ArticleLa Radiologia medica2026
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.
Article in La Radiologia medica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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.
methodsIn 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.
resultsA 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).
conclusionIn 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.
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