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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

Germinoma in a 12-month-old girl. Poorly-lobulated mass arising from the pineal gland (arrow), which has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b), and shows contrast enhancement on sagittal T1-weighted image (c). Disseminated tumour (arrowhead) is also seen in the lateral and third ventricles with prominent enhancement. The tumour shows no restricted diffusion (d). MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with PRESS demonstrates elevated choline peak (*) and slightly decreased NAA peak (**) (e). Corresponding T1-weighted image post contrast shows the location of the voxel around the lesion (f)
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Fig6: Germinoma in a 12-month-old girl. Poorly-lobulated mass arising from the pineal gland (arrow), which has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b), and shows contrast enhancement on sagittal T1-weighted image (c). Disseminated tumour (arrowhead) is also seen in the lateral and third ventricles with prominent enhancement. The tumour shows no restricted diffusion (d). MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with PRESS demonstrates elevated choline peak (*) and slightly decreased NAA peak (**) (e). Corresponding T1-weighted image post contrast shows the location of the voxel around the lesion (f)

Mentions: On MRI, germinomas can appear as a solid pineal mass with intermediate to slightly-high signal compared with grey matter on both T1- and T2-weighted images (Fig. 6). Cystic components are commonly identified in 20–52 % of cases [9, 10, 22] and post-contrast enhancement is usually present on MRI (Fig. 6). Germinomas demonstrate ADC values that overlap those for pineocytoma, PPTID and PTPR. Dumrongpisutikul et al. [23] demonstrated that when the region of interest includes both solid and cystic portions of germinomas, the ADC values are often higher than those of the more densely cellular pineal cell tumours, particularly pineoblastomas, which is likely due to the abundance of cytoplasm, presence of cystic components, less tumour cellularity and lesser nuclear/cytoplasmic ratio. However, when only the solid portions of germinomas are included, normal, decreased or increased ADC values can be demonstrated relative to normal brain tissue [24]. Leptomeningeal and intraventricular tumour deposits typically show contrast enhancement (Fig. 6) and occur in 13 % of patients at the time of diagnosis [22].Fig. 6


Magnetic resonance imaging of pineal region tumours.

Fang AS, Meyers SP - Insights Imaging (2013)

Germinoma in a 12-month-old girl. Poorly-lobulated mass arising from the pineal gland (arrow), which has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b), and shows contrast enhancement on sagittal T1-weighted image (c). Disseminated tumour (arrowhead) is also seen in the lateral and third ventricles with prominent enhancement. The tumour shows no restricted diffusion (d). MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with PRESS demonstrates elevated choline peak (*) and slightly decreased NAA peak (**) (e). Corresponding T1-weighted image post contrast shows the location of the voxel around the lesion (f)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig6: Germinoma in a 12-month-old girl. Poorly-lobulated mass arising from the pineal gland (arrow), which has intermediate to high signal on sagittal T1-weighted image (a) and axial T2-weighted image (b), and shows contrast enhancement on sagittal T1-weighted image (c). Disseminated tumour (arrowhead) is also seen in the lateral and third ventricles with prominent enhancement. The tumour shows no restricted diffusion (d). MR spectroscopy at 1.5 T using a single voxel (2 × 2 × 2 cm3) acquisition with PRESS demonstrates elevated choline peak (*) and slightly decreased NAA peak (**) (e). Corresponding T1-weighted image post contrast shows the location of the voxel around the lesion (f)
Mentions: On MRI, germinomas can appear as a solid pineal mass with intermediate to slightly-high signal compared with grey matter on both T1- and T2-weighted images (Fig. 6). Cystic components are commonly identified in 20–52 % of cases [9, 10, 22] and post-contrast enhancement is usually present on MRI (Fig. 6). Germinomas demonstrate ADC values that overlap those for pineocytoma, PPTID and PTPR. Dumrongpisutikul et al. [23] demonstrated that when the region of interest includes both solid and cystic portions of germinomas, the ADC values are often higher than those of the more densely cellular pineal cell tumours, particularly pineoblastomas, which is likely due to the abundance of cytoplasm, presence of cystic components, less tumour cellularity and lesser nuclear/cytoplasmic ratio. However, when only the solid portions of germinomas are included, normal, decreased or increased ADC values can be demonstrated relative to normal brain tissue [24]. Leptomeningeal and intraventricular tumour deposits typically show contrast enhancement (Fig. 6) and occur in 13 % of patients at the time of diagnosis [22].Fig. 6

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