Table 2.

Management guidelines for MRI changes

Clinico-radiologic category	Imaging changes grading	MRI changesa	Neurological statusb	Corticosteroids recommendationsc	Suggested follow-up
I	I	Hyperintense signal abnormality on FLAIR related to catheter tract or tip only; no new contrast-enhancement	No worsening	No change	Scheduled follow-up MRI and clinical assessment
IIa	II	Mild contrast-enhancement (<1.0 cm or linear) related to catheter tract or tip	No worsening	Consider resuming or increasing based on imaging features	Repeat clinical assessment in 2–4 wks and MRI in 4–8 wks depending on clinical findings
IIb	II	Mild contrast-enhancement (<1.0 cm or linear) related to catheter tract or tip	Worsening	Promptly resume or increase	Repeat MRI and clinical assessment in 2 wks
IIIa	III	Moderate contrast-enhancement (1.0–3.0 cm) related to catheter tract or tip	No worsening	Promptly resume or increase	Repeat MRI and clinical assessment in 2 wks
IIIb	III	Moderate contrast-enhancement (1.0–3.0 cm) related to catheter tract or tip	Worsening	Promptly resume or increase	Repeat MRI and clinical assessment in 2 wks
IV	IV	Extensive contrast-enhancement (>3.0 cm) related to catheter tract or tip, with or without central hypointensity	Worsening	Promptly resume or increase	Repeat MRI and clinical assessment in 2 wks

^aContrast-enhancing lesions diameter include the central hypointensity, if present.

^bNeurological symptoms/signs localization have to be related to prior catheter trajectory(ies).

^cIncrement, maintenance dose, and duration of treatment are based on clinical findings (eg, neurological symptoms, severity of neurological signs, or interference with activity of daily living) and imaging features (eg, size of the abnormality, severity of mass effect, or proximity to eloquent brain parenchyma).