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