Table 3.
Scorecard for radiographic assessment in leptomeningeal metastases
| MRI Findings | Present (1) or Absent (0) or Non-evaluable (NE) | Dimensions Of Measurable Nodules Defined as >5 x 10 mm (orthogonal diameters) | Change from Previous MRI (−3 to +3) |
|---|---|---|---|
| BRAIN | |||
| Nodules (subarachnoid or ventricular) | |||
| Leptomeningeal enhancement* | |||
| Cranial nerve enhancement | |||
| Hydrocephalus^ | |||
| Parenchymal (brain metastases)^ | |||
| SPINE | |||
| Nodules (subarachnoid) | |||
| Leptomeningeal enhancement | |||
| Nerve root enhancement | |||
| Parenchymal(intramedullary metastases)^ | |||
| Epidural metastasis ^ | |||
| TOTAL SCORE |
Legend:
*Leptomeningeal enhancement may include pia, cerebellar folia, ventricular ependyma or cerebral sulci.
^Both hydrocephalus and parenchymal metastases, either brain or spine, are noted as present or absent but not used for LM response determination.
Column 2: scored as 1 (present) or 0- (absent) or non-evaluable (NE). A maximum of 5 radiographic target lesions are selected from baseline imaging to score on follow-up.
Column 3: scores each measurable lesion (at least 5 × 10 mm) excluding parenchymal as 1 (present with maximum orthogonal diameters) or 0 (absent).
Column 4: change from baseline or prior image scored as same (0), probable improvement (+1), definite improvement (+2), no evidence of disease (+3) or probable worsening (−1), definite worsening (−2), new site(s) of disease (−3). Measurable nodules defined as ≥5 × 10 mm are scored as same (0), resolved (no evidence of disease, complete response), definitely better (+2; partial response) [decrease by >50% in the summed product of orthogonal diameters], definite worsening (−2; progressive disease) [increase by >25% in the summed product of orthogonal diameters]. A composite score (total score) is calculated and compared with the baseline total score. A 25% worsening in the current score relative to baseline defines radiographic progressive disease. A 50% improvement in the current score defines a radiographic partial response. Resolution of all baseline radiographic abnormalities defines a complete response. All other situations define stable disease.