Objective To investigate the clinical value of CT， MR and frame stereotactic biopsy in patients with germ cell tumors in pineal region， and the safety of stereotactic biopsy in pineal region tumor. Methods From September 2017 to December 2019， a total of 41 cases of suspected of germioma treated in Sanbo Brain Hospital were analyzed retrospectively. The patients completed brain CT and MR imaging， as well as cerebrospinal fluid（ CSF） and serum alpha-fetoprotein（ AFP）， human chorionic gonadotropin β subunit expression level（ β-hCG） monitoring. All of the patients underwent frame-based stereotactic biopsy， with the pathological examination of diseased brain tissue as the diagnosis "gold standard". Brain CT， MR and tumor markers were evaluated for diagnostic value in pineal germinoma. Results （1）AFP levels in serum and cerebrospinal fluid of 41 patients were less than 8 μg/L. The serum β hCG of 2 patients was greater than or equal to 3 U/L， and that of CSF in 3 patients was greater than or equal to 3 U/L.（ 2）CT examinations of head： 40 cases of slightly high density， 38 cases of "Engulfed" pineal gland with centrical bullet like calcification （calcification is usually surrounded by tumor）. MRI examination of the head： 38 cases showed equal signal on T1 weighted imaging and T2 weighted imaging； 36 cases showed high signal on diffusion weighted imaging，38 cases showed obvious enhancement on enhanced scan after drug injection， and "salt and pepper sign" was seen inside. CT/MRI showed ventricular enlargement and hydrocephalus in 31 patients.（ 3） Totally 41 patients underwent stereotactic frame biopsy under local anesthesia. Postoperative head CT examination showed 2 cases of micro bleeding in the operation area， and no bleeding sign was found in the rest. There was no significant change in clinical manifestations before and after operation.（ 4） All 41 cases were confirmed as germinoma by pathology. Conclusions CT showed high density with "Englfed" central calcification， MRI showed equal signal on T1 and T2 weighted imaging， high signal on diffusion weighted imaging， enhancement on enhanced scan， and "salt and pepper sign" were all signs of high diagnostic specificity. Frame stereotactic biopsy has the advantages of minimally invasive， high diagnosis rate and few complications， which has high application value for accurate diagnosis of pineal lesions.