An enhancing pineal mass with a surrounding rim of coarse calcification is present. The mass has relatively low ADC values (ADC 700 x 10^-6 mm^2/s). Moderate lateral and third ventricular dilatation, which anteriorly has remodelled the dorsum sellae. The pituitary is flattened within the sella. The fourth ventricle is normal in size. No transependymal CSF leakage to suggest an acute hydrocephalus.
There appears abnormal signal within the cerebral aqueduct with associated enhancement which could represent tumour extension or prolapse into the cerebral aqueduct. CSF flow studies show reduced flow in the cerebral aqueduct. The remainder of the brain parenchyma is unremarkable. Incidental right occipital developmental venous anomaly.
Conclusion
Enhancing pineal mass has a differential including pineal parenchymal tumour favoured over than germ cell tumour given the peripheral distribution of calcification.