SUMMARY:We report the imaging features of 4 cases of patients with papillary tumor of the pineal region, a tumor newly recognized in the 2007 World Health Organization "Classification of Tumors of the Nervous System." In each case, the tumor was intrinsically hyperintense on T1-weighted images with a characteristic location in the posterior commissure or pineal region. The pathologic hallmarks of the tumor are discussed, including a possible explanation for the MR imaging characteristics in our cases. P rimary papillary tumors of the central nervous system and particularly the pineal region are rare. Papillary tumor of the pineal region (PTPR) is a recently described neoplasm that has been formally recognized in the 2007 World Health Organization (WHO) "Classification of Tumors of the Nervous System."1 Histologic features and immunohistochemical staining distinguish this type of papillary tumor from other papillary-like tumors that occur in the region. [2][3][4][5][6][7] It is postulated that the masses arise from the specialized ependymocytes of the subcommissural organ located in the lining of the posterior commissure. 4 There are documented cases in the neuropathology and neurosurgery literature but limited descriptions of MR imaging features.7-9 Here, we present 4 patients who underwent MR imaging and surgical resection of tumors in the posterior commissure and pineal region where the pathologic diagnosis was a PTPR. Case Reports Case 1A 27-year-old woman presented with headache and hydrocephalus. MR imaging at 1.5T revealed a mass centered between the posterior commissure and pineal region, which compressed the tectum and aqueduct (Fig 1). The mass was hyperintense on noncontrast T1-weighted images and enhanced heterogeneously after administration of gadolinium.The patient underwent ventriculostomy and surgical resection of the mass. Gross and histologic examinations of the mass did not display evidence of hemorrhage, calcification, melanin, keratin debris, or fat. Focal calcification was present in the adjacent pineal gland, which was displaced to the left. The pineal gland was normal on histologic examination. Case 2A 51-year-old woman presented with a headache and impairment of upward gaze. Imaging demonstrated a mass centered on the posterior commissure with mass effect on the pineal gland, aqueduct, and posterior third ventricle (Fig 2A). As in case 1, there was intrinsic hyperintensity on T1-weighted images throughout the mass on 1.5T unenhanced sequences. Small cystic areas were present in the mass, and the solid portions of the mass enhanced heterogeneously. Resection of the mass was accomplished by an infratentorial-supracerebellar approach, and immunohistochemical profiling confirmed the mass to be a PTPR. Case 3A 50-year-old woman presented with a 3-year history of gait imbalance, fatigue, and short-term memory loss. She reported a recent episode of confusion associated with weakness of the right lower extremity and was taken to the emergency department, where a 1.5T MR imaging examination demons...

Level III-case-control prognostic study.

This study evaluates the impact of extended cardiac views on examination time, repeat imaging, and anomaly detection before and after implementation of 76811 guidelines (American Institute of Ultrasound in Medicine Consensus 2014). It is a retrospective study of singleton pregnancies undergoing detailed ultrasound imaging at 18 weeks' gestation or greater before and after the protocol change in an academic, tertiary care fetal center. Views required prior to 2014: 4-chamber, left outflow tract, right outflow tract. Additional views required after 2014: bicaval, aortic arch, 3-vessel, and 3-vessel trachea. Fetuses with known anomalies were excluded. Rates of detection of congenital heart disease (CHD), examination completion, repeat examination recommendation, fetal echocardiogram recommendation, completion by body mass index, and cardiac examination time were determined. Six hundred twenty-four subjects were included, 217 before and 407 after protocol change. Views obtained were as stated in the American Institute of Ultrasound in Medicine/Society for Maternal-Fetal Medicine consensus. Detection of CHD was not improved. Examination times increased by 20% (6.4 vs 7.7 minutes, P < 0.05). Number of incomplete studies increased by 130% (11% to 26%, P < 0.05). Twice as many patients were referred for repeat examination (6% vs 13%, P < 0.05). Completion rates were negatively correlated with body mass index. Recommendations for fetal echocardiogram were unchanged (5% vs 6%, P = 0.6). Additional imaging did not increase detection rate of CHD (3% vs 2%, P = 0.3). Extended cardiac views resulted in increased examination time, more incomplete examinations, and more repeat examinations without changing detection rates of CHD.