Germinoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [4]

Overview

MRI of the brain and spine with and without gadolinium is the imaging modality of choice for germinoma. On MRI, intracranial GCTs appear isointense or hypointense on T1 sequences and hyperintense on T2 sequences.[1]

MRI

On head and neck MRI, intracranial GCTs appear isointense or hypointense on T1 sequences and hyperintense on T2 sequences. Germ cell tumors typically show homogeneous enhancement with gadolinium or heterogeneous enhancement if cysts are present. Since imaging characteristics of the histologic subtypes are similar, and MRIs cannot reliably distinguish germinomas from non germinomatous germ cell tumors NGGCTs. Since leptomeningeal metastasis is present at diagnosis in 10-15% of patients, MRI of the entire spine is indispensable for adequate staging of intracranial GCTs.[2][3][4][5][6]

Type of the tumor Features on MRI
Germinoma
  • Germinomas are homogeneous and show isointensity or slightly low signal intensity on T1-weighted images, and isointensity or high intensity on T2-weighted images
Nongerminomatous germ cell tumor
  • NGGCTs are more heterogeneous and may have hemorrhage
Malignant teratoma
  • Malignant teratomas are heterogeneous, with small cysts and irregular tumor margins, and may demonstrate peri-tumor edema

MRI demonstrates a soft tissue mass, typically ovoid or lobulated in contour, engulfing the calcified pineal gland with the following signal characteristic:

MRI component Features
T1
  • isointense or slightly hyperintense to adjacent brain
T2
  • isointense or slightly hyperintense to adjacent brain
  • may have areas of cyst formation
  • may have areas of haemorrhage
  • have a predilection to invade adjacent brain
  • central calcification appears low signal
T1 contrast + gadolinium
  • vivid and homogenous

References

  1. Germinoma. Radiopedia(2015) http://radiopaedia.org/articles/central-nervous-system-germinoma Accessed on January 25, 2016
  2. Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T; et al. (2002). "MRI of intracranial germ-cell tumours". Neuroradiology. 44 (5): 382–8. doi:10.1007/s00234-001-0752-0. PMID 12012121.
  3. Douglas-Akinwande AC, Ying J, Momin Z, Mourad A, Hattab EM (2009). "Diffusion-weighted imaging characteristics of primary central nervous system germinoma with histopathologic correlation: a retrospective study". Acad Radiol. 16 (11): 1356–65. doi:10.1016/j.acra.2009.05.004. PMID 19643635.
  4. Ogiwara H, Tsutsumi Y, Matsuoka K, Kiyotani C, Terashima K, Morota N (2015). "Apparent diffusion coefficient of intracranial germ cell tumors". J Neurooncol. 121 (3): 565–71. doi:10.1007/s11060-014-1668-y. PMID 25413617.
  5. Jennings MT, Gelman R, Hochberg F (1985). "Intracranial germ-cell tumors: natural history and pathogenesis". J Neurosurg. 63 (2): 155–67. doi:10.3171/jns.1985.63.2.0155. PMID 2991485.
  6. Packer RJ, Cohen BH, Cooney K, Coney K (2000). "Intracranial germ cell tumors". Oncologist. 5 (4): 312–20. PMID 10964999.
  7. 7.0 7.1 7.2 7.3 7.4 Image courtesy of Dr. Ahmed Abd Rabou [1] (original file [2]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC

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