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Japanese journal of radiology
Oct, 2025;43 (10): 1557-1574.

RANO 2.0: critical updates and practical considerations for radiological assessment in neuro-oncology.

Akihiko Sakata, Yasutaka Fushimi, Sonoko Oshima, Megumi Uto, Yohei Mineharu, Satoshi Nakajima, Sachi Okuchi, Takayuki Yamamoto, Sayo Otani, Satoshi Ikeda, Shigeki Takada, Takashi Mizowaki, Yoshiki Arakawa, Yuji Nakamoto
Author Information
  1. Akihiko Sakata: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. asakata@kuhp.kyoto-u.ac.jp. ORCID
  2. Yasutaka Fushimi: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  3. Sonoko Oshima: Department of Diagnostic Radiology, Shiga General Hospital, 5-4-30, Moriyama-Cho, Moriyama, 524-8524, Japan.
  4. Megumi Uto: Department of Radiation Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan.
  5. Yohei Mineharu: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan.
  6. Satoshi Nakajima: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  7. Sachi Okuchi: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  8. Takayuki Yamamoto: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  9. Sayo Otani: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  10. Satoshi Ikeda: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
  11. Shigeki Takada: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan.
  12. Takashi Mizowaki: Department of Radiation Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan.
  13. Yoshiki Arakawa: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan.
  14. Yuji Nakamoto: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
PMID: 40586994 DOI: 10.1007/s11604-025-01821-6

Abstract

Appropriate response assessment criteria are crucial for accurate evaluation of clinical trial outcomes, and numerous criteria have been proposed to address this need. With the introduction of Response Assessment in Neuro-Oncology (RANO) criteria version 2.0 (RANO 2.0) in 2023, response assessment in gliomas has evolved significantly, requiring both clinicians and radiologists to develop a comprehensive understanding of its modifications and implementation. This review first provides an overview of standard management and imaging schedule in glioma treatment. We then review the basic framework of RANO 2.0, inherited from previous response criteria, with particular emphasis on major modifications to this framework: the implementation of the Brain Tumor Imaging Protocol and the adoption of post-radiation scan as the baseline scan. Additionally, we analyze critical changes in response evaluation and interpretation, specifically focusing on the role of preliminary progressive disease assessment with confirmation scans, and the elimination of T2/FLAIR lesion measurements from enhancing tumor assessment. Through illustrative clinical cases, we demonstrate the practical application of these modifications and discuss the implementation of three distinct imaging-based categories: enhancing tumor, non-enhancing tumor, and tumors with both enhancing and non-enhancing components (in short, mixed tumor). This comprehensive narrative review provides clinicians with practical guidance for implementing RANO 2.0 in their clinical practice.

Keywords

Glioma MRI Pseudoprogression Pseudoresponse RANO 2.0 Treatment response criteria

References

J Neurooncol. 2024 Sep;169(3):517-529 [PMID: 39105956]
Cancers (Basel). 2023 Oct 13;15(20): [PMID: 37894340]
Neurooncol Pract. 2023 Oct 03;11(1):36-45 [PMID: 38222046]
Lancet Oncol. 2024 Jan;25(1):e29-e41 [PMID: 38181810]
Neurooncol Adv. 2024 Nov 16;6(1):vdae199 [PMID: 39659831]
Neurooncol Adv. 2021 May 20;3(1):vdab069 [PMID: 34286277]
Jpn J Radiol. 2025 Mar;43(3):355-364 [PMID: 39548049]
Lancet Oncol. 2015 Nov;16(15):e534-e542 [PMID: 26545842]
AJNR Am J Neuroradiol. 2025 May 2;46(5):990-998 [PMID: 39542725]
Brain Tumor Pathol. 2023 Jan;40(1):1-3 [PMID: 36538117]
Korean J Radiol. 2025 Mar;26(3):246-268 [PMID: 39999966]
Br J Radiol. 2011 Dec;84 Spec No 2:S159-67 [PMID: 22433826]
Neuro Oncol. 2015 Sep;17(9):1188-98 [PMID: 26250565]
Neurosurgery. 2025 Jun 1;96(6):1181-1192 [PMID: 39570018]
Brain Commun. 2024 Mar 27;6(2):fcae108 [PMID: 38646145]
Front Radiol. 2023 Dec 13;3:1267615 [PMID: 38152383]
Radiology. 2024 Jul;312(1):e232640 [PMID: 39041936]
Korean J Radiol. 2025 Apr;26(4):368-389 [PMID: 40015559]
Diagnostics (Basel). 2023 Feb 20;13(4): [PMID: 36832282]
Neuro Oncol. 2024 Oct 3;26(10):1823-1836 [PMID: 38808755]
Neurooncol Adv. 2024 Nov 28;6(1):vdae176 [PMID: 39659832]
Curr Opin Oncol. 2024 Nov 1;36(6):536-544 [PMID: 39011735]
J Neurosurg. 2018 Aug 10;131(1):209-216 [PMID: 30095340]
Lancet Oncol. 2024 Nov;25(11):e589-e601 [PMID: 39481415]
Sci Rep. 2021 Jul 13;11(1):14408 [PMID: 34257410]
Neuro Oncol. 2022 Jul 1;24(7):1035-1047 [PMID: 35137214]
Neuro Oncol. 2024 Oct 6;26(Supplement_6):vi1-vi85 [PMID: 39371035]
Cancers (Basel). 2020 Dec 26;13(1): [PMID: 33375286]
Acta Neurochir (Wien). 2019 Mar;161(3):569-576 [PMID: 30756242]
AJNR Am J Neuroradiol. 2024 Dec 9;45(12):1846-1856 [PMID: 38926092]
Clin Neuroradiol. 2018 Sep;28(3):401-411 [PMID: 28466127]
Jpn J Radiol. 2024 Dec;42(12):1399-1402 [PMID: 39096483]
Neurooncol Adv. 2020 Dec 07;3(1):vdaa172 [PMID: 33681765]
Neuro Oncol. 2012 May;14(5):667-73 [PMID: 22492961]
Neuro Oncol. 2022 May 4;24(5):770-778 [PMID: 34751786]
Cochrane Database Syst Rev. 2017 Apr 27;4:CD009319 [PMID: 28447767]
Magn Reson Med Sci. 2024 Nov 19;: [PMID: 39567017]
Lancet Oncol. 2024 Mar;25(3):400-410 [PMID: 38423052]
Asia Pac J Clin Oncol. 2018 Oct;14(5):e359-e365 [PMID: 29114999]
J Magn Reson Imaging. 2023 Sep;58(3):677-689 [PMID: 37069792]
J Magn Reson Imaging. 2023 Jun;57(6):1676-1695 [PMID: 36912262]
Neuro Oncol. 2017 May 1;19(5):719-725 [PMID: 28453748]
J Clin Oncol. 1990 Jul;8(7):1277-80 [PMID: 2358840]
Nat Rev Clin Oncol. 2021 Mar;18(3):170-186 [PMID: 33293629]
Neuro Oncol. 2021 May 5;23(5):837-847 [PMID: 33130858]
N Engl J Med. 2023 Aug 17;389(7):589-601 [PMID: 37272516]
Neuro Oncol. 2023 Mar 14;25(3):495-507 [PMID: 35953421]
AJNR Am J Neuroradiol. 2025 Jan 8;46(1):220 [PMID: 39730159]
AJNR Am J Neuroradiol. 2025 May 2;46(5):983-989 [PMID: 39477545]
Korean J Radiol. 2024 Sep;25(9):859-864 [PMID: 39028016]
Lancet Oncol. 2011 Jun;12(6):583-93 [PMID: 21474379]
Neuro Oncol. 2025 Jun 21;27(5):1341-1355 [PMID: 39700439]
J Neurosurg. 2023 Feb 10;139(3):748-759 [PMID: 36790010]
Brain Tumor Pathol. 2017 Jul;34(3):103-112 [PMID: 28447171]
J Magn Reson Imaging. 2023 Jun;57(6):1655-1675 [PMID: 36866773]
Jpn J Radiol. 2024 Jan;42(1):3-15 [PMID: 37540463]
World J Clin Oncol. 2024 Feb 24;15(2):178-194 [PMID: 38455131]
Cochrane Database Syst Rev. 2019 Jun 06;6:CD002034 [PMID: 31169915]
J Clin Oncol. 2023 Jun 10;41(17):3160-3171 [PMID: 37027809]
J Neurosurg. 2016 Apr;124(4):977-88 [PMID: 26495941]
Neurooncol Adv. 2023 Mar 18;5(1):vdad028 [PMID: 37128507]
J Neurooncol. 2025 Jan;171(2):255-264 [PMID: 39527382]
Lancet Oncol. 2024 Nov;25(11):e581-e588 [PMID: 39481414]
Radiology. 2021 Jan;298(1):E61 [PMID: 33347400]
Neurosurgery. 2019 Sep 1;85(3):E448-E456 [PMID: 30407589]
Am J Surg Pathol. 2023 Dec 1;47(12):1364-1375 [PMID: 37737691]
BMC Cancer. 2021 Oct 15;21(1):1105 [PMID: 34654402]
Neuro Oncol. 2025 May 15;27(4):1102-1115 [PMID: 39665363]
Neurooncol Pract. 2017 Jun;4(2):120-134 [PMID: 31386017]
JAMA. 2015 Dec 15;314(23):2535-43 [PMID: 26670971]
Jpn J Radiol. 2023 Oct;41(10):1062-1071 [PMID: 37071249]
Eur J Nucl Med Mol Imaging. 2024 May;51(6):1698-1702 [PMID: 38228970]
Neurosurg Clin N Am. 2025 Jan;36(1):83-89 [PMID: 39542552]
J Neuroimaging. 2022 Jan;32(1):17-27 [PMID: 34632671]
Neurooncol Adv. 2024 Oct 24;6(1):vdae178 [PMID: 39659835]
AJNR Am J Neuroradiol. 2011 Dec;32(11):1978-85 [PMID: 21393407]
Radiol Case Rep. 2024 Aug 19;19(11):5038-5043 [PMID: 39253041]
Radiol Case Rep. 2023 Jul 01;18(9):3243-3247 [PMID: 37424770]
J Neurosurg. 1977 Sep;47(3):329-35 [PMID: 894339]
Eur J Radiol. 2023 Feb;159:110658 [PMID: 36571926]
J Comput Assist Tomogr. 2023 Jul-Aug 01;47(4):659-665 [PMID: 36877775]
Neuro Oncol. 2024 Aug 5;26(8):1536-1537 [PMID: 38856584]
Eur Radiol. 2022 Jun;32(6):3672-3682 [PMID: 35022811]
J Neurooncol. 2024 Mar;167(1):133-144 [PMID: 38326661]
Acta Neuropathol. 2018 Nov;136(5):805-810 [PMID: 30259105]
AJR Am J Roentgenol. 2025 Jan;224(1):e2330612 [PMID: 38477525]
PLoS Med. 2019 May 28;16(5):e1002810 [PMID: 31136584]
Curr Neurol Neurosci Rep. 2024 Feb;24(2):17-25 [PMID: 38170429]
Radiat Oncol. 2025 Mar 09;20(1):32 [PMID: 40059195]
Neuro Oncol. 2021 Aug 2;23(8):1231-1251 [PMID: 34185076]
BMC Cancer. 2018 Mar 1;18(1):239 [PMID: 29490632]
Radiographics. 2022 Sep-Oct;42(5):1474-1493 [PMID: 35802502]
Neuroradiology. 2024 Jun;66(6):973-981 [PMID: 38653782]
Neurotherapeutics. 2017 Apr;14(2):307-320 [PMID: 28108885]
Clin Cancer Res. 2016 Feb 1;22(3):575-81 [PMID: 26490307]
Nucl Med Mol Imaging. 2024 Jun;58(4):237-245 [PMID: 38932755]
J Clin Oncol. 2010 Feb 20;28(6):e91-3 [PMID: 19933906]
J Clin Oncol. 2023 Nov 20;41(33):5187-5199 [PMID: 37774317]
Neuro Oncol. 2020 Dec 18;22(12):1822-1830 [PMID: 32328652]
Neuroradiology. 2023 Sep;65(9):1343-1352 [PMID: 37468750]
Brain Tumor Res Treat. 2022 Apr;10(2):83-93 [PMID: 35545827]
J Clin Oncol. 2010 Apr 10;28(11):1963-72 [PMID: 20231676]
J Neurooncol. 2019 Mar;142(1):69-77 [PMID: 30488294]
World Neurosurg. 2016 Jun;90:440-447 [PMID: 27001238]
Neuro Oncol. 2024 Jul 5;26(7):1181-1194 [PMID: 38466087]
Jpn J Radiol. 2024 Jul;42(7):685-696 [PMID: 38551772]
Jpn J Radiol. 2023 Nov;41(11):1255-1264 [PMID: 37219717]
N Engl J Med. 2005 Mar 10;352(10):987-96 [PMID: 15758009]
JAMA Oncol. 2020 Apr 1;6(4):495-503 [PMID: 32027343]

Grants

  1. ISHIZUE 2024/Kyoto University

MeSH Term

Humans
Brain Neoplasms
Glioma
Neuroimaging
Magnetic Resonance Imaging
Response Evaluation Criteria in Solid Tumors
Brain
Journal Article Review

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