MRI of pineal region tumours: relationship between tumours and adjacent structures
Abstract
A variety of tumours may arise in the pineal region; accurate diagnosis is important in the selection of treatment and prognosis. A retrospective analysis of the MRI studies of 25 patients with pathologically proven pineal region tumours was performed, focused on the relationship between the tumour and neighbouring structures. Compression of the tectal plate was classified as expansive or invasive, and compression of the corpus callosum as inferior, anterior or posterior. In 10 of the 14 patients (71%) with germ cell tumours tectal compression was of the invasive type; 8 patients (57%) had multiple tumours and in 13 (93%) the tumour margins were irregular. Teratomas were readily diagnosed because of characteristic heterogeneous signal intensity. Pineal cell tumours were differentiated from germ cell tumours by their rounded shape, solid nature, sharp margins, and expansive type of tectal compression. Meningiomas were characterised by their falcotentorial attachments, posterior callosal compression, and a low-intensity rim on T2-weighted images. Gd-DTPA injection enabled clear demonstration of the site and extent of tumour spread and was useful in differentiating cystic and solid components. The appearances described, while not pathognomonic, are helpful in the differential diagnosis of pineal region tumours, and valuable in planning appropriate treatment.
Key words
Pineal region tumours Magnetic resonance imaging Germ cell tumours Pineal cell tumours MeningiomasPreview
Unable to display preview. Download preview PDF.
References
- 1.Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D (1991) Intracranial germ-cell tumors in childhood. J Neurosurg 74:545–551Google Scholar
- 2.Russell DS, Rubinstein LJ (1977) Pathology of tumors of the nervous system, 4th edn. Williams & Wilkins, Baltimore, pp 283–298Google Scholar
- 3.Forell WM, Schroth G, Egan PJ (1988) MR imaging in tumors of the pineal region. Neuroradiology 30:224–231Google Scholar
- 4.Tien RD, Barkovich AJ, Edwards MSB (1990) MR imaging of pineal tumors. AJNR 11:557–565Google Scholar
- 5.Zee CS, Segall H, Apuzzo M, Destian S, Colletti P, Ahmadi J, Clark C (1991) MR imaging of pineal region neoplasms. J Comput Assist Tomogr 15:56–63Google Scholar
- 6.Koide O, Watanabe Y, Sato K (1980) A pathological survey of intracranial germinoma and pinealoma in Japan. Cancer 45:2119–2130Google Scholar
- 7.Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167Google Scholar
- 8.Hoffman HJ, Becker L, Craven MA (1980) A clinically and pathologically distinct group of benign brain stem gliomas. Neurosurgery 7:243–248Google Scholar
- 9.Pendl G, Vorkapic P, Koniyama M (1990) Microsurgery of midbrain lesions. Neurosurgery 26:641–648Google Scholar
- 10.Yamazaki T, Takahashi S, Ishii K, Matsumoto K, Ishibashi T, Sakamoto K, Ogawa A (1991) Meningioma in the pineal region: preoperative diagnosis with CT, MRI, and angiography. Radiat Med 9:22–25Google Scholar
- 11.Committee of Brain Tumor Registry in Japan (1990) Brain tumor registry in Japan (in Japanese)Google Scholar
- 12.Halpart B, Ethel EE, William SF (1960) Intracranial involvement from carcinoma of the lung. AMA Arch Pathol 69:93–103Google Scholar
- 13.Hansen G (1955) Karcinommetastase in der Epiphyse. Zentralbl. Allg Pathol Anat 93:357–360Google Scholar
- 14.Joyer JE (1962) Metastatic gastric adenocarcinoma to the pineal body. Acta Neuropathol (Berl) 1:416–419Google Scholar
- 15.Keyaki A, Makita Y, Nabeshima S, Tei T, Takahashi J, Nioka H, Nambu Y, Kitamura H (1989) Pineal metastatic tumor from lung cancer initially caused by neurological abnormalities of pineal body tumor (in Japanese). Neurol Surg 17:495–499Google Scholar
- 16.Ortega P, Malamud N, Shimkin MB (1951) Metastasis of carcinoma to pineal body. Arch Pathol 52:518–528Google Scholar
- 17.Ouyang R, Rozdilsky B (1966) Metastasis of carcinoma to pineal body. Arch Neurol 15:399–403Google Scholar