diff --git a/common/reviews/api/tools.api.md b/common/reviews/api/tools.api.md
index 39ab0f21a..c51d3030c 100644
--- a/common/reviews/api/tools.api.md
+++ b/common/reviews/api/tools.api.md
@@ -1000,6 +1000,8 @@ enum ChangeTypes {
     MetadataReferenceModified = "MetadataReferenceModified",
     // (undocumented)
     StatsUpdated = "StatsUpdated"
+    // (undocumented)
+    LabelChange = 'LabelChange',
 }
 
 // @public (undocumented)
diff --git a/packages/tools/src/enums/ChangeTypes.ts b/packages/tools/src/enums/ChangeTypes.ts
index cc7e05558..4f77cd978 100644
--- a/packages/tools/src/enums/ChangeTypes.ts
+++ b/packages/tools/src/enums/ChangeTypes.ts
@@ -42,6 +42,10 @@ enum ChangeTypes {
    * so as to cause it to be drawn on the change, or removed if it is no longer visible.
    */
   MetadataReferenceModified = 'MetadataReferenceModified',
+  /**
+   * Occurs when an annotation label is updated.
+   */
+  LabelChange = 'LabelChange',
 }
 
 export default ChangeTypes;
diff --git a/packages/tools/src/tools/SculptorTool.ts b/packages/tools/src/tools/SculptorTool.ts
index e4bb43585..0188bf77b 100644
--- a/packages/tools/src/tools/SculptorTool.ts
+++ b/packages/tools/src/tools/SculptorTool.ts
@@ -10,7 +10,12 @@ import type {
   ContourAnnotation,
 } from '../types';
 import { point } from '../utilities/math';
-import { Events, ToolModes, AnnotationStyleStates } from '../enums';
+import {
+  Events,
+  ToolModes,
+  AnnotationStyleStates,
+  ChangeTypes,
+} from '../enums';
 import { triggerAnnotationRenderForViewportIds } from '../utilities/triggerAnnotationRenderForViewportIds';
 import {
   hideElementCursor,
@@ -428,7 +433,11 @@ class SculptorTool extends BaseTool {
       activeAnnotation.invalidated = true;
     }
 
-    triggerAnnotationModified(activeAnnotation, element);
+    triggerAnnotationModified(
+      activeAnnotation,
+      element,
+      ChangeTypes.HandlesUpdated
+    );
   };
 
   /**
diff --git a/packages/tools/src/tools/annotation/AngleTool.ts b/packages/tools/src/tools/annotation/AngleTool.ts
index a3ee1328b..3120398e1 100644
--- a/packages/tools/src/tools/annotation/AngleTool.ts
+++ b/packages/tools/src/tools/annotation/AngleTool.ts
@@ -1,4 +1,4 @@
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import {
   getEnabledElement,
   utilities as csUtils,
@@ -477,6 +477,14 @@ class AngleTool extends AnnotationTool {
     const { renderingEngine } = enabledElement;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   cancel = (element: HTMLDivElement) => {
@@ -874,7 +882,7 @@ class AngleTool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   }
diff --git a/packages/tools/src/tools/annotation/ArrowAnnotateTool.ts b/packages/tools/src/tools/annotation/ArrowAnnotateTool.ts
index d2cc7951a..32b0a1fdd 100644
--- a/packages/tools/src/tools/annotation/ArrowAnnotateTool.ts
+++ b/packages/tools/src/tools/annotation/ArrowAnnotateTool.ts
@@ -1,4 +1,4 @@
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import {
   getEnabledElement,
   utilities as csUtils,
@@ -45,6 +45,7 @@ import type {
 import type { ArrowAnnotation } from '../../types/ToolSpecificAnnotationTypes';
 import type { StyleSpecifier } from '../../types/AnnotationStyle';
 import { isAnnotationVisible } from '../../stateManagement/annotation/annotationVisibility';
+import { setAnnotationLabel } from '../../utilities';
 
 class ArrowAnnotateTool extends AnnotationTool {
   static toolName = 'ArrowAnnotate';
@@ -352,8 +353,13 @@ class ArrowAnnotateTool extends AnnotationTool {
     const eventDetail = evt.detail;
     const { element } = eventDetail;
 
-    const { annotation, viewportIdsToRender, newAnnotation, hasMoved } =
-      this.editData;
+    const {
+      annotation,
+      viewportIdsToRender,
+      newAnnotation,
+      hasMoved,
+      movingTextBox,
+    } = this.editData;
     const { data } = annotation;
 
     if (newAnnotation && !hasMoved) {
@@ -389,11 +395,16 @@ class ArrowAnnotateTool extends AnnotationTool {
         triggerAnnotationCompleted(annotation);
         // This is only new if it wasn't already memoed
         this.createMemo(element, annotation, { newAnnotation: !!this.memo });
+        setAnnotationLabel(annotation, element, text);
 
         triggerAnnotationRenderForViewportIds(viewportIdsToRender);
       });
-    } else {
-      triggerAnnotationModified(annotation, element);
+    } else if (!movingTextBox) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
     }
 
     this.doneEditMemo();
diff --git a/packages/tools/src/tools/annotation/BidirectionalTool.ts b/packages/tools/src/tools/annotation/BidirectionalTool.ts
index 1123c3a81..f9162d2ed 100644
--- a/packages/tools/src/tools/annotation/BidirectionalTool.ts
+++ b/packages/tools/src/tools/annotation/BidirectionalTool.ts
@@ -22,7 +22,7 @@ import {
   drawLinkedTextBox as drawLinkedTextBoxSvg,
 } from '../../drawingSvg';
 import { state } from '../../store/state';
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import { getViewportIdsWithToolToRender } from '../../utilities/viewportFilters';
 import * as lineSegment from '../../utilities/math/line';
 import { getTextBoxCoordsCanvas } from '../../utilities/drawing';
@@ -568,6 +568,7 @@ class BidirectionalTool extends AnnotationTool {
     annotation.invalidated = true;
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
 
+    triggerAnnotationModified(annotation, element, ChangeTypes.HandlesUpdated);
     this.editData.hasMoved = true;
   };
 
@@ -620,6 +621,14 @@ class BidirectionalTool extends AnnotationTool {
     }
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   /**
@@ -1313,7 +1322,7 @@ class BidirectionalTool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   };
diff --git a/packages/tools/src/tools/annotation/CircleROITool.ts b/packages/tools/src/tools/annotation/CircleROITool.ts
index 4f12b23c9..d54d567c9 100644
--- a/packages/tools/src/tools/annotation/CircleROITool.ts
+++ b/packages/tools/src/tools/annotation/CircleROITool.ts
@@ -30,7 +30,7 @@ import {
   drawLinkedTextBox as drawLinkedTextBoxSvg,
 } from '../../drawingSvg';
 import { state } from '../../store/state';
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import { getViewportIdsWithToolToRender } from '../../utilities/viewportFilters';
 import { getTextBoxCoordsCanvas } from '../../utilities/drawing';
 import getWorldWidthAndHeightFromTwoPoints from '../../utilities/planar/getWorldWidthAndHeightFromTwoPoints';
@@ -431,6 +431,8 @@ class CircleROITool extends AnnotationTool {
     this.editData.hasMoved = true;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    triggerAnnotationModified(annotation, element, ChangeTypes.HandlesUpdated);
   };
 
   _dragModifyCallback = (evt: EventTypes.InteractionEventType): void => {
@@ -482,6 +484,14 @@ class CircleROITool extends AnnotationTool {
     const { renderingEngine } = enabledElement;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   _dragHandle = (evt: EventTypes.InteractionEventType): void => {
@@ -1012,7 +1022,7 @@ class CircleROITool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   };
diff --git a/packages/tools/src/tools/annotation/CobbAngleTool.ts b/packages/tools/src/tools/annotation/CobbAngleTool.ts
index 1c70ff3ab..f7017f21b 100644
--- a/packages/tools/src/tools/annotation/CobbAngleTool.ts
+++ b/packages/tools/src/tools/annotation/CobbAngleTool.ts
@@ -1,5 +1,5 @@
 import { vec3 } from 'gl-matrix';
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import { getEnabledElement } from '@cornerstonejs/core';
 import type { Types } from '@cornerstonejs/core';
 
@@ -477,6 +477,14 @@ class CobbAngleTool extends AnnotationTool {
     const { renderingEngine } = enabledElement;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   cancel = (element: HTMLDivElement) => {
@@ -1024,7 +1032,7 @@ class CobbAngleTool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   }
diff --git a/packages/tools/src/tools/annotation/EllipticalROITool.ts b/packages/tools/src/tools/annotation/EllipticalROITool.ts
index 2a9b7b2b8..a9f69eba5 100644
--- a/packages/tools/src/tools/annotation/EllipticalROITool.ts
+++ b/packages/tools/src/tools/annotation/EllipticalROITool.ts
@@ -28,7 +28,7 @@ import {
   drawLinkedTextBox as drawLinkedTextBoxSvg,
 } from '../../drawingSvg';
 import { state } from '../../store/state';
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import { getViewportIdsWithToolToRender } from '../../utilities/viewportFilters';
 import { getTextBoxCoordsCanvas } from '../../utilities/drawing';
 import getWorldWidthAndHeightFromTwoPoints from '../../utilities/planar/getWorldWidthAndHeightFromTwoPoints';
@@ -550,6 +550,7 @@ class EllipticalROITool extends AnnotationTool {
     this.editData.hasMoved = true;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+    triggerAnnotationModified(annotation, element, ChangeTypes.HandlesUpdated);
   };
 
   _dragModifyCallback = (evt: EventTypes.InteractionEventType): void => {
@@ -601,6 +602,14 @@ class EllipticalROITool extends AnnotationTool {
     const { renderingEngine } = enabledElement;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   _dragHandle = (evt: EventTypes.InteractionEventType): void => {
@@ -1163,7 +1172,7 @@ class EllipticalROITool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   };
diff --git a/packages/tools/src/tools/annotation/LengthTool.ts b/packages/tools/src/tools/annotation/LengthTool.ts
index e642f8388..f7b3a9d4d 100644
--- a/packages/tools/src/tools/annotation/LengthTool.ts
+++ b/packages/tools/src/tools/annotation/LengthTool.ts
@@ -1,4 +1,4 @@
-import { Events } from '../../enums';
+import { Events, ChangeTypes } from '../../enums';
 import {
   getEnabledElement,
   utilities as csUtils,
@@ -481,6 +481,14 @@ class LengthTool extends AnnotationTool {
     this.editData.hasMoved = true;
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   cancel = (element: HTMLDivElement) => {
@@ -888,7 +896,7 @@ class LengthTool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   }
diff --git a/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts b/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
index d8e78e614..b47a06a56 100644
--- a/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
+++ b/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
@@ -683,10 +683,7 @@ class PlanarFreehandROITool extends ContourSegmentationBaseTool {
 
     if (!this.commonData?.movingTextBox) {
       const { data } = annotation;
-      if (
-        !data.cachedStats[targetId] ||
-        data.cachedStats[targetId].areaUnit == null
-      ) {
+      if (!data.cachedStats[targetId]?.unit) {
         data.cachedStats[targetId] = {
           Modality: null,
           area: null,
@@ -694,6 +691,7 @@ class PlanarFreehandROITool extends ContourSegmentationBaseTool {
           mean: null,
           stdDev: null,
           areaUnit: null,
+          unit: null,
         };
 
         this._calculateCachedStats(
diff --git a/packages/tools/src/tools/annotation/RectangleROITool.ts b/packages/tools/src/tools/annotation/RectangleROITool.ts
index 6a5d0ba06..6ceb0acae 100644
--- a/packages/tools/src/tools/annotation/RectangleROITool.ts
+++ b/packages/tools/src/tools/annotation/RectangleROITool.ts
@@ -27,7 +27,7 @@ import {
   drawRectByCoordinates as drawRectSvg,
 } from '../../drawingSvg';
 import { state } from '../../store/state';
-import { Events } from '../../enums';
+import { ChangeTypes, Events } from '../../enums';
 import { getViewportIdsWithToolToRender } from '../../utilities/viewportFilters';
 import * as rectangle from '../../utilities/math/rectangle';
 import { getTextBoxCoordsCanvas } from '../../utilities/drawing';
@@ -477,6 +477,14 @@ class RectangleROITool extends AnnotationTool {
     const enabledElement = getEnabledElement(element);
 
     triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+
+    if (annotation.invalidated) {
+      triggerAnnotationModified(
+        annotation,
+        element,
+        ChangeTypes.HandlesUpdated
+      );
+    }
   };
 
   cancel = (element: HTMLDivElement) => {
@@ -954,7 +962,7 @@ class RectangleROITool extends AnnotationTool {
     annotation.invalidated = false;
 
     // Dispatching annotation modified
-    triggerAnnotationModified(annotation, element);
+    triggerAnnotationModified(annotation, element, ChangeTypes.StatsUpdated);
 
     return cachedStats;
   };
diff --git a/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts b/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
index d13ca26d1..97b502967 100644
--- a/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
+++ b/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
@@ -3,7 +3,7 @@ import {
   resetElementCursor,
   hideElementCursor,
 } from '../../../cursors/elementCursor';
-import { Events } from '../../../enums';
+import { ChangeTypes, Events } from '../../../enums';
 import type { EventTypes } from '../../../types';
 import { state } from '../../../store/state';
 import { vec3 } from 'gl-matrix';
@@ -13,7 +13,10 @@ import {
 } from '../../../utilities/planarFreehandROITool/smoothPoints';
 import getMouseModifierKey from '../../../eventDispatchers/shared/getMouseModifier';
 import triggerAnnotationRenderForViewportIds from '../../../utilities/triggerAnnotationRenderForViewportIds';
-import { triggerContourAnnotationCompleted } from '../../../stateManagement/annotation/helpers/state';
+import {
+  triggerAnnotationModified,
+  triggerContourAnnotationCompleted,
+} from '../../../stateManagement/annotation/helpers/state';
 import type { PlanarFreehandROIAnnotation } from '../../../types/ToolSpecificAnnotationTypes';
 import findOpenUShapedContourVectorToPeak from './findOpenUShapedContourVectorToPeak';
 import { polyline } from '../../../utilities/math';
@@ -170,9 +173,13 @@ function mouseDragDrawCallback(evt: EventTypes.InteractionEventType): void {
 
       this.drawData.polylineIndex = polylineIndex + numPointsAdded;
     }
+    annotation.invalidated = true;
   }
 
   triggerAnnotationRenderForViewportIds(viewportIdsToRender);
+  if (annotation.invalidated) {
+    triggerAnnotationModified(annotation, element, ChangeTypes.HandlesUpdated);
+  }
 }
 
 /**
diff --git a/packages/tools/src/types/AnnotationTypes.ts b/packages/tools/src/types/AnnotationTypes.ts
index 87d16318a..0b6ead02e 100644
--- a/packages/tools/src/types/AnnotationTypes.ts
+++ b/packages/tools/src/types/AnnotationTypes.ts
@@ -53,34 +53,12 @@ type Annotation = {
    */
   data: {
     /** Annotation handles that are grabbable for manipulation */
-    handles?: {
-      /** world location of the handles in the space */
-      points?: Types.Point3[];
-      /** index of the active handle being manipulated */
-      activeHandleIndex?: number | null;
-      /** annotation text box information */
-      textBox?: {
-        /** whether the text box has moved */
-        hasMoved?: boolean;
-        /** the world location of the text box */
-        worldPosition?: Types.Point3;
-        /** text box bounding box information */
-        worldBoundingBox?: {
-          /** Top left location of the text box in the world space */
-          topLeft: Types.Point3;
-          /** Top right location of the text box in the world space */
-          topRight: Types.Point3;
-          /** Bottom left location of the text box in the world space */
-          bottomLeft: Types.Point3;
-          /** Bottom right location of the text box in the world space */
-          bottomRight: Types.Point3;
-        };
-      };
-      [key: string]: unknown;
-    };
+    handles?: Handles;
     [key: string]: unknown;
     /** Cached Annotation statistics which is specific to the tool */
     cachedStats?: Record<string, unknown>;
+    /** Label of an annotation */
+    label?: string;
   };
 };
 
@@ -106,9 +84,36 @@ type AnnotationState = {
   [key: string]: GroupSpecificAnnotations;
 };
 
+type Handles = {
+  /** world location of the handles in the space */
+  points?: Types.Point3[];
+  /** index of the active handle being manipulated */
+  activeHandleIndex?: number | null;
+  /** annotation text box information */
+  textBox?: {
+    /** whether the text box has moved */
+    hasMoved?: boolean;
+    /** the world location of the text box */
+    worldPosition?: Types.Point3;
+    /** text box bounding box information */
+    worldBoundingBox?: {
+      /** Top left location of the text box in the world space */
+      topLeft: Types.Point3;
+      /** Top right location of the text box in the world space */
+      topRight: Types.Point3;
+      /** Bottom left location of the text box in the world space */
+      bottomLeft: Types.Point3;
+      /** Bottom right location of the text box in the world space */
+      bottomRight: Types.Point3;
+    };
+  };
+  [key: string]: unknown;
+};
+
 export type {
   Annotation,
   Annotations,
   GroupSpecificAnnotations,
   AnnotationState,
+  Handles,
 };
diff --git a/packages/tools/src/types/ToolSpecificAnnotationTypes.ts b/packages/tools/src/types/ToolSpecificAnnotationTypes.ts
index c8a73f2d9..e94ffdc53 100644
--- a/packages/tools/src/types/ToolSpecificAnnotationTypes.ts
+++ b/packages/tools/src/types/ToolSpecificAnnotationTypes.ts
@@ -12,6 +12,7 @@ export interface ROICachedStats {
     max: number;
     mean: number;
     stdDev: number;
+    unit?: number;
   };
 }
 
diff --git a/packages/tools/src/utilities/index.ts b/packages/tools/src/utilities/index.ts
index fca1df2d2..edd8506b4 100644
--- a/packages/tools/src/utilities/index.ts
+++ b/packages/tools/src/utilities/index.ts
@@ -51,6 +51,7 @@ const roundNumber = utilities.roundNumber;
 import normalizeViewportPlane from './normalizeViewportPlane';
 import IslandRemoval from './segmentation/islandRemoval';
 import { getPixelValueUnits } from './getPixelValueUnits';
+import setAnnotationLabel from './setAnnotationLabel';
 
 export {
   math,
@@ -96,4 +97,5 @@ export {
   pointInSurroundingSphereCallback,
   normalizeViewportPlane,
   IslandRemoval,
+  setAnnotationLabel,
 };
diff --git a/packages/tools/src/utilities/setAnnotationLabel.ts b/packages/tools/src/utilities/setAnnotationLabel.ts
new file mode 100644
index 000000000..9b68778bb
--- /dev/null
+++ b/packages/tools/src/utilities/setAnnotationLabel.ts
@@ -0,0 +1,12 @@
+import type { Annotation } from '../types/AnnotationTypes';
+import { triggerAnnotationModified } from '../stateManagement/annotation/helpers/state';
+import { ChangeTypes } from '../enums';
+
+export default function setAnnotationLabel(
+  annotation: Annotation,
+  element: HTMLDivElement,
+  updatedLabel: string
+) {
+  annotation.data.label = updatedLabel;
+  triggerAnnotationModified(annotation, element, ChangeTypes.LabelChange);
+}