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Magnetic resonance imaging of pineal region tumours.

Fang AS, Meyers SP - Insights Imaging (2013)

Bottom Line: Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses.A variety of cases of pineal lesions are presented.Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning. • Pineal parenchymal tumours show an "explosion" of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).

View Article: PubMed Central - PubMed

Affiliation: Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA, adam_fang@urmc.rochester.edu.

ABSTRACT

Objectives: Pineal lesions can present as a heterogeneous collection of benign and malignant disease conditions. Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses.

Methods: A variety of cases of pineal lesions are presented. The important clinical features and typical imaging findings of each pineal lesion are described with emphasis on their morphological appearance and signal intensity characteristics on magnetic resonance imaging (MRI).

Conclusion: Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning.

Teaching points: • Pineal parenchymal tumours show an "explosion" of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).

No MeSH data available.


Related in: MedlinePlus

Pineoblastoma in a 18-month-old boy. A well-circumscribed tumour arising from the pineal gland (arrow), which is isointense to grey matter on sagittal T1-weighted image (a), intermediate to high signal on axial T2-weighted image (b) and shows contrast enhancement on sagittal T1-weighted image (c). The tumour shows restricted diffusion as seen on diffusion-weighted image (d). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate and cerebral aqueduct. Hydrogen MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with point resolved spectroscopy (PRESS) demonstrates elevated choline peak (*) and decreased NAA (**) (e). Corresponding T1-weighted image shows location of the voxel surrounding the tumour (f)
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Fig5: Pineoblastoma in a 18-month-old boy. A well-circumscribed tumour arising from the pineal gland (arrow), which is isointense to grey matter on sagittal T1-weighted image (a), intermediate to high signal on axial T2-weighted image (b) and shows contrast enhancement on sagittal T1-weighted image (c). The tumour shows restricted diffusion as seen on diffusion-weighted image (d). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate and cerebral aqueduct. Hydrogen MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with point resolved spectroscopy (PRESS) demonstrates elevated choline peak (*) and decreased NAA (**) (e). Corresponding T1-weighted image shows location of the voxel surrounding the tumour (f)

Mentions: On MRI, pineoblastomas show low to intermediate signal on T1-weighted images, intermediate to high signal on T2-weighted images and demonstrate contrast enhancement (Fig. 5). Given their highly malignant nature, it is not uncommon to see haemorrhage and necrosis within the lesion, as well as infiltration into adjacent structures with cerebral spinal fluid (CSF) seeding and dissemination within the subarachnoid space [9]. Pineoblastomas usually have low minimum apparent diffusion coefficient (minADC) and restricted diffusion on diffusion-weighted imaging (DWI) (Fig. 5). On MR spectroscopy (Fig. 5), there is elevated choline, decreased N-acetylaspartate (NAA), as well as slightly elevated glutamate and taurine peaks (∼3.4 ppm).Fig. 5


Magnetic resonance imaging of pineal region tumours.

Fang AS, Meyers SP - Insights Imaging (2013)

Pineoblastoma in a 18-month-old boy. A well-circumscribed tumour arising from the pineal gland (arrow), which is isointense to grey matter on sagittal T1-weighted image (a), intermediate to high signal on axial T2-weighted image (b) and shows contrast enhancement on sagittal T1-weighted image (c). The tumour shows restricted diffusion as seen on diffusion-weighted image (d). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate and cerebral aqueduct. Hydrogen MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with point resolved spectroscopy (PRESS) demonstrates elevated choline peak (*) and decreased NAA (**) (e). Corresponding T1-weighted image shows location of the voxel surrounding the tumour (f)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig5: Pineoblastoma in a 18-month-old boy. A well-circumscribed tumour arising from the pineal gland (arrow), which is isointense to grey matter on sagittal T1-weighted image (a), intermediate to high signal on axial T2-weighted image (b) and shows contrast enhancement on sagittal T1-weighted image (c). The tumour shows restricted diffusion as seen on diffusion-weighted image (d). The tumour causes obstructive hydrocephalus by exerting localised mass effect and compression of the quadrigeminal plate and cerebral aqueduct. Hydrogen MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with point resolved spectroscopy (PRESS) demonstrates elevated choline peak (*) and decreased NAA (**) (e). Corresponding T1-weighted image shows location of the voxel surrounding the tumour (f)
Mentions: On MRI, pineoblastomas show low to intermediate signal on T1-weighted images, intermediate to high signal on T2-weighted images and demonstrate contrast enhancement (Fig. 5). Given their highly malignant nature, it is not uncommon to see haemorrhage and necrosis within the lesion, as well as infiltration into adjacent structures with cerebral spinal fluid (CSF) seeding and dissemination within the subarachnoid space [9]. Pineoblastomas usually have low minimum apparent diffusion coefficient (minADC) and restricted diffusion on diffusion-weighted imaging (DWI) (Fig. 5). On MR spectroscopy (Fig. 5), there is elevated choline, decreased N-acetylaspartate (NAA), as well as slightly elevated glutamate and taurine peaks (∼3.4 ppm).Fig. 5

Bottom Line: Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses.A variety of cases of pineal lesions are presented.Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning. • Pineal parenchymal tumours show an "explosion" of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).

View Article: PubMed Central - PubMed

Affiliation: Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA, adam_fang@urmc.rochester.edu.

ABSTRACT

Objectives: Pineal lesions can present as a heterogeneous collection of benign and malignant disease conditions. Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses.

Methods: A variety of cases of pineal lesions are presented. The important clinical features and typical imaging findings of each pineal lesion are described with emphasis on their morphological appearance and signal intensity characteristics on magnetic resonance imaging (MRI).

Conclusion: Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning.

Teaching points: • Pineal parenchymal tumours show an "explosion" of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).

No MeSH data available.


Related in: MedlinePlus