloquent area of the
brain? * Speech motor, speech receptive, motor, vision |
| Enhancement quality 1. None; 2. Minimal*; 3. Marked* |
Qualitative degree of contrast
enhancement * Grouped so that the presence of enhancement is in a single category |
| Proportion CET 1. 0%*; 2. < 5%*; 3. 6-33%*; 4. 34-67%†; 5. 68-95%†; 6. > 95%† |
Assuming that the entire
abnormality may be comprised of an enhancing component, a
non-enhancing compo-nent, a necrotic component, and an edema
component, what proportion of the tumor is
enhancing? * 0-33% (grouped categories);† > 34% (grouped categories) |
| Proportion nCET 1. 0%*; 2. < 5%*; 3. 6-33%*; 4. 34-67%*; 5. 68-95%†; 6. > 95%† |
An nCET is defined as regions of
T2WI hyperintensity (less than the intensity of the
cerebrospinal fluid, with cor-responding T1WI hypointensity. In
view of that, what proportion of the tumor is
non-enhancing? * 0-33% (grouped categories);† > 34% (grouped categories) |
| Proportion necrosis 1. 0%*; 2. < 5%*; 3. 6-33%†; 4. 34-67%†; 5. 68- 95%†; 6. > 95%† |
Defined as a region within the tumor
that does not enhance or shows markedly diminished enhancement,
with hyperintensity on T2WI, hypointensity on T1WI, and an
irregular border * < 5% (grouped categories); †> 5% (grouped categories) |
| Cysts 1. Yes; 2. No |
Well-defined, rounded, often eccentric regions of very high and low signal intensity on T2WI and T1WI, respec-tively, essentially matching that of the cerebrospinal fluid, with very thin, regular, smooth, non-enhancing or regularly enhancing walls, possibly with thin, regular, internal septations |
| Multifocal or multicentric 1. No; 2. Multifocal*; 3. Multicentric*; 4. Gliomatosis* |
Multifocal is defined as having at
least one region of tumor, either enhancing or non-enhancing,
which is not contiguous with the dominant lesion. Multicentric
is defined as widely separated lesions in different lobes or
dif-ferent hemispheres. Gliomatosis refers to the generalized
neoplastic transformation of the white matter of most of a
hemisphere * Grouped into one category |
| Tl/FLAIR ratio 1. Expansive; 2.Mixed*; 3. Infiltrative* |
Expansive = size of the
abnormality on an unenhanced T1WI approximates that seen on a
FLAIR sequence. Mixed = size of the abnormality on an unenhanced
T1WI moderately less than that seen on a FLAIR sequence.
Infiltrative = size of the abnormality on an unenhanced T1WI
much smaller than that seen on a FLAIR
sequence * Grouped into one category |
| Thickness of enhancing
margin 1. Not applicable; 2. None; 3. Thin; 4. Thick |
The scoring is not applicable if there is no contrast enhancement. If most of the enhancing rim is thin, regular, and homogenous, the grade is thin. If most of the rim demonstrates nodular or thick enhancement, the grade is thick. If there is only solid enhancement and no rim, the grade is none |
| Definition of enhancing
margin 1. Not applicable; 2. Well-defined; 3. Poorly defined |
The score is not applicable if there is no contrast enhancement. Assess if most of the outside margin of the en-hancement is well defined or poorly defined |
| Definition of the non-enhancing margin 1. Smooth; 2. Irregular; 3. Not applicable | If most of the outside non-enhancing margin of the tumor is well defined and smooth (geographic), versus poorly defined and irregular |
| Proportion of edema 1. 0%*; 2. < 5%*; 3. 6-33%t; ; 4. 34-67%†; 5. 68-95%†; 6. > 95%† |
What proportion of the abnormality is vasogenic edema? Edema should be greater in signal than nCET * < 5% (grouped categories);† > 5% (grouped categories) |
| Edema crossing the midline 1. Yes; 2. No |
Edema spans white matter commissures extending into the contralateral hemisphere |
| Hemorrhage 1. No; 2. Yes | Intrinsic hemorrhage in the tumor matrix. Any intrinsic foci of low signal intensity on T2WI and SWI or high signal intensity on T1WI |
| Diffusion 1. Facilitated*; 2. Restricted; 3. Neither/equivocal* |
Predominantly facilitated or
restricted diffusion in the enhancing or non-enhancing portion
of tumor. (Based on the ADC map). The proportion of tissue is
not relevant * Grouped into one category |
| Pial invasion 1. Yes; 2. No |
Enhancement of the overlying pia in continuity with CET or nCET |
| Ependymal invasion 1. Yes; 2. No |
Invasion of any adjacent ependymal surface in continuity with CET or nCET matrix |
| Cortical involvement 1. Yes; 2. No | CET or nCET extending to the cortical mantle, or cortex is no longer distinguishable relative to the subjacent tumor |
| Deep white matter
invasion 1. Yes; 2. No |
CET or nCET extending into the internal capsule or brainstem |
| nCET crossing the midline 1. Yes; 2. No |
nCET crosses into the contralateral hemisphere through white matter commissures |
| CET crossing the midline 1. Yes; 2. No |
Enhancing tissue crosses into the contralateral hemisphere through white matter commissures |
| Satellites 1. Yes; 2. No | A satellite lesion is an area of enhancement within the region of signal abnormality surrounding the dominant lesion but not contiguous in any part with the major tumor mass |
CET, contrast-enhancing tumor; nCET, non-contrast-enhancing tumor; T2WI, T2-weighted imaging; T1WI, T1-weighted imaging; FLAIR, fluid-attenuated inversion recovery; SWI, susceptibility-weighted imaging; ADC, apparent diffusion coefficient.