Brainstem gliomas are an important oncologic problem in the pediatric age group, constituting between 10 and 15% of childhood central nervous system neoplasms. A new classification scheme based on magnetic resonance imaging (MRI) has recently been proposed leading to speculation that gadolinium-DTPA-enhanced MRI may prove useful in defining the prognosis of subsets of patients with these tumors. We retrospectively reviewed gadolinium-DTPA-enhanced MRIs in 26 consecutive newly diagnosed pediatric patients (11 males, 15 females) from our institution between June 1988 and June 1994 with the diagnosis of diffuse brainstem glioma. The site, extent of invasion, T1 and T2 signals, and the pattern and the degree of contrast enhancement of the tumors were evaluated. We correlated the image features, clinical symptoms, and survival period in each patient. Seventeen tumors demonstrated contrast enhancement and 9 did not. The survival in the whole group ranged between 3 months and > 5 years with a median of 9 months. There was no statistical difference in the median survival between patients with or without contrast enhancement (11 versus 8 months).