Post-operative status after shunting.
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A ventricular shunt tube is seen terminating in the body of the right lateral ventricle associated with moderate dilatation of the supra-tentorial ventricular system and with periventricular patchy areas of high T2/FLAIR signal intensity (trans-ependymal CSF permeation).
A sizable irregular mass in the pineal region is seen eliciting isointense to hypointense signal to the adjacent brain on T1 WI, isointense signal on T2 WI, with areas of cyst formation and vivid heterogeneous postcontrast enhancement. It is seen inseparable from and deforms the midbrain and pontine posterior surfaces as well as the antero-superior cerebellum. Spinal axis nodular leptomeningeal thickening is seen and is more evident caudally.
MR picture diagnostic of pineoblastoma with hydrocephalic changes and transependymal CSF permeation and CSF seeding (pathologically proven).
Pineoblastomas tend to appear as sizable (>4 cm) irregular masses, often with evidence of invasion into adjacent brain. Typical signal characteristics include isointense to hypointense signal to the adjacent brain on T1 WI, isointense signal to the adjacent brain on T2 WI, with vivid heterogeneous enhancement. It also shows restricted diffusion due to dense cellular packing. Whole neural axis examination is mandatory as CSF seeding is seen in 45% of cases.