We studied 18 formalin-fixed brains using MRI, and correlated our data with subsequent gross and microscopic examinations. 9 of our patients died from brain diseases (stroke due to infarction 4, stroke due to hemorrhage 1, encephalitis 2, head injury 1, brain tumor 1). 9 of our patients died from non-CNS diseases (stomach cancer 1, colon cancer 1, liver cirrhosis 1, myocardial infarction 2, trauma 4). In MRI of postmortem brain, T1WI and T 2WI was able to clearly show the myelination process of brainstem, basal ganglia, internal capsule and optic radiation in a 2 months-old-boy. The findings were similar to MRI of live infants. In normal adult postmortem brains, the T1WI showed a relatively low signal intensity of white matter as compared to gray matter. The pictures were similar to proton density images, not T1WI of normal adult brains. The reason why the signal intensity of the white matter was lower than the gray matter may have been due to lysis of lipid of myelin sheath in the formalin solution. Postmortem MRI was able to detect the periventricular hyperintensity (corresponding to arteriosclerotic encephalopathy) and subcortical hyperintensity spots (which corresponding to the widening of the Virchow-Robin perivascular space because of arteriosclerosis) in the brains of our elderly patients. Postmortem MRI detected the intracerebral hemorrhage, which appeared as a dark signal in both short and long TR images. However, MRI did not show blood in the ventricles, sulci, or superficial hemorrhages in the cortex of brain. Brain edema was revealed in the postmortem MRI and appeared as low signal intensity in T1WI and hyperintensity in T2WI. It was associated with a significant mass effect.(ABSTRACT TRUNCATED AT 250 WORDS)
We report on 19 cases of intracranial germ cell tumors, including 12 male and 7 female patients; the average age was 16.5 +/- 4.9 years. These tumors included germinoma in 15 cases, yolk sac tumor in 3 cases, embryonal cell carcinoma in 1 case, and mixed tumor in 3 cases. Each of 5 cases had 2 to 3 different kinds of tumor cells, either in one tumor or in different tumors. The locations of tumors were pineal region in 13 cases, suprasellar region in 3 cases, basal ganglion-thalamus in 3 cases, and cerebral hemispheres in 4 cases. Six of them had 2 or more locations. One case had spinal seeding and extraneural metastasis to the liver, retroperitoneum and neck lymph nodes. Eighteen cases received CT scan and 6 cases received MRI examinations, all the tumors had good enhancement by iodium content contrast medium in CT and Gadolinium-DTPA in MRI. Alfa-fetoprotein was elevated in yolk sac tumor, AFT and HCG were elevated only slightly or remained normal in germinoma. Germinomas had good response to radiation therapy and chemotherapy, while nongerminoma had poor response and worse prognosis.