La Radiologia medica · 2026
Influence of metastases composition on the conspicuity of melanoma brain metastases: a comparative study of post-contrast 3D T1WI GRE versus 3D T1WI TSE black blood.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Chen Zhou Zhao Hui, Salvador Álvarez Elena, Hilario Amaya, Cárdenas Agustín, Romero Juan, Lechuga Carmen, Martínez de Aragón Ana, Ramos Ana
Аннотация
PURPOSE: To compare the conspicuity of melanoma brain metastases on post-contrast 3D T1 gradient-recalled echo (GRE) and 3D T1 turbo spin-echo (TSE) black blood sequences, according to metastases composition.
METHODS: In this prospective single-center study, consecutive adult melanoma patients underwent contrast-enhanced brain MRI at 1.5 T, including standardized post-contrast 3D T1 GRE and 3D T1 TSE black blood sequences. Metastases were categorized as melanotic, non-melanotic, or hemorrhagic based on pre-contrast T1WI and susceptibility-weighted imaging (SWI). Two blinded neuroradiologists independently rated lesion conspicuity using a 5-point comparative visual scale. Interobserver agreement was assessed using the quadratically weighted Cohen's kappa coefficient. For lesions ≥ 5 mm visible on both sequences, contrast-to-noise ratio (CNR) was measured and compared using paired non-parametric tests.
RESULTS: A total of 261 brain metastases in 27 patients were analyzed (melanotic n = 121, non-melanotic n = 114, and hemorrhagic n = 26). Melanotic metastases were more conspicuous on post-contrast 3D T1 GRE, with 70.3% rated as GRE-dominant (visual scores 4-5). Conversely, non-melanotic and hemorrhagic metastases were more conspicuous on black blood imaging, with 60.6 and 61.5%, respectively, rated as black blood dominant (visual scores 1-2). CNR analysis confirmed these findings, showing higher CNR for melanotic metastases on GRE (median: 15.46 vs. 7.24; p < 0.001) and higher CNR for non-melanotic and hemorrhagic metastases on black blood imaging (p<0.01). Interobserver agreement was substantial (κ = 0.67).
CONCLUSION: In melanoma, the conspicuity of brain metastases on post-contrast 3D T1 was composition-dependent: Melanotic metastases were more conspicuous on GRE, whereas non-melanotic and hemorrhagic metastases were more conspicuous on black blood. These complementary patterns suggest that 3D T1 TSE black blood may be insufficient as a standalone sequence in melanoma. Whether combining both sequences improves lesion detection, staging accuracy, or clinical decision-making requires validation in dedicated diagnostic accuracy studies.
METHODS: In this prospective single-center study, consecutive adult melanoma patients underwent contrast-enhanced brain MRI at 1.5 T, including standardized post-contrast 3D T1 GRE and 3D T1 TSE black blood sequences. Metastases were categorized as melanotic, non-melanotic, or hemorrhagic based on pre-contrast T1WI and susceptibility-weighted imaging (SWI). Two blinded neuroradiologists independently rated lesion conspicuity using a 5-point comparative visual scale. Interobserver agreement was assessed using the quadratically weighted Cohen's kappa coefficient. For lesions ≥ 5 mm visible on both sequences, contrast-to-noise ratio (CNR) was measured and compared using paired non-parametric tests.
RESULTS: A total of 261 brain metastases in 27 patients were analyzed (melanotic n = 121, non-melanotic n = 114, and hemorrhagic n = 26). Melanotic metastases were more conspicuous on post-contrast 3D T1 GRE, with 70.3% rated as GRE-dominant (visual scores 4-5). Conversely, non-melanotic and hemorrhagic metastases were more conspicuous on black blood imaging, with 60.6 and 61.5%, respectively, rated as black blood dominant (visual scores 1-2). CNR analysis confirmed these findings, showing higher CNR for melanotic metastases on GRE (median: 15.46 vs. 7.24; p < 0.001) and higher CNR for non-melanotic and hemorrhagic metastases on black blood imaging (p<0.01). Interobserver agreement was substantial (κ = 0.67).
CONCLUSION: In melanoma, the conspicuity of brain metastases on post-contrast 3D T1 was composition-dependent: Melanotic metastases were more conspicuous on GRE, whereas non-melanotic and hemorrhagic metastases were more conspicuous on black blood. These complementary patterns suggest that 3D T1 TSE black blood may be insufficient as a standalone sequence in melanoma. Whether combining both sequences improves lesion detection, staging accuracy, or clinical decision-making requires validation in dedicated diagnostic accuracy studies.