Department of Neuroradiology, University of Utah, 30 N 1900 E, #1A071, Salt Lake City, UT 84132, USA.
Neuroradiology. 2011 Aug;53(8):577-84. doi: 10.1007/s00234-010-0794-2. Epub 2010 Nov 16.
Pineal parenchymal tumor of intermediate differentiation (PPTID) was recognized in the 2007 World Health Organization (WHO) classification as a new pineal parenchymal neoplasm, intermediate in malignancy (WHO grade II or III) between pineocytoma (grade I) and pineoblastoma (grade IV). The imaging spectrum of this new tumor has not been previously delineated. We describe the imaging spectrum in 11 pathologically proven PPTIDs and identify findings that may suggest the preoperative diagnosis of this newly recognized entity.
Electronic medical records over the last 9 years and teaching files between the years 1985 and 1995 were searched for atypical pineal lesions. Additional cases were added from the teaching files of contributing authors.
Imaging studies in nine patients (9/11) showed bulky, aggressive pineal region masses with local brain invasion; two patients (2/11) demonstrated circumscribed pineal masses. Two patients had spinal metastases at presentation. On computed tomography (CT), five patients had classic "exploded" calcifications characteristic of pineal parenchymal tumors. All tumors were heterogeneously hypointense on T1WIs and heterogeneously hyperintense on T2WIs. Post-contrast scans showed marked heterogeneous (10/11) or uniform (1/11) enhancement. Cystic foci were identified in eight cases. Intratumoral hemorrhage was present in one case.
While no singular neuroimaging feature is pathognomonic of PPTID, these tumors are usually larger, demonstrate local invasion, and appear much more heterogeneous than pineocytoma. Because PPTIDs have a higher grade and increased potential for recurrence as compared to pineocytomas, it is important to consider this diagnosis as shorter follow-up, and adjuvant therapy may be indicated in selected cases.
在 2007 年世界卫生组织（WHO）分类中，中分化的松果体实质肿瘤（PPTID）被认定为一种新的松果体实质肿瘤，其恶性程度处于中间水平（WHO 分级 II 或 III 级），介于松果体细胞瘤（I 级）和松果体母细胞瘤（IV 级）之间。这种新肿瘤的影像学特征以前尚未被描述。我们描述了 11 例经病理证实的 PPTID 的影像学特征，并确定了可能提示该新认识实体术前诊断的发现。
在过去 9 年的电子病历和 1985 年至 1995 年的教学档案中搜索了非典型的松果体病变。从撰稿作者的教学档案中添加了额外的病例。
9 例患者（9/11）的影像学研究显示体积大、侵袭性强的松果体区域肿块，伴有局部脑侵犯；2 例患者（2/11）表现为局限性松果体肿块。2 例患者在就诊时已有脊柱转移。在计算机断层扫描（CT）上，5 例患者有典型的松果体实质肿瘤的“爆裂”样钙化。所有肿瘤在 T1WI 上呈不均匀低信号，在 T2WI 上呈不均匀高信号。增强扫描显示明显不均匀（10/11）或均匀（1/11）强化。8 例病例中发现囊性灶。1 例患者存在肿瘤内出血。
虽然没有单一的神经影像学特征是 PPTID 的特征性表现，但这些肿瘤通常更大，表现为局部侵犯，与松果体细胞瘤相比，其信号更不均匀。由于与松果体细胞瘤相比，PPTID 分级更高，复发的可能性更大，因此在某些情况下，考虑到较短的随访时间和辅助治疗可能是必要的。
