CT of pineal region tumors

The computed tomographic (CT) features of pineal region tumors were analyzed in 60 histologically proven tumors. This is the largest reported series of histologically verified pineal region tumors studied with CT. The tumors were classified as germ-cell tumors, glial tumors, pineal parenchymal tumors, and meningiomas. Preenhancement germinomas revealed characteristically high-density areas with calcification; uniform enhancement was seen after injection of contrast material. When present, pineal calcification was engulfed by the tumor. Teratomas, present only in male patients, revealed areas of mixed densities (e.g., calcification and fatty areas) and did not show significant contrast enhancement. Spontaneous intraventricular rupture was noted in one case. Unlike other tumors, the original pineal calcification could be recognized in two-thirds of glioma cases and was displaced anteriorly and superiorly in most. Gliomas were hypodense to isodense on precontrast scans and enhanced in a nodular and a ring fashion. Benign pineal parenchymal tumors showed iso- to hyperdense areas with nodular enhancement after injection of contrast material. Pineoblastomas were well defined hyperdense masses without calcification on precontrast scans. After injection of contrast material, they showed well defined enhancement with occasional small, central lucencies. Meningiomas were hyperdense in most cases, uniformly enhanced in a homogeneous fashion, and showed a tentorial attachment.