Presentation
History of chronic headaches. A CT scan was performed (not available) showing obstructive hydrocephalus with a pineal mass. A VP shunt was inserted and an MRI was requested for characterization.
Patient Data
The MRI sequences demonstrate a large well-circumscribed lobulated mass centered on the pineal region measuring (5.5 x 5.3 x 4.3 cm). It elicits an isosignal to the cortical grey matter on T1/T2 and FLAIR vivid contrast enhancement following IV contrast and restricted diffusion on DWI/ADC. A mass effect is noted on the midbrain mainly the tectal plate with compression of the aqueduct of Sylvius. The vein of Galen/internal cerebral vein as well as the basal vein of Rosenthal are patent, coursing through the mass well-visualized on postcontrast sequences.
Case Discussion
MRI features of a pineal mass probably a meningioma.
On imaging, the pineal region masses have a relatively broad differential due to the presence of a variety of cell types found in this region (see pineal region masses).
Additional contributor: R. Bouguelaa, MD
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