Pineal germinoma imaging

T1-weighted, gadolinium-enhanced coronal and axial MRI scans of a 16-year-old boy with a biopsy-proven pineal region germinoma before (A, B) and after (C, D) one course of chemotherapy with cis-platinum and etoposide. The lobulated appearance; dense, homogeneous enhancement; sharply defined margins; and lack of surrounding edema are characteristic. Artifact due to ventriculo-peritoneal shunt placement is seen on the post-operative, post-chemotherapy scans (C, D). (Contributed by Dr. Santosh Kesari.)