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<meta name="DC.Title" content="Distinguishing between Germinomas and Pineal Cell Tumors on MR Imaging" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2806" />
<meta name="DC.Date" content="2012-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2012 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Tumors of pineal cell origin have different prognosis and treatment than those of germ cell origin. The recent literature suggests that these tumors often look alike. Our study aimed to differentiate between pineal cell tumor and germinoma based on ADC values, the homogeneity of the mass, and MR imaging characteristics.

MATERIALS AND METHODS: We enrolled 20 patients who had pretreatment MR imaging scans with histologic verification of tumors of pineal cell origin and germinomas. The tumors were measured for the ADC values and for homogeneity by the coefficient of variation of ADC values, and T1WI and T2WI signal intensity values.

RESULTS: The 20 subjects (8 females and 12 males) ranged in age from 1.5–64.9 years, with a mean age of 23.9 years (SD 17.7 years). The mean age of those with germinomas was 13.7 years (SD 3.8 years), less than the mean of 29.4 years for those with pineal cell tumors (SD 19.9 years; P = .016). These 2 groups showed no significant difference in coefficients of variation on T1WI, T2WI, and ADC images. However, germinomas showed statistically significant higher ADC values (mean 1590.69 ± 532.96 × 10−6 mm2/s) than pineal cell tumors (mean 883.58 ± 317.48 × 10−6 mm2/s; P = .02). An accuracy of 89.5%, sensitivity of 83.3%, specificity of 92.3%, PPV of 83.3%, and NPV of 92.3% were yielded for an ADC threshold of 1250.00 × 10−6 mm2/s.

CONCLUSIONS: Germinomas showed higher ADC values than the pineal cell tumors ( P = .02), and the patients were younger. Otherwise, there were no definitive imaging characteristics that distinguished pineal cell tumors from germinomas.

NPV
:   negative predictive value
PNET
:   primitive neuroectodermal tumor
PPTID
:   pineal parenchymal tumor of intermediate differentiation
PPV
:   positive predictive value
PTPR
:   papillary tumor of the pineal region
TR/TE
:   repetition time/time-to-echo
WHO
:   World Health Organization" />
<meta name="DC.Contributor" content="N. Dumrongpisutikul" />
<meta name="DC.Contributor" content="J. Intrapiromkul" />
<meta name="DC.Contributor" content="D.M. Yousem" />
<meta name="article:published_time" content="2012-03-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Distinguishing between Germinomas and Pineal Cell Tumors on MR Imaging" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Tumors of pineal cell origin have different prognosis and treatment than those of germ cell origin. The recent literature suggests that these tumors often look alike. Our study aimed to differentiate between pineal cell tumor and germinoma based on ADC values, the homogeneity of the mass, and MR imaging characteristics.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We enrolled 20 patients who had pretreatment MR imaging scans with histologic verification of tumors of pineal cell origin and germinomas. The tumors were measured for the ADC values and for homogeneity by the coefficient of variation of ADC values, and T1WI and T2WI signal intensity values.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The 20 subjects (8 females and 12 males) ranged in age from 1.5–64.9 years, with a mean age of 23.9 years (SD 17.7 years). The mean age of those with germinomas was 13.7 years (SD 3.8 years), less than the mean of 29.4 years for those with pineal cell tumors (SD 19.9 years; &lt;i&gt;P&lt;/i&gt; = .016). These 2 groups showed no significant difference in coefficients of variation on T1WI, T2WI, and ADC images. However, germinomas showed statistically significant higher ADC values (mean 1590.69 ± 532.96 × 10&lt;sup&gt;−6&lt;/sup&gt; mm&lt;sup&gt;2&lt;/sup&gt;/s) than pineal cell tumors (mean 883.58 ± 317.48 × 10&lt;sup&gt;−6&lt;/sup&gt; mm&lt;sup&gt;2&lt;/sup&gt;/s; &lt;i&gt;P&lt;/i&gt; = .02). An accuracy of 89.5%, sensitivity of 83.3%, specificity of 92.3%, PPV of 83.3%, and NPV of 92.3% were yielded for an ADC threshold of 1250.00 × 10&lt;sup&gt;−6&lt;/sup&gt; mm&lt;sup&gt;2&lt;/sup&gt;/s.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Germinomas showed higher ADC values than the pineal cell tumors (&lt;i&gt;P&lt;/i&gt; = .02), and the patients were younger. Otherwise, there were no definitive imaging characteristics that distinguished pineal cell tumors from germinomas.&lt;/p&gt;" />
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<meta name="twitter:title" content="Distinguishing between Germinomas and Pineal Cell Tumors on MR Imaging" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Tumors of pineal cell origin have different prognosis and treatment than those of germ cell origin. The recent literature suggests that these tumors often look alike. Our study aimed to differentiate between pineal cell tumor and germinoma based on ADC values, the homogeneity of the mass, and MR imaging characteristics.

MATERIALS AND METHODS: We enrolled 20 patients who had pretreatment MR imaging scans with histologic verification of tumors of pineal cell origin and germinomas. The tumors were measured for the ADC values and for homogeneity by the coefficient of variation of ADC values, and T1WI and T2WI signal intensity values.

RESULTS: The 20 subjects (8 females and 12 males) ranged in age from 1.5–64.9 years, with a mean age of 23.9 years (SD 17.7 years). The mean age of those with germinomas was 13.7 years (SD 3.8 years), less than the mean of 29.4 years for those with pineal cell tumors (SD 19.9 years; P = .016). These 2 groups showed no significant difference in coefficients of variation on T1WI, T2WI, and ADC images. However, germinomas showed statistically significant higher ADC values (mean 1590.69 ± 532.96 × 10−6 mm2/s) than pineal cell tumors (mean 883.58 ± 317.48 × 10−6 mm2/s; P = .02). An accuracy of 89.5%, sensitivity of 83.3%, specificity of 92.3%, PPV of 83.3%, and NPV of 92.3% were yielded for an ADC threshold of 1250.00 × 10−6 mm2/s.

CONCLUSIONS: Germinomas showed higher ADC values than the pineal cell tumors ( P = .02), and the patients were younger. Otherwise, there were no definitive imaging characteristics that distinguished pineal cell tumors from germinomas.

NPV
:   negative predictive value
PNET
:   primitive neuroectodermal tumor
PPTID
:   pineal parenchymal tumor of intermediate differentiation
PPV
:   positive predictive value
PTPR
:   papillary tumor of the pineal region
TR/TE
:   repetition time/time-to-echo
WHO
:   World Health Organization" />
<meta name="og-title" property="og:title" content="Distinguishing between Germinomas and Pineal Cell Tumors on MR Imaging" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/33/3/550" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Tumors of pineal cell origin have different prognosis and treatment than those of germ cell origin. The recent literature suggests that these tumors often look alike. Our study aimed to differentiate between pineal cell tumor and germinoma based on ADC values, the homogeneity of the mass, and MR imaging characteristics.

MATERIALS AND METHODS: We enrolled 20 patients who had pretreatment MR imaging scans with histologic verification of tumors of pineal cell origin and germinomas. The tumors were measured for the ADC values and for homogeneity by the coefficient of variation of ADC values, and T1WI and T2WI signal intensity values.

RESULTS: The 20 subjects (8 females and 12 males) ranged in age from 1.5–64.9 years, with a mean age of 23.9 years (SD 17.7 years). The mean age of those with germinomas was 13.7 years (SD 3.8 years), less than the mean of 29.4 years for those with pineal cell tumors (SD 19.9 years; P = .016). These 2 groups showed no significant difference in coefficients of variation on T1WI, T2WI, and ADC images. However, germinomas showed statistically significant higher ADC values (mean 1590.69 ± 532.96 × 10−6 mm2/s) than pineal cell tumors (mean 883.58 ± 317.48 × 10−6 mm2/s; P = .02). An accuracy of 89.5%, sensitivity of 83.3%, specificity of 92.3%, PPV of 83.3%, and NPV of 92.3% were yielded for an ADC threshold of 1250.00 × 10−6 mm2/s.

CONCLUSIONS: Germinomas showed higher ADC values than the pineal cell tumors ( P = .02), and the patients were younger. Otherwise, there were no definitive imaging characteristics that distinguished pineal cell tumors from germinomas.

NPV
:   negative predictive value
PNET
:   primitive neuroectodermal tumor
PPTID
:   pineal parenchymal tumor of intermediate differentiation
PPV
:   positive predictive value
PTPR
:   papillary tumor of the pineal region
TR/TE
:   repetition time/time-to-echo
WHO
:   World Health Organization" />
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<div id="hw-article-author-popups-top-node-11845--6820501943" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">N. Dumrongpisutikul </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BDumrongpisutikul%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dumrongpisutikul%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.%2BDumrongpisutikul%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Intrapiromkul </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BIntrapiromkul%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Intrapiromkul%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BIntrapiromkul%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D.M. Yousem </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.M.%2BYousem%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yousem%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.M.%2BYousem%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-book" id="cit-33.3.550.1"><div class="cit-metadata"><ol class="duplicate"><li><span class="cit-ed"><span class="cit-name-surname">Yousem</span>  <span class="cit-name-given-names">DM</span></span>, </li><li><span class="cit-ed"><span class="cit-name-surname">Grossman</span>  <span class="cit-name-given-names">RI</span></span></li></ol><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yousem</span>  <span class="cit-name-given-names">DM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Grossman</span>  <span class="cit-name-given-names">RI</span></span></li></ol><cite>.
<span class="cit-article-title">Neoplasms of the brain</span>. 
In: 

<span class="cit-ed"><span class="cit-name-surname">Yousem</span>  <span class="cit-name-given-names">DM</span></span>, 
<span class="cit-ed"><span class="cit-name-surname">Grossman</span>  <span class="cit-name-given-names">RI</span></span>,
eds. 
<span class="cit-source">Neuroradiology: The Requisites</span>, <span class="cit-edition">3rd ed.</span>, 
<span class="cit-publ-loc">Philadelphia</span>: <span class="cit-publ-name">Mosby</span>;<span class="cit-pub-date">2010</span>:<span class="cit-fpage">94</span>–<span class="cit-lpage">98</span></cite></div><div class="cit-extra"></div></div>
</li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.2" data-doi="10.1148/rg.307105131"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Smith</span>  <span class="cit-name-given-names">AB</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rushing</span>  <span class="cit-name-given-names">EJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Smirniotopoulos</span>  <span class="cit-name-given-names">JG</span></span></li></ol><cite>.
<span class="cit-article-title">From the archives of the AFIP: lesions of the pineal region: radiologic-pathologic correlation</span>. 
<abbr class="cit-jnl-abbrev">Radiographics</abbr> 
<span class="cit-pub-date">2010</span>;<span class="cit-vol">30</span>:<span class="cit-fpage">2001</span>–<span class="cit-lpage">20</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/rg.307105131&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21057132&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

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</li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

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</li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a>

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</li><li><span class="ref-label">6.</span><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6. in text" id="ref-6">↵</a>

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</li><li><span class="ref-label">7.</span><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7. in text" id="ref-7">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.7"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">DeLano</span>  <span class="cit-name-given-names">MC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Cooper</span>  <span class="cit-name-given-names">TG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Siebert</span>  <span class="cit-name-given-names">JE</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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</li><li><span class="ref-label">8.</span><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8. in text" id="ref-8">↵</a>

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</li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a>

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</li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.10" data-doi="10.1007/s003309900310"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Okamoto</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ito</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ishikawa</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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</li><li><span class="ref-label">11.</span><a class="rev-xref-ref" href="#xref-ref-11-1" title="View reference 11. in text" id="ref-11">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.11"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cartes-Zumelzu</span>  <span class="cit-name-given-names">FW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Stavrou</span>  <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Castillo</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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</li><li><span class="ref-label">12.</span><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12. in text" id="ref-12">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.12"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Guzman</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Barth</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lovblad</span>  <span class="cit-name-given-names">KO</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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<div class="cit ref-cit ref-journal" id="cit-33.3.550.13" data-doi="10.1148/radiology.217.2.r00nv24331"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Schaefer</span>  <span class="cit-name-given-names">PW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Grant</span>  <span class="cit-name-given-names">PE</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gonzalez</span>  <span class="cit-name-given-names">RG</span></span></li></ol><cite>.
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</li><li><span class="ref-label">14.</span><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 14. in text" id="ref-14">↵</a>

<div class="cit ref-cit ref-book" id="cit-33.3.550.14"><div class="cit-metadata"><ol class="duplicate"><li><span class="cit-ed"><span class="cit-name-surname">Louis</span>  <span class="cit-name-given-names">DN</span></span>, </li><li><span class="cit-ed"><span class="cit-name-surname">Ohgaki</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-ed"><span class="cit-name-surname">Wiestler</span>  <span class="cit-name-given-names">OD</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Nakazato</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Jouvet</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Scheithauer</span>  <span class="cit-name-given-names">BW</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1227/00006123-199509000-00003&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=7501100&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1995RU16100006&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">17.</span><a class="rev-xref-ref" href="#xref-ref-17-1" title="View reference 17. in text" id="ref-17">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.17"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Fevre-Montange</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hasselblatt</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Figarella-Branger</span>  <span class="cit-name-given-names">D</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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<span class="cit-pub-date">2006</span>;<span class="cit-vol">65</span>:<span class="cit-fpage">1004</span>–<span class="cit-lpage">11</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=17021405&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000241692600008&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">18.</span><a class="rev-xref-ref" href="#xref-ref-18-1" title="View reference 18. in text" id="ref-18">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.18"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Komakula</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Warmuth-Metz</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hildenbrand</span>  <span class="cit-name-given-names">P</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Pineal parenchymal tumor of intermediate differentiation: imaging spectrum of an unusual tumor in 11 cases</span>. 
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</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=21080159&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">19.</span><a class="rev-xref-ref" href="#xref-ref-19-1" title="View reference 19. in text" id="ref-19">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.19" data-doi="10.3174/ajnr.A0784"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chang</span>  <span class="cit-name-given-names">AH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Fuller</span>  <span class="cit-name-given-names">GN</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Debnam</span>  <span class="cit-name-given-names">JM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">MR imaging of papillary tumor of the pineal region</span>. 
<abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> 
<span class="cit-pub-date">2008</span>;<span class="cit-vol">29</span>:<span class="cit-fpage">187</span>–<span class="cit-lpage">89</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyOS8xLzE4NyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zMy8zLzU1MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
</li><li><span class="ref-label">20.</span><a class="rev-xref-ref" href="#xref-ref-20-1" title="View reference 20. in text" id="ref-20">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.20" data-doi="10.4103/0028-3886.73750"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Vaghela</span>  <span class="cit-name-given-names">V</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Radhakrishnan</span>  <span class="cit-name-given-names">N</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Radhakrishnan</span>  <span class="cit-name-given-names">VV</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
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<span class="cit-pub-date">2010</span>;<span class="cit-vol">58</span>:<span class="cit-fpage">928</span>–<span class="cit-lpage">32</span>
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</li><li><span class="ref-label">21.</span><a class="rev-xref-ref" href="#xref-ref-21-1" title="View reference 21. in text" id="ref-21">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.21" data-doi="10.1007/s00381-010-1247-2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Wang</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Zou</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gao</span>  <span class="cit-name-given-names">B</span></span></li></ol><cite>.
<span class="cit-article-title">Intracranial germinoma: clinical and MRI findings in 56 patients</span>. 
<abbr class="cit-jnl-abbrev">Childs Nerv Syst</abbr> 
<span class="cit-pub-date">2010</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1773</span>–<span class="cit-lpage">77</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00381-010-1247-2&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=20665036&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">22.</span><a class="rev-xref-ref" href="#xref-ref-22-1" title="View reference 22. in text" id="ref-22">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.22" data-doi="10.1016/j.acra.2009.05.004"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Douglas-Akinwande</span>  <span class="cit-name-given-names">AC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ying</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Momin</span>  <span class="cit-name-given-names">Z</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Diffusion-weighted imaging characteristics of primary central nervous system germinoma with histopathologic correlation: a retrospective study</span>. 
<abbr class="cit-jnl-abbrev">Acad Radiol</abbr> 
<span class="cit-pub-date">2009</span>;<span class="cit-vol">16</span>:<span class="cit-fpage">1356</span>–<span class="cit-lpage">65</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.acra.2009.05.004&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=19643635&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">23.</span><a class="rev-xref-ref" href="#xref-ref-23-1" title="View reference 23. in text" id="ref-23">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.23" data-doi="10.1590/S0004-282X2008000100015"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Gasparetto</span>  <span class="cit-name-given-names">EL</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Cruz</span>  <span class="cit-name-given-names">LC</span>  <span class="cit-name-suffix">Jr</span>.</span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Doring</span>  <span class="cit-name-given-names">TM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Diffusion-weighted MR images and pineoblastoma: diagnosis and follow-up</span>. 
<abbr class="cit-jnl-abbrev">Arq Neuropsiquiatr</abbr> 
<span class="cit-pub-date">2008</span>;<span class="cit-vol">66</span>:<span class="cit-fpage">64</span>–<span class="cit-lpage">68</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1590/S0004-282X2008000100015&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=18392417&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">24.</span><a class="rev-xref-ref" href="#xref-ref-24-1" title="View reference 24. in text" id="ref-24">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.24" data-doi="10.1148/radiol.2353031338"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yamasaki</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kurisu</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Satoh</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Apparent diffusion coefficient of human brain tumors at MR imaging</span>. 
<abbr class="cit-jnl-abbrev">Radiology</abbr> 
<span class="cit-pub-date">2005</span>;<span class="cit-vol">235</span>:<span class="cit-fpage">985</span>–<span class="cit-lpage">91</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2353031338&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15833979&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000229217400034&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">25.</span><a class="rev-xref-ref" href="#xref-ref-25-1" title="View reference 25. in text" id="ref-25">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.25" data-doi="10.1007/s10014-008-0231-y"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Inoue</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kumabe</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kanamori</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Papillary tumor of the pineal region: a case report</span>. 
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</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s10014-008-0231-y&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=18987834&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F3%2F550.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000260684000006&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div>
</li><li><span class="ref-label">26.</span><a class="rev-xref-ref" href="#xref-ref-26-1" title="View reference 26. in text" id="ref-26">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.3.550.26" data-doi="10.1007/s00330-003-2121-3"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Steens</span>  <span class="cit-name-given-names">SC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Admiraal-Behloul</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Schaap</span>  <span class="cit-name-given-names">JA</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>.
<span class="cit-article-title">Reproducibility of brain ADC histograms</span>. 
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<span class="cit-pub-date">2004</span>;<span class="cit-vol">14</span>:<span class="cit-fpage">425</span>–<span class="cit-lpage">30</span>
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</li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 33</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2012 </div></div>
      
      
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