Differentiation between normal and metastatic lymph nodes in patients with skin melanoma: Preliminary findings using a DIXON-based whole-body MRI approach

C Brussaard; L Faggioni; F E Ramirez-Barbosa; M Vervoort; Y Jansen; B Neyns; J de Mey; I Willekens; D Cioni; E Neri

doi:10.1016/j.ejro.2024.100560

Differentiation between normal and metastatic lymph nodes in patients with skin melanoma: Preliminary findings using a DIXON-based whole-body MRI approach

Eur J Radiol Open. 2024 Mar 19:12:100560. doi: 10.1016/j.ejro.2024.100560. eCollection 2024 Jun.

Authors

C Brussaard¹, L Faggioni², F E Ramirez-Barbosa³, M Vervoort³, Y Jansen⁴, B Neyns⁴, J de Mey¹, I Willekens¹, D Cioni⁵, E Neri²

Affiliations

¹ Universitair Ziekenhuis Brussel, Department of Radiology, Belgium.
² Academic Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy.
³ Universitair Ziekenhuis Brussel, Department of Biotechnology, Belgium.
⁴ Universitair Ziekenhuis Brussel, Department of Medical Oncology, Belgium.
⁵ Academic Radiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.

Abstract

Purpose: Metastatic melanoma lymph nodes (MMLns) might be challenging to detect on MR-WBI, as both MMLns and normal lymph nodes (NLns) can show restricted water diffusion. Our purpose is to assess the potential contribution of the DIXON sequence in differentiating MMLns from NLns.

Material and methods: We followed a cohort of 107 patients with stage IIIb/c and IV skin melanoma for 32 months using MR-WBI with DIXON, STIR, and DWI/ADC sequences. We compared signal intensity (SI) values of MMLns and NLns in the four series of the DIXON sequence (in/out-of-phase, fat_only, and water_only series). The fat fraction (SI_{fat_only}/SI_in) and the long:short axis ratio of MMLns were calculated. The fat fraction was also calculated in the fatty hila of NLns.

Results: All MMLns (8 from 7 patients) showed SI_out>SI_in with a mean fat fraction of 10%. In 40 normal fatty hila (25 patients), the proportion of SI_out>SI_in was 100% and mean fat fraction was 89% (p<0.001 for fat fraction, Mann-Whitney U-test). In the cortex of NLns, a SI_out>SI_in pattern was identified in 41/113 cases from 19/40 patients. The median long:short axis ratio in MMLns was 1.13 (range 1.03-1.25).

Conclusion: The combination of three features of MMLns (SI_out>SI_in, low-fat fraction and rounded shape) might hold promise in differentiating NLns from MMLns in patients with skin melanoma. Further research is warranted due to the small number of MMLns in our cohort.

Keywords: DIXON sequence; Lymph nodes; Magnetic resonance whole body imaging; Metastatic melanoma.