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MRI findings in Parinaud's syndrome: a closer look at pineal masses
Amrita-Amanda D Vuppala1, Nanki Hura2, Sadaf Sahraian2
1Department of Neurology and Ophthalmology, University of Nebraska Medical Center, Omaha, NE, USA.
Purpose:
The association between MRI findings in patients with pineal lesions and the presence or absence of Parinaud's syndrome (PS) remains poorly described. We sought to better understand what MRI characteristics of a pineal lesion make PS more likely. Can these features predict prognosis for clinical resolution? Based on the anatomical relationship of the pineal gland and midbrain, we hypothesized that the degree of midbrain injury by a pineal mass as assessed by abutment, displacement, or intrinsic midbrain signal abnormality (IMSA) may predict PS.
Methods:
We reviewed our institution's databases to find patients with MRI evidence of an intrinsic lesion of the pineal gland. Seventy-seven patients with intrinsic pineal gland lesions, 26 with PS and 51 without PS (NPS), were identified. Data regarding clinical history were collected, and an experienced neuroradiologist reviewed all MRI studies and recorded mass size, midbrain abutment, displacement by the pineal lesion, and presence or absence of IMSA.
Results:
IMSA occurred with increased frequency in pineal lesions with PS (85%) when compared with NPS (39.2%) (p = 0.0001). Midbrain abutment, compression, and displacement occurred with similar frequencies in both groups, with no statistically significant difference. Hydrocephalus was present in 80.8% of patients with PS and 84% without PS (p = 0.75).
Conclusion:
IMSA in a patient with an intrinsic pineal gland mass is associated with PS. Other findings such as hydrocephalus and midbrain displacement are common in patients with pineal masses both with and without PS and do not have any predictive value.
Insights
Intrinsic midbrain signal abnormality on MRI is linked to Parinaud's syndrome in pineal lesions. This finding may help predict the syndrome
Area of Science:
- Neuroradiology
- Neuro-oncology
- Ophthalmology
Background:
- Parinaud's syndrome (PS) is a complex neurological condition affecting vertical gaze.
- The association between MRI characteristics of pineal lesions and PS is not well-established.
- Understanding these associations can aid in diagnosis and prognosis.
Purpose of the Study:
- To investigate MRI features of pineal lesions that correlate with the presence of PS.
- To determine if specific MRI findings can predict the likelihood of developing PS.
- To assess the prognostic value of MRI findings for clinical resolution of PS.
Main Methods:
- Retrospective review of 77 patients with intrinsic pineal gland lesions.
- Categorization of patients into those with PS (n=26) and without PS (NPS, n=51).
- Analysis of MRI studies for mass size, midbrain abutment, displacement, and intrinsic midbrain signal abnormality (IMSA).
Main Results:
- Intrinsic midbrain signal abnormality (IMSA) was significantly more frequent in patients with PS (85%) compared to NPS (39.2%) (p=0.0001).
- Midbrain abutment, compression, and displacement showed no significant difference between PS and NPS groups.
- Hydrocephalus prevalence was similar in both groups (80.8% in PS vs. 84% in NPS).
Conclusions:
- IMSA on MRI is a key indicator associated with PS in patients with pineal masses.
- Midbrain displacement and hydrocephalus are common in pineal lesions but lack predictive value for PS.
- Identifying IMSA may aid in predicting PS development and guiding clinical management.