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


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


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