Neuroimaging of Pediatric Pineal Region Tumors and Other Mass Lesions

SUMMARY: Tumors of the pineal region are rare but important, accounting for approximately 4% of all pediatric intracranial tumors in the United States. The pineal region presents a wide variety of pathologies in children. Germ cell tumors are the most common pineal region tumor in children, representing more than 40% of all pineal region tumors. Pineoblastomas (World Health Organization grade 4) account for 40% of pineal parenchymal tumors. Neuroimaging, including CT and both standard and advanced MRI sequences, plays a key role in differentiating these entities by identifying characteristic features. Because management varies significantly among types, ranging from primary chemotherapy and radiation for germinomas to aggressive surgical resection for pineoblastomas, understanding these imaging characteristics and correlating them with clinical data and biomarkers are essential for appropriate patient management. Abbreviations AFP: α-fetoprotein AT/RT: atypical teratoid rhabdoid tumor β-hCG: β human chorionic gonadotropin PAT: pineal anlage tumor PLAP: placental alkaline phosphatase PPTID: pineal parenchymal tumor of intermediate differentiation PTPR: papillary tumor of the pineal region rCBV: relative CBV WHO: World Health Organization