Objective: Preliminary reports based on limited numbers of cases have proposed that specific MR imaging patterns may permit a distinction between melanotic and amelanotic brain metastases in melanoma patients. The purpose of this study was to test this hypothesis by categorizing MR images obtained from a large series of patients and correlating the results with the percentage of melanin-containing cells in surgically resected metastases.
Subjects and methods: The MR images of 30 patients with histologically proven intracerebral melanoma were reviewed retrospectively. Precontrast MR images were obtained with T1-weighted spin-echo sequences in axial and sagittal sections and with proton density-weighted and T2-weighted sequences in axial sections. After IV injection of gadopentetate dimeglumine (0.1 mmol/kg of body weight), T1-weighted images were obtained in axial and coronal sections. All patients had undergone gross total resection of the evaluated lesions. MR images of the metastases were reviewed and sorted into four groups on the basis of putative patterns: (1) melanotic pattern--hyperintense in relation to cortex on T1-weighted images, hypointense in relation to cortex on T2-weighted images, and isointense or hyperintense in relation to cortex on proton density-weighted images; (2) amelanotic pattern--hypointense or isointense in relation to cortex on T1-weighted images and hyperintense or isointense in relation to cortex on T2-weighted and proton density-weighted images; (3) indeterminate, or mixed, pattern--MR imaging characteristics that did not conform to those of one of the first two categories; and (4) hematoma pattern--MR imaging features that exhibited only hematoma characteristics. Tissue sections from all evaluated lesions were independently reviewed by a neuropathologist (G.N.F.), and the percentage of melanin-containing tumor cells in each resected metastatic lesion was estimated. The MR imaging data and histologic data were then compared to assess the predictive value of the MR imaging patterns.
Results: Forty-two metastatic lesions were identified and categorized by MR imaging pattern as follows: 10 melanotic, 11 indeterminate (mixed), 16 amelanotic, and five hematoma. Correlation with histologic findings revealed that a majority (7/10) of lesions that exhibited a melanotic MR imaging pattern had more than 10% melanin-containing cells, over half (9/16) of lesions that exhibited an amelanotic MR imaging pattern contained histologically identifiable melanin (but always in less than 10% of cells), and lesions that exhibited a mixed MR imaging pattern were either amelanotic or contained less than 10% melanotic cells. Conversely, a majority of lesions containing more than 10% melanotic cells (7/8) demonstrated the typical melanotic MR imaging pattern, lesions with less than 10% melanin-containing cells exhibited a variety of MR imaging patterns, and only about half of patients with amelanotic lesions (6/13) showed the characteristic amelanotic MR imaging pattern. For five lesions, potentially informative imaging data on melanin content was obscured by histologically documented hematoma formation.
Conclusion: Only a minority of melanoma metastases have the anticipated MR imaging findings of melanotic melanoma, which consist of high signal intensity relative to that of cortex on T1-weighted images and low signal intensity relative to that of cortex on T2-weighted images. Of tumors that do exhibit this melanotic pattern, the majority have more than 10% melanin-containing cells. The putative MR imaging pattern for amelanotic melanoma is nonspecific, as over half of tumors with this pattern contain melanin.