Pineal and tectal plate protocol (MRI)

Last revised by Andrew Murphy on 23 Mar 2023

Citation, DOI, disclosures and article data

Citation:

Di Muzio B, Murphy A, Glick Y, Pineal and tectal plate protocol (MRI). Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-67906

DOI:

https://doi.org/10.53347/rID-67906

Permalink:

https://radiopaedia.org/articles/67906

rID:

67906

Article created:

30 Apr 2019, Bruno Di Muzio ◉ ◈

Disclosures:

At the time the article was created Bruno Di Muzio had no recorded disclosures.

View Bruno Di Muzio's current disclosures

Last revised:

23 Mar 2023, Andrew Murphy ◉

Disclosures:

At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.

View Andrew Murphy's current disclosures

Revisions:

4 times, by 3 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Sections:

Radiography

Tags:

mri protocol, cns protocol

Synonyms:

MRI protocol: pineal and tectal plate protocol
MRI protocol: pineal gland
MRI protocol: tectal plate
MRI protocol: tectal plate region
MRI protocol: pineal tumour

MRI protocol for the pineal and tectal plate assessment is a group of MRI sequences put together to best approach tumors involving this region.

The pineal region is best imaged with MRI although CT, angiography, and ultrasound (in infants) also play a role. Please refer to the article pineal region (an approach), for the discussion on a systematic approach to the pineal region.

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints.

Sequences

A good protocol for this purpose would include:

T1 weighted
- plane: sagittal or volumetric 3D (thin section high-resolution imaging)
- sequence: fast-spin echo (T1 FSE) or gradient (T1 MPRAGE)
- purpose: anatomical overview
T2 weighted
- plane: sagittal (thin section high-resolution imaging)
- sequence: T2 FSE
- purpose: assessment of pineal cysts, evaluation of basal cisterns, ventricular system, and subdural spaces. Also, it provided good visualization of flow-voids in the surrounding vessels
FLAIR
- plane: axial
- sequence: FLAIR
- purpose: asses the presence of edema
diffusion-weighted imaging (DWI)
- plane: axial
- sequence: DWI: B=0, B=1000 and ADC
- purpose: evaluation of the tumor cellularity
susceptibility weighted imaging (SWI)
- plane: axial
- sequence: susceptibility weighted imaging (ideal) or T2*
- purpose: to assess for calcification and hemorrhage
postcontrast sequences
- plane: at least two different planes or volumetric 3D
- sequence: post-contrast fast-spin echo (T1 FSE) or gradient (T1 MPRAGE). A fat-saturated sequence is considered in at least one plane
- purpose: determine how well circumscribed is the mass and assess for local CSF seeding in aggressive lesions
  - Gadolinium-based contrast agents (GBCAs) for CNS ¹:
    - gadoterate meglumine (Dotarem®)
    - gadobutrol (Gadavist®)
    - gadopentetate dimeglumine (Magnevist®)
    - gadobenate dimeglumine (MultiHance®)
    - gadodiamide (Omniscan®)
    - gadoversetamide (OptiMARK®)
    - gadoteridol (ProHance®)
  - all these GBCAs are approved by FDA at identical administered total doses of 0.1mmol/kg body weight ¹