Learning objectives
The pineal region is as important as often overlooked and its pathology unacknowledged: the peculiar features of some of its lesions frequently lead to diagnostic misinterpretations.
Magnetic Resonance Imaging can be of great help,
if not crucial,
in guiding the differential diagnosis through some semeiologic characteristics that are by now widely acknowledged in literature.
The comparison with pre-existing iconography can furthermore help the radiologist to correctly identify and differentiate the various lesions.
Background
The pineal gland is a small,
median structure located in the epithalamus,
in a recess created by the splenium of the corpus callosum,
the superior colliculi and the cisterna ambiens,
and connected to the posterior wall of the third ventricle.
Its dimensions vary from 7 to 14 mm,
and it is located outside the blood-brain barrier.
Histologically,
pineocytes are the cells that make up most of its volume,
followed by a small number of astrocytes.
Pineocytes are specialized neurons that show many similarities with rods...
Findings and procedure details
Masses in the pineal region can be essentially cystic or neoplastic,
with a significantly lower rate of vascular malformations of adjacent structures that can mimic,
especially if thrombosed,
a mass of the pineal gland (like an aneurysm of the vein of Galen).
Other imaging features to adress,
pineal gland calcifications are detected at CT scan in about 70% of the general adult population and are associated with aging brain (they are extremely rare in children up to 14yo,
and their detection in younger age should...
Conclusion
A wide spectrum of lesions can affect the pineal gland and the adjacent structures.
Some of these have special features that allow easy identification with imaging,
while others have similar non-specific characteristics and are often completely overlapping.
In these cases,
it is useful to extend the MR examination to other segments,
perform more advanced sequences or integrate it with laboratory tests to add useful elements to narrow the field of the differential diagnosis.
Diffusion imaging is not of fundamental diagnostic support in most cases,
since...
Personal information
Dr.
Stefania Gangi,
Dipartimento di Radiologia diagnostica ed interventistica dell'Azienda Ospedaliera Universitaria “Maggiore della
Carità” c.so Mazzini 18,
Novara,
Italia
email:
[email protected]
Dr.
Eleonora Soligo,
Dipartimento di Radiologia diagnostica ed interventistica dell'Azienda Ospedaliera Universitaria “Maggiore della
Carità” c.so Mazzini 18,
Novara,
Italia
Dr Simone Bor,
Dipartimento di Radiologia diagnostica ed interventistica dell'Azienda Ospedaliera Universitaria “Maggiore della Carità” c.so Mazzini 18,
Novara,
Italia
Dr.
Luca Samman,
Dipartimento di Radiologia diagnostica ed interventistica dell'Azienda Ospedaliera Universitaria “Maggiore della
Carità” c.so Mazzini 18,
Novara,
Italia
Prof.
Alessandro Stecco,...
References
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Smith AB,
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From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation.
Radiographics.
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Lensing FD,
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