Sankar et al.15 retrospectively review their single-institution experience with oliogodendrogliomas that enhance preoperatively to determine if the amount of postoperative residual enhancing volume has prognostic importance. They use a semiautomated, free software tool that provides quantitative volumetric measurements of residual enhancing volume and demonstrate enviable intraand interobserver reliability. Their analysis shows that reduced postoperative residual enhancing volume and a greater resection of enhancing tissue are associated with longer overall survival times. Of note, the amount of resection that was required for this prognostic benefit was greater than 95%. Computed methods of image segmentation for assessing enhancing brain tumor were first reported in the late 1990s and have been increasingly utilized in recent years.8,9, 11,16,18 Compared to measurements of tumor on 2-dimensional MR images, which form the basis of the RECIST17 and Macdonald10 criteria, computed image segmentation provides a more precise and reproducible measure of tumor volume from MRI studies.4 A precise tumor volume measurement is critical for studies, such as this one, that evaluate tumor volume as a prognostic factor. Sankar and colleagues’ findings15 are supported by a prior study that show volumetric measurements correlate better with prognosis compared to 1-dimensional (RECIST7) and 2-dimensional (Macdonald10) measurements for recurrent malignant glioma.5 Sankar et al. utilize Medical Image Processing and Visualization (MIPAV) software that is made freely available by the National Institutes of Health, but there are multiple other methods of semiautomated image segmentation utilized by several different software applications.3,11,12 Com mon to all is the process of selecting representative seed points within the tumor and editing the images to include or exclude improperly classified regions. We are in desperate need of a method of determining residual disease that is highly reproducible and has low interobserver variability, even among users of variable experience levels. Malignant primary brain tumors are often irregular in shape, cystic, or have satellite lesions that make traditional 1or 2-dimensional methods difficult, if not impossible, to use. Moreover, after resection, thin rims of enhancement may be seen which cannot be represented accurately using these other methods.9 An assessment of tumor response or progression in the context of these small rims of enhancement is impossible. This is important because tumor response is now being accepted as a criterion for drug approval by the FDA.6,13,14,21 In addition, if we could better and more quickly assess tumor progression, we might be able to stop ineffective treatments earlier and better serve our patients. There still remain some problems with the method proposed by Sankar et al.,15 however. First of all, the signal from blood, again not uncommonly seen in postoperative resection cavities, would be difficult to differentiate from tumor enhancement using their approach. In addition, changes in gadolinium contrast enhancement are not linear, so better methods of quantitating residual tumor as it relates to gadolinium contrast enhancement are still needed. Finally, in the age of “pseudo-progression”1,2 and “pseudo-response,”19 we will need to develop additional criteria above and beyond imaging enhancement to assess tumor volume and progression.15,20 (http://thejns.org/doi/abs/10.3171/2011.10.JNS111437)