A ventricular shunt tube is seen terminating in the body of the right lateral ventricle associated with moderate dilatation of the supra-tentorial ventricular system and with periventricular patchy areas of high T2/FLAIR signal intensity (trans-ependymal CSF permeation).
A sizable irregular mass in the pineal region is seen eliciting isointense to hypointense signal to the adjacent brain on T1 WI, isointense signal on T2 WI, with areas of cyst formation and vivid heterogeneous postcontrast enhancement. It is seen inseparable from and deforms the midbrain and pontine posterior surfaces as well as the antero-superior cerebellum. Spinal axis nodular leptomeningeal thickening is seen and is more evident caudally.