Pineal region tumors: prognostic stratification based on magnetic resonance imaging features-a retrospective cohort study

Background: Pineal region tumors encompass a wide range of pathologies, presenting challenges in pre-surgical characterization and exhibiting variable prognostic outcomes across different tumor types. This study aims to identify key imaging features from pre-treatment magnetic resonance imaging (MRI) of pineal region tumors to aid in prognostic analysis.

Methods: We retrospectively enrolled 33 patients with pineal region tumors who underwent pre-treatment imaging at the Seventh Medical Center of the Chinese PLA General Hospital between January 2010 and June 2023. Two radiologists assessed imaging features including lesion morphology, border delineation, intensity, enhancement pattern, maximum tumor diameter, and secondary changes such as intratumoral hemorrhage and cystic changes. Tumor prognoses were categorized based on reported overall survival rates from recent literature as either good (overall survival rate ≥90%) or poor (overall survival rate <90%). Significant imaging features were selected using one-way analysis of variance (ANOVA) and binary logistic regression.

Results: The study cohort comprised 33 patients (27 males), aged 1 to 72 years [mean ± standard deviation (SD), 26.4±17.7 years]. We identified 13 distinct pathology types, with 15 cases classified as having a good prognosis and 18 cases as having a poor prognosis. A significant feature identified through one-way ANOVA was intratumoral hemorrhage (P=0.017). Binary logistic regression also highlighted intratumoral hemorrhage as a significant independent predictor of prognosis, irrespective of age and other factors. Tumors with intratumoral hemorrhage had a nearly 19-fold (P=0.015, 95% CI: 1.780-202.798) higher likelihood of an unfavorable prognosis compared to those without.

Conclusions: Intratumoral hemorrhage emerges as a significant indicator of poor prognosis in pineal region tumors. This finding underscores the importance of incorporating specific imaging features, particularly intratumoral hemorrhage, into the prognostic evaluation of pineal region tumors.