Hemorrhagic cerebral metastases from malignant melanoma

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Known melanoma. Metastases?

Patient Data

Age: 65 years
Gender: Female
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Right temporal and left frontal hyperdense metastatic deposits measuring 1.2 cm and 2.2 cm with perilesional edema. No significant mass effect.

This study is a stack
Sagittal
T1
This study is a stack
Axial
T2
This study is a stack
Axial
FLAIR
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Axial
SWI
This study is a stack
Coronal
T1 C+
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
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Info

Widespread supra and infratentorial metastases, the largest 3.5 cm in the left parietal lobe with internal hemorrhage and layering of blood products. Additional right temporal lobe hemorrhagic metastasis as evidenced by severe susceptibility artifact.

The smaller metastases are high signal on T1.

Moderate perilesional edema in relation to the larger metastases, but no significant mass effect.

Case Discussion

The MRI appearances of high T1 lesions are typical of metastatic melanoma due to the inherent high signal of melanin.

The high attenuation lesions on CT with corresponding intense susceptibility artifact on MRI indicate these are both in addition hemorrhagic metastases.

The appearances are typical of metastatic malignant melanoma consistent with the patient's medical history.

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