Imaging diagnosis of basal ganglia germ cell tumors: subtype features subtype imaging features of GCTs

Abstract

Objectives: To evaluate the subtype imaging features of basal ganglia germ cell tumors (GCTs). Methods: Clinical and imaging data of 33 basal ganglia GCTs were retrospectively analyzed, including 17 germinomas and 16 mixed germ cell tumors (MGCTs). Results: The cyst/mass ratio of germinomas (0.53 ± 0.32) was higher than that of MGCTs (0.28 ± 0.19, p = 0.030). CT density of the solid part of germinomas (41.47 ± 5.22 Hu) was significantly higher than that of MGCTs (33.64 ± 3.75 Hu, p < 0.001), while apparent diffusion coefficients (ADC, ×10-3 mm2/s) value of the solid part was significantly lower in geminomas (0.86 ± 0.27 ×10-3 mm2/s) than in MGCTs (1.42 ± 0.39 ×10-3 mm2/s, p < 0.001). MGCTs were more common with intratumoral hemorrhage (68.75% vs 11.76%, p = 0.01), T1 hyperintense foci (68.75% vs 5.88%, p < 0.001) and calcification (64.29% vs 20.00%, p = 0.025) than germinomas. There was no significant difference in internal capsule involvement between the two subtypes (p = 0.303), but Wallerian degeneration was more common in germinomas than in MGCTs (70.59% vs 25.00%, p = 0.015). Conclusion: The subtypes of GCT have different imaging features. Tumoral cystic-solidity, heterogeneity, ADC value, CT density, and Wallerian degeneration are helpful to differentiate germinomas and MGCTs in basal ganglia. Advances in knowledge: The subtypes of GCT have different histological characteristics, leading to various imaging findings. The imaging features of GCT subtypes in basal ganglia may aid clinical diagnosis and treatment.

Intratumoural haemorrhage in intracranial germ cell tumours: A review of literature with an illustrative case

“…In a retrospective review of intracranial germinomas and mixed germ cell tumours, Li et al had found that the incidence of intratumoural haemorrhage was significantly more in mixed germ cell tumours than in germinomas (68.75% vs 11.76%). 30 Liang et al also reported presence of intratumoural haemorrhage only in mixed germ cell tumours. 31 However, Chen et al noted presence of intracranial haemorrhage in 7 cases of germinomas and in 10 cases of non-germinomatous germ cell tumours.…”

Update on MRI in pediatric intracranial germ cell tumors—The clinical and radiological features

“…Germinomas in the basal ganglia region are relatively rare with a strong male predominance ( 25 ). The most common manifestation is slow progressive hemiplegia, with involuntary movement, cognitive decline, language disorder, and personality change ( 30 ).…”

“…Mild or no space-occupying effect is often observed. Hypointensity on T2* GRE/SWI and Wallerian degeneration of corticospinal tract, which is defined as ipsilateral atrophy of the cerebral hemisphere or cerebral peduncle, have been emphasized as reliable signs of basal ganglia germinoma ( 11 , 30 , 31 ) ( Figure 7 ). Hypointensity on SWI is very important in identifying early stages of germinomas.…”

“…It has been reported that 11 C-methionine-positron emission tomography (MET-PET) may be helpful for the early diagnosis of basal ganglia germinomas when conventional MRI cannot diagnose them, especially for tumor contouring ( 32 ). Li et al reported on 33 basal ganglia GCTs and found that, compared with NGGCTs, germinomas showed more cystic changes and inhomogeneous enhancement ( 30 ).…”

Neuroimaging of pediatric tumors of the sellar region—A review in light of the 2021 WHO classification of tumors of the central nervous system

“…The MRI appearance of suprasellar GCT spans from a small homogeneous stalk or infundibular lesion with absence of the normal T1WI neurohypophyseal bright spot to a larger predominantly solid mass with avid contrast enhancement and signs of reduced free water content, namely iso- to hypointense T2 signal and restricted diffusion (also high density on CT) ( 12 , 135 ). The former presentation overlaps with that of LCH, although a GCT diagnosis may be favored in the presence of hypothalamus infiltration or unilateral basal ganglia involvement, atrophy and Wallerian degeneration ( 135 , 136 ). A recent study by Esfahani et al ( 137 ) reviewed clinical and radiographic features of 42 pediatric suprasellar GCTs and found notable morphologic differences between solitary GCT and bifocal GCT.…”