Ces radiol. 2026, 80(1):7-15 | DOI: 10.55095/CesRadiol2026/010

Expansion in the pineal region - comprehensive review of diagnostic and therapeutic approachesReview article

Pavel Ryška1, Milan Vajda1, Manuela Vaněčková2, Jaroslav Storm1, Jiří Vaňásek1, Michal Čech1, Radka Dvořáková1, Aleš Kohout3, Tomáš Česák4, Petr Hoffmann1, Vendelín Chovanec1, Jiří Jandura1
1 Radiologická klinika LF UK a FN, Hradec Králové
2 Oddělení MR, Radiodiagnostická klinika 1. LF UK a VFN, Praha
3 Fingerlandův ústav patologie FN, Hradec Králové
4 Neurochirurgická klinika LF UK a FN, Hradec Králové Korespondenční adresa:

Objective: To provide a comprehensive review of pineal region lesions - their etiology, morphology, imaging, calcifications, followup, and therapeutic strategies.

Methods: Narrative review of peerreviewed literature indexed in PubMed, Scopus and Web of Science focusing on pineal cysts, pineal parenchymal tumors and intracranial germ cell tumors. In the paper, the authors present their experience and graphic findings in various types of epiphyseal mass.

Results: Advances in MRI, CT and PET together with molecular diagnostics improve differential diagnosis and treatment planning. Artificial intelligence contributes to lesion classification and outcome prediction.

Conclusion: Management of pineal region lesions requires a multidisciplinary approach; integrating morphologic, functional and molecular tools enables personalized care and minimizes invasive procedures.

Keywords: pineal gland, pineal cyst, pineal tumor, germinoma, calcification, MRI, differential diagnosis, hydrocephalus, neuro

Received: February 19, 2026; Revised: February 19, 2026; Accepted: February 15, 2026; Published: May 1, 2026  Show citation

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Ryška P, Vajda M, Vaněčková M, Storm J, Vaňásek J, Čech M, et al.. Expansion in the pineal region - comprehensive review of diagnostic and therapeutic approaches. Ces radiol. 2026;80(1):7-15. doi: 10.55095/CesRadiol2026/010.
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    References

    1. Allen JC, Nisselbaum J, Epstein F, Rosen G, Schwartz MK. Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg. 1979; 51(3): 368-374. doi:10.3171/jns.1979.51.3.0368 Go to original source... Go to PubMed...
    2. Arendt J. Melatonin and the pineal gland: Influence on mammalian seasonal and circadian physiology. Rev Reprod. 1998; 3(1): 13-22. doi:10.1530/ror.0.0030013 Go to original source...
    3. Balmaceda C, Modak S, Finlay J. Central nervous system germ cell tumors: Advances in diagnosis and therapy. Curr Oncol Rep. 1998; 1(2): 121-127.
    4. Barboriak DP, Lee L, Provenzale JM. Serial MR imaging of pineal cysts: implications for natural history and follow-up. AJR Am J Roentgenol. 2001; 176(3): 737-743. doi: 10.2214/ajr.176.3.1760737 Go to original source... Go to PubMed...
    5. Blakeley JO, Grossman SA. Management of pineal region tumors. Curr Treat Options Oncol. 2006; 7(6): 505-516. doi: 10.1007/s11864-006-0025-6 Go to original source... Go to PubMed...
    6. Tanaka T, Arnold L, Gabriela Mazuru D, Golzy M, Carr SB, Litofsky NS. Pineal cysts: Does anyone need long-term follow up? J Clin Neurosci. 2021; 83: 146-151. doi: 10.1016/j.jocn.2020.10.051 Go to original source... Go to PubMed...
    7. Chang SM, Lillis-Hearne PK, Larson DA, Wara WM, Bollen AW, Prados MD. Pineoblastoma in adults. Neurosurgery 1995; 37(3): 383-390; discussion 390-391. doi: 10.1227/00006123-199509000-00003 Go to original source...
    8. Favero G, Bonomini F, Rezzani R. Pineal Gland Tumors: A Review. Cancers 2021; 13(7): 1547. Available from: https://doi.org/10.3390/cancers13071547 Go to original source...
    9. Dunet V, Rossier C, Buck A, Stupp R, Prior JO. Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: a systematic review and Metaanalysis. J Nucl Med. 2012; 53(2): 207-214. doi: 10.2967/jnumed.111.096859 Go to original source... Go to PubMed...
    10. Echevarría ME, Fangusaro J, Goldman S. Pediatric central nervous system germ cell tumors: a review. Oncologist. 2008; 13(6): 690-699. doi: 10.1634/theoncologist.2008-0037 Go to original source... Go to PubMed...
    11. Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S, Jänisch W. Cystic lesions of the pineal region - MRI and pathology. Neuroradiology 2000; 42(6): 399-402. doi: 10.1007/s002340000308 Go to original source... Go to PubMed...
    12. Fauchon F, Jouvet A, Paquis P, Saint-Pierre G, Mottolese C, Ben Hassel M, Chauveinc L, Sichez JP, Philippon J, Schlienger M, Bouffet E. Parenchymal pineal tumors: a clinicopathological study of 76 cases. Int J Radiat Oncol Biol Phys. 2000; 46(4): 959-968. doi: 10.1016/s0360-3016(99)00389-2 Go to original source...
    13. Shields M, Sinkar S, Chan W, Crompton J. Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases. Acta Ophthalmol. 2017; 95(8): e792-e793. doi: 10.1111/aos.13283 Go to original source... Go to PubMed...
    14. Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumors. Insights Imaging 2013; 4(3): 369-382. doi: 10.1007/s13244-013-0248-6 Go to original source... Go to PubMed...
    15. Gailloud P, O'Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ, Murphy KJ, Lehmann CU. Diagnosis and management of vein of galen aneurysmal malformations. J Perinatol. 2005; 25(8): 542-551. doi: 10.1038/sj.jp.7211349 Go to original source...
    16. Di Chirico A, Di Rocco F, Velardi F. Spontaneous regression of a symptomatic pineal cyst after endoscopic third-ventriculostomy. Childs Nerv Syst. 2001; 17(1-2): 42-46. doi: 10.1007/pl00013724 Go to original source... Go to PubMed...
    17. Galldiks N, Kaufmann TJ, Vollmuth P, Lohmann P, Smits M, Veronesi MC, Langen KJ, Rudà R, Albert NL, Hattingen E, Law I, Hutterer M, Soffietti R, Vogelbaum MA, Wen PY, Weller M, Tonn JC. Challenges, limitations, and pitfalls of PET and advanced MRI in patients with brain tumors: A report of the PET/RANO group. Neuro Oncol. 2024; 26(7): 1181-1194. doi: 10.1093/neuonc/noae049 Go to original source...
    18. Gaillard F, Campos A, Glick Y, et al. Pineal parenchymal tumors. Reference article, Radiopaedia.org (Accessed on 09 Dec 2025). Available from: https://doi.org/10.53347/rID-22604 Go to original source...
    19. Klein P, Rubinstein LJ. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature. J Neurol Neurosurg Psychiatry 1989; 52(8): 991-995. doi: 10.1136/jnnp.52.8.991 Go to original source... Go to PubMed...
    20. Gunata M, Parlakpinar H, Acet HA. Melatonin: A review of its potential functions and effects on neurological diseases. Rev Neurol. (Paris) 2020; 176(3): 148-165. doi: 10.1016/j.neurol.2019.07.025 Go to original source... Go to PubMed...
    21. Lassman AB, DeAngelis LM. Brain metastases. Neurol Clin. 2003; 21(1): 1-23, vii. doi: 10.1016/s0733-8619(02)00035-x Go to original source...
    22. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: A summary. Neuro-Oncology 2021; 23(8): 1231-1251. doi: 10.1093/neuonc/noab106 Go to original source... Go to PubMed...
    23. Macchi MM, Bruce JN. Human pineal physiology and functional significance of melatonin. Front Neuroendocrinol. 2004; 25(3-4): 177-195. doi: 10.1016/j.yfrne.2004.08.001 Go to original source... Go to PubMed...
    24. Quick-Weller J, Lescher S, Baumgarten P, Dinc N, Bruder M, Weise L, Seifert V, Marquardt G. Stereotactic Biopsy of Pineal Lesions. World Neurosurg. 2016; 96: 124-128. doi: 10.1016/j.wneu.2016.04.130. Go to original source... Go to PubMed...
    25. Lassman AB, Bruce JN, Fetell MR. Metastases to the pineal gland. Neurology. 2006; 67(7): 1303-1304. doi: 10.1212/01.wnl.0000238516.29603.33 Go to original source...
    26. Osborn AG, Preece MT. Intracranial cysts: Radiologic-pathologic correlation and imaging approach. Radiology 2006; 239(3): 650-664. doi: 10.1148/radiol.2393050823 Go to original source... Go to PubMed...
    27. Pastel DA, Mamourian AC, Duhaime AC. Internal structure in pineal cysts on high-resolution magnetic resonance imaging: not a sign of malignancy. J Neurosurg Pediatr. 2009; 4(1): 81-84. doi: 10.3171/2008.5.17681 Go to original source... Go to PubMed...
    28. Tate MC, Rutkowski MJ, Parsa AT. Contemporary Management of Pineoblastoma. Neurosurgery Clinics of North America 2011; 22(3): 409-412. doi: 10.1016/j.nec.2011.05.001 Go to original source... Go to PubMed...
    29. Pu Y, Mahankali S, Hou J, Li J, Lancaster JL, Gao JH, Appelbaum DE, Fox PT. High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. AJNR Am J Neuroradiol. 2007; 28(9): 1706-1709. doi: 10.3174/ajnr. A0656 Go to original source...
    30. Raleigh DR, Solomon DA, Lloyd SA, et al. Histopathologic review of pineal parenchymal tumors identifies novel morphologic subtypes and prognostic factors for outcome. Neuro-Oncology 2017; 19(1): 78-88. doi: 10.1093/neuonc/now105 Go to original source... Go to PubMed...
    31. Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics 1992; 12(3): 577-596. doi: 10.1148/radiographics.12.3.1609147 Go to original source... Go to PubMed...
    32. Sumida M, Barkovich AJ, Newton TH. Development of the pineal gland: measurement with MR. AJNR Am J Neuroradiol. 1996; 17(2): 233-236.
    33. Tate M, Sughrue ME, Rutkowski MJ, Kane AJ, Aranda D, McClinton L, McClinton L, Barani IJ, Parsa AT. The long-term postsurgical prognosis of patients with pineoblastoma. Cancer 2012; 118(1): 173-179. doi: 10.1002/cncr.26300. Go to original source... Go to PubMed...
    34. Rose M, Burgess JT, O'Byrne K, Richard DJ, Bolderson E. PARP Inhibitors: Clinical Relevance, Mechanisms of Action and Tumor Resistance. Front Cell Dev Biol. 2020; 8: 564601. doi: 10.3389/fcell.2020.564601 Go to original source...
    35. Zimmerman RA, Bilaniuk LT. Age-related incidence of pineal calcification detected by computed tomography. Radiology 1982; 142(3): 659-662. doi: 10.1148/radiology Go to original source...
    36. D'Alessandro A, Cortini F, Pardolesi A, et al. Cerebrospinal fluid levels of AFP and hCG: validation of an automated immunoassay for CNS germ cell tumors. Diagnostics (Basel) 2021; 11(11): 1980. doi: 10.3390/diagnostics11111980 Go to original source... Go to PubMed...
    37. Osborn AG. Diagnostic imaging: brain. 3rd ed. Salt Lake City: Amirsys/Elsevier 2016.
    38. Guzman-De-Villoria JA, Fernández-Garcîa P, Fernández Armayor A, et al. Conventional MRI, DWI and MR spectroscopy in brain tumor imaging: a practical review. Insights Imaging 2011; 2(6): 525-540. doi:10.1007/s13244-011-0115-2 Go to original source... Go to PubMed...
    39. Byrne JV. Imaging of calcification in the brain. Clin Radiol. 1998; 53(3): 159-168. doi: 10.1016/S0009-9260(98)80254-8 Go to original source...
    40. Galldiks N, Law I, Pope WB, et al. The use of amino acid PET in neuro-oncology. Nat Rev Neurol. 2017; 13(4): 259-271. doi:10.1038/nrneurol.2017.3 Go to original source...
    41. Law M, Yang S, Wang H, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging. AJNR Am J Neuroradiol. 2003; 24(10): 1989-1998.
    42. Langen KJ, Stoffels G, Filss CP, et al. Imaging of amino acid transport in brain tumors using PET. Methods 2017; 130: 124-134. doi: 10.1016/j.ymeth.2017.07.010 Go to original source... Go to PubMed...
    43. Smirniotopoulos JG, Rushing EJ, Mena H. Lesions of the pineal region: radiologicpathologic correlation. Radiographics 2010; 30(7): 2001-2021. Go to original source... Go to PubMed...
    44. Zimmermann RA, Bilaniuk LT. Age-related incidence of pineal calcification detected by computed tomography. Radiology 1982; 142(3): 659-662. Go to original source... Go to PubMed...
    45. Koeller KK, Rushing EJ. Pineal region masses. Radiographics 2003; 23(5): 1211-1231. Go to original source...
    46. Engel U, Gottschalk S, Niehaus L, et al. Cystic lesions of the pineal region - MRI and pathology. Neuroradiology 2000; 42(6): 399-402. Go to original source... Go to PubMed...
    47. Macchi MM, Bruce JN. Human pineal physiology and melatonin. Front Neuroendocrinol. 2004; 25(3-4): 177-195. Go to original source... Go to PubMed...
    48. Osborn AG, Preece MT. Intracranial cysts: radiologicpathologic correlation and imaging approach. Radiology 2006; 239(3): 650-664. Go to original source... Go to PubMed...
    49. Smirniotopoulos JG, Rushing EJ, Mena H. Lesions of the pineal region. Radiographics 2010; 30(7): 2001-2021. Go to original source...
    50. Barboriak DP, Lee L, Provenzale JM. Serial MR imaging of pineal cysts. AJR 2001; 176(5): 1303-1306. Go to original source... Go to PubMed...
    51. Pu Y, Mahankali S, Hou J, et al. Pineal cysts: a benign finding with potential symptomatic implications. AJNR 2007; 28(9): 1706-1709. Go to original source... Go to PubMed...
    52. Oertel J, Mondorf Y, Gaab MR. Endoscopic treatment of pineal cysts: clinical outcome and longterm followup. Neurosurgery 2010; 67(4): 974-983. doi: 10.1227/NEU.0b013e3181ef25a9 Go to original source...
    53. Holtas S, Heiling M, Lönntoft M. Spontaneous regression of a pineal cyst. Acta Radiol. 1998; 39(3): 324-326.
    54. AlHolou WN, Garton HJL, Muraszko KM, Maher CO. The natural history of pineal cysts in children and young adults. J Neurosurg Pediatr. 2010; 5(2): 162-166. doi: 10.3171/2009.8. PEDS09161 Go to original source...
    55. Oertel J, Mondorf Y, Baldauf J, Gaab MR. Endoscopic management of symptomatic pineal cysts. Neurosurg Focus. 2011; 30(4): E11. Doi: 10.3171/2011.1. FOCUS10305 Go to original source...
    56. Fauchon F, Jouvet A, Paquis P, et al. Parenchymal pineal tumors. Int J Radiat Oncol Biol Phys. 2000; 46(4): 959-968. Go to original source... Go to PubMed...
    57. Echevarría ME, Fangusaro J, Goldman S. Pediatric CNS germ cell tumors. Oncologist. 2008; 13(6): 690-699. Go to original source... Go to PubMed...
    58. OrtegaMartínez M, CabezudoArtero JM, FernándezPortales I, et al. Metastatic tumors in the pineal region. Acta Neurochir. (Wien) 2007; 149(11): 1157-1164.
    59. Güneş A, Yilmaz B, Uğur HC, et al. Inflammatory and infectious lesions of the pineal region. Neurosurg Rev. 2015; 38(1): 71-80.
    60. Venker BT, Christ AB, Parikh KA, et al. PARP inhibitors in pineoblastoma. Neuro Oncol Adv. 2020; 2(1): vdaa056.
    61. Mueller S, Chang S. Pediatric brain tumors: current treatment strategies and future therapeutic approaches. Neurotherapeutics 2009; 6(3): 570-586. Go to original source... Go to PubMed...
    62. Foreman NK, Merchant TE. Ethical considerations in the management of pediatric brain tumors. Childs Nerv Syst. 2018; 34(10): 1959-1968.
    63. Tate M, Sughrue ME, Rutkowski MJ, et al. The longterm postsurgical prognosis of patients with pineoblastoma. Cancer 2012; 118(1): 173-179. Go to original source... Go to PubMed...
    64. Kickingereder P, Isensee F, Tursunova I, et al. Automated quantitative tumour response assessment of MRI in neurooncology with artificial neural networks: a multicentre, retrospective study. Lancet Oncol. 2019; 20(5): 728-740. doi: 10.1016/S14702045(19)300981 Go to original source...
    65. VillanuevaMeyer JE, Galldiks N, Bakas S, et al. Artificial Intelligence for Response Assessment in NeuroOncology (AIRANO): policy review. Lancet Oncol. 2024; 25(11): e589-e601. doi: 10.1016/S14702045(24)003152 Go to original source...

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