A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults

Benjamin M Ellingson; Francesco Sanvito; Timothy F Cloughesy; Raymond Y Huang; Javier E Villanueva-Meyer; Whitney B Pope; Daniel P Barboriak; Lalitha K Shankar; Marion Smits; Timothy J Kaufmann; Jerrold L Boxerman; Michael Weller; Evanthia Galanis; John de Groot; Mark R Gilbert; Andrew B Lassman; Mark S Shiroishi; Ali Nabavizadeh; Minesh Mehta; Roger Stupp; Wolfgang Wick; David A Reardon; Michael A Vogelbaum; Martin van den Bent; Susan M Chang; Patrick Y Wen

doi:10.3174/ajnr.A8396

A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults

AJNR Am J Neuroradiol. 2024 Dec 9;45(12):1846-1856. doi: 10.3174/ajnr.A8396.

Authors

Benjamin M Ellingson¹, Francesco Sanvito¹, Timothy F Cloughesy², Raymond Y Huang³, Javier E Villanueva-Meyer⁴, Whitney B Pope⁵, Daniel P Barboriak⁶, Lalitha K Shankar⁷, Marion Smits⁸, Timothy J Kaufmann⁹, Jerrold L Boxerman¹⁰, Michael Weller¹¹, Evanthia Galanis¹², John de Groot¹³, Mark R Gilbert¹⁴, Andrew B Lassman¹⁵, Mark S Shiroishi¹⁶, Ali Nabavizadeh¹⁷, Minesh Mehta¹⁸, Roger Stupp¹⁹, Wolfgang Wick²⁰, David A Reardon²¹, Michael A Vogelbaum²², Martin van den Bent²³, Susan M Chang¹³, Patrick Y Wen²¹

Affiliations

¹ From the UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences (B.M.E., F.S.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
² UCLA Brain Tumor Program, Department of Neurology (T.F.C.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
³ Department of Radiology, Brigham and Women's Hospital (R.Y.H.), Harvard Medical School, Boston, MA.
⁴ Departments of Radiology and Neurosurgery (J.E.V.-M.), University of California San Francisco, CA.
⁵ Department of Radiological Sciences (W.B.P.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
⁶ Department of Radiology (D.P.B.), Duke University Medical Center, Durham, NC.
⁷ Clinical Trials Branch, Cancer Imaging Program (L.K.S.), National Cancer Institute, National Institutes of Health, Bethesda, MD.
⁸ Department of Radiology & Nuclear Medicine (M.S.), Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.
⁹ Department of Radiology (T.J.K.), Mayo Clinic, Rochester, MN.
¹⁰ Department of Diagnostic Imaging (J.L.B.), Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI.
¹¹ Department of Neurology (M.W.), University Hospital and University of Zurich, Zurich, Switzerland.
¹² Department of Oncology (E.G.), Mayo Clinic, Rochester, MN.
¹³ Division of Neuro-Oncology, Department of Neurosurgery (J.d.G., S.M.C.), University of California, San Francisco, CA.
¹⁴ Neuro-Oncology Branch, Center for Cancer Research (M.R.G.), National Cancer Institute, National Institutes of Health, Bethesda, MD.
¹⁵ Division of Neuro-Oncology, Department of Neurology (A.B.L.), Herbert Irving Comprehensive Cancer Center and Irving Institute for Clinical and Translational Research, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY.
¹⁶ Department of Radiology (M.S.S.), Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA.
¹⁷ Department of Radiology (A.N.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
¹⁸ Miami Cancer Institute (M.M.), Miami, FL.
¹⁹ Malnati Brain Tumor Institute, Lurie Comprehensive Cancer Center and Departments of Neurological Surgery, Neurology and Division of Hematology/Oncology (R.S.), Northwestern University, Chicago, IL.
²⁰ Department of Neurology Heidelberg University Hospital & Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
²¹ Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School(D.A.R., P.Y.W.), Boston, MA.
²² Department of Neuro-Oncology (M.A.V.), Moffitt Cancer Center, Tampa, FL.
²³ Department Neuro-Oncology (M.v.d.B.), Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

PMID: 38926092
PMCID: PMC11630866 (available on 2025-12-01)
DOI: 10.3174/ajnr.A8396

Abstract

Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults. This article provides an overview of significant updates to the criteria including (1) the use of a unified set of criteria for high and low grade gliomas in adults; (2) the use of the post-radiotherapy MRI scan as the baseline for evaluation in newly diagnosed high-grade gliomas; (3) the option for the trial to mandate a confirmation scan to more reliably distinguish pseudoprogression from tumor progression; (4) the option of using volumetric tumor measurements; and (5) the removal of subjective non-enhancing tumor evaluations in predominantly enhancing gliomas (except for specific therapeutic modalities). Step-by-step pragmatic guidance is hereby provided for the neuroradiologist and imaging core lab involved in operationalization and technical execution of RANO 2.0 in clinical trials, including the display of representative cases and in-depth discussion of challenging scenarios.

Publication types

Review

MeSH terms

Adult
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / pathology
Brain Neoplasms* / therapy
Glioma* / diagnostic imaging
Glioma* / pathology
Glioma* / therapy
Humans
Magnetic Resonance Imaging / methods
Magnetic Resonance Imaging / standards

Abstract

Publication types

MeSH terms

Grants and funding