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==Overview==
==Overview==
Head and neck [[MRI scan]] is diagnostic of germinoma. On [[head]] and [[neck]] [[MRI]], germinoma is characterized by isointense or slightly hyperintense to adjacent brain on T1 and T2 weighted MRI and  vivad and homogenous enhancement on T1 contrast with gadolinium.<ref name="radio"> Germinoma. Radiopedia(2015) http://radiopaedia.org/articles/central-nervous-system-germinoma Accessed on January 25, 2016</ref>
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.<ref name="radio"> Germinoma. Radiopedia(2015) http://radiopaedia.org/articles/central-nervous-system-germinoma Accessed on January 25, 2016</ref>


==MRI==
==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.<ref name="pmid12012121">{{cite journal| author=Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T et al.| title=MRI of intracranial germ-cell tumours. | journal=Neuroradiology | year= 2002 | volume= 44 | issue= 5 | pages= 382-8 | pmid=12012121 | doi=10.1007/s00234-001-0752-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12012121  }} </ref><ref name="pmid19643635">{{cite journal| author=Douglas-Akinwande AC, Ying J, Momin Z, Mourad A, Hattab EM| title=Diffusion-weighted imaging characteristics of primary central nervous system germinoma with histopathologic correlation: a retrospective study. | journal=Acad Radiol | year= 2009 | volume= 16 | issue= 11 | pages= 1356-65 | pmid=19643635 | doi=10.1016/j.acra.2009.05.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19643635  }} </ref><ref name="pmid25413617">{{cite journal| author=Ogiwara H, Tsutsumi Y, Matsuoka K, Kiyotani C, Terashima K, Morota N| title=Apparent diffusion coefficient of intracranial germ cell tumors. | journal=J Neurooncol | year= 2015 | volume= 121 | issue= 3 | pages= 565-71 | pmid=25413617 | doi=10.1007/s11060-014-1668-y | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25413617  }} </ref><ref name="pmid2991485">{{cite journal| author=Jennings MT, Gelman R, Hochberg F| title=Intracranial germ-cell tumors: natural history and pathogenesis. | journal=J Neurosurg | year= 1985 | volume= 63 | issue= 2 | pages= 155-67 | pmid=2991485 | doi=10.3171/jns.1985.63.2.0155 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2991485  }} </ref><ref name="pmid10964999">{{cite journal| author=Packer RJ, Cohen BH, Cooney K, Coney K| title=Intracranial germ cell tumors. | journal=Oncologist | year= 2000 | volume= 5 | issue= 4 | pages= 312-20 | pmid=10964999 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10964999  }} </ref>
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Type of the tumor}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features on MRI}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Germinoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Germinomas are homogeneous and show isointensity or slightly low signal intensity on T1-weighted images, and isointensity or high intensity on T2-weighted images
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Nongerminomatous germ cell tumor
| style="padding: 5px 5px; background: #F5F5F5;" |
*NGGCTs are more heterogeneous and may have hemorrhage
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Malignant teratoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*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 demonstrates a soft tissue mass, typically ovoid or lobulated in contour, engulfing the calcified pineal gland with the following signal characteristic:  
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center

Revision as of 19:46, 16 February 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

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.


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