grading
Subependymal hemorrhage (SEH) into germinal matrix
Subependymal hemorrhage or germinal matrix hemorrhage occurs in premature infants with very low birth weight (<1500g). The germinal matrix in the immature brain is located around the lateral ventricles and it contains a fine network of fragile blood vessels, which are sensitive to ischemia and changes in perfusion pressure. Subependymal hemorrhage in premature neonates can be easily assessed by ultrasound and be divided into four grades.
| Grade | Description |
|---|---|
| Grade I | hemorrhage confined to the germinal matrix |
| Grade II | intraventricular hemorrhage (hemocephalus) without ventricular dilation |
| Grade III | intraventricular hemorrhage (hemocephalus) with ventricular dilation |
| Grade IV | intraventricular rupture with hemorrhage into the surrounding white matter |
References:
1. Bowerman R, Donn S, Silver T, Jaffe M. Natural history of neonatal periventricular/intraventricular hemorrhage and its complications: sonographic observations. American Journal of Roentgenology. 1984 Nov 1;143(5):1041–52.
2. Radack DM, Baumgart S, Gross GW. Subependymal (grade 1) intracranial hemorrhage in neonates on extracorporeal membrane oxygenation. Frequency and patterns of evolution. Clin Pediatr (Phila). 1994 Oct;33(10):583–7.
3. Smith WL, McGuinness G, Cavanaugh D, Courtney S. Ultrasound screening of premature infants: longitudinal follow-up of intracranial hemorrhage. Radiology. 1983 May 1;147(2):445–8.
Grading of meniscal injury
Lesions of the menisci on MRI are divided into four grades. Normal meniscus has uniformly low signal intensity on T2-weighted images (T2W). Grade I and II lesions can be a normal appearance of ageing in older patients.
| Grade | Description |
|---|---|
| Grade I | small focus of increased signal intensity on T2W, that does not extend to the articular surface |
| Grade II | linear area of increased signal intensity without extension to the articular surface |
Grading of injury of the collateral ligament of the knee on MRI and ultrasound
Injuries to the medial collateral injury are divided into three grades similarly to other ligamentous lesions elsewhere.
| Grade | Description | Description - MRI | Description - US |
|---|---|---|---|
| Grade I | microscopic tear or strain injury | edema superficial to the ligament | hypoechoic fluid parallel to the ligament |
| Grade II | partial tear |
Grades of osteoarthritis by Ahlbäck
Grading of joint osteoarthritis by Ahlbäck uses plain postero-anterior weight-bearing radiographs to assess the extent of degenerative disease as joint space narrowing and bone attrition.
| Grade - Changes | Description |
|---|---|
| Grade I | joint space narrowing (<3mm) |
| Grade II | joint space obliteration |
| Grade III | minor bone attrition (0 - 5mm) |
| Grade IV |
Gastroesophageal reflux - grading on barium study
In 1977, a grading system of gastroesophageal reflux on barium study was devised. It is based on the extent of retrograde flow of barium.
| Grade | Description |
|---|---|
| I | reflux into distal esophagus only |
| II | reflux extending above carina |
| III | reflux into cervical esophagus |
| IV | free persistent reflux into cervical esopagus with a wide open cardia (chalasia) |
Coxarthrosis - degenerative disease of the hip joint - grading of osteoarthrosis (modified Kellgren and Lawrence grades)
This is an alternative grading system for degenerative disease of the hip joint - coxarthrosis. Rather than giving percentage of joint space narrowing, it preferes descriptive approach to the typical degenerative changes of the hip joint.
| Grade | Description |
|---|---|
| Grade I | medial joint space narrowing, beginning osteophytes |
| Grade II | inferomedial joint space narrowing, marked osteophytes, subchondral sclerosis |
| Grade III |
Chondromalacia - MRI grading by modified Noyes System
The modified Noyes system was published in 2009. It is a modification of the Noyes grading system for the purpose of MRI grading. The original Noyes grading system was based on arthroscopic findings.
| Grade | Description |
|---|---|
| Grade 0 | normal cartilage |
| Grade 1 | increased T2 signal intensity of morphologically normal cartilage not oriented at 55° to the external magnetic field |
| Grade 2A |
Chondromalacia - MRI grading by modified Outerbridge System
The modified Outerbridge system was published in 2006. It differs from the Outerbridge system in grade I only, the definition of which was adjusted to reflect changes on MRI, because the original system was based on arthroscopic findings.
| Grade | Description |
|---|---|
| Grade 0 | normal cartilage |
| Grade 1 | signal intensity alterations with an intact surface of the articular cartilage compared with the surrounding normal cartilage |
WHO grading of astrocytomas
The WHO grading system is currently most widely used for grading of astrocytomas. The last revision was published in 2007. It has four cathegories.
| Grade | Description | Types |
|---|---|---|
| Grade I | slow growing, benign, localised | pilocytic astrocytoma, xanthoastrocytoma, subependymal giant cell astrocytoma, subependymoma |
| Grade II | low grade, infiltrative, slow-growing | low-grade (fibrillary) astrocytoma, mixed oligoastrocytoma |
Kernohan grading of astrocytomas
The Kernohan grading system was fist described in 1949 and is no longer used. It was replaced by the WHO grading system.
| Grade | Description |
|---|---|
| Grade 1 | benign astrocytoma |
| Grade 2 | low-grade astrocytoma |
| Grade 3 | anaplastic astrocytoma |
| Grade 4 | glioblastoma |
References:
