Dynamic contrast-enhanced MRI coupled with a subtraction technique is useful for treatment response evaluation of malignant melanoma hepatic metastasis

Abstract

PurposeTo determine whether contrast-enhanced MRI including subtraction sequences can predict the treatment response of melanoma liver metastasis.ResultsHigh precontrast T1 signal intensity (SI) of melanoma lesions obscured detection of enhancement after contrast injection. It was impossible to determine whether or not enhancement occurred in the majority of lesions (85.4%, n = 35/41) without including the subtraction technique. Positive enhancement was identified in 14.6% (n = 6/41) of patients without subtraction images, but increased to 68.3% (n = 28/41) by including subtraction images. Follow-up studies determined lesion progression in 34.1% (n = 14/41) of patients. Positive enhancement on the subtraction image (odds ratio = 12.1, P = 0.048) and intermediate high T2 SI (odds ratio = 8.16, P = 0.040) were significantly associated with higher risk of lesion progression.Materials and MethodsPatients who underwent MRI for melanoma liver metastases between January 2007 and February 2015 were enrolled. The study analyzed 41 liver metastases in 15 patients [11 male and four female; median age 56 years (range 21–81)] for size, lesion enhancement with and without subtraction images, and T2 SI. Follow-up imaging studies were used to determine treatment response. Data were analyzed with generalized estimating equations.ConclusionsMRI including the subtraction technique is useful for determining the treatment response of melanoma liver metastases. Lesion contrast enhancement and intermediate high T2 SI increased the risk of lesion progression.

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“…Modern MRI techniques, including dynamic contrast-enhanced MRI, are also available for high resolution imaging of tumor perfusion or cell-membrane permeability ( 177 ). This technique could be particularly useful for assessment of specific metastatic sites, e.g., hepatic metastasis ( 178 ). Another potential application could be MRI-based immune-cell tracking and assessment of drug delivery ( 179 ).…”

Multimodal therapy with surgery and adjuvant nivolumab for late-onset multiple liver metastases of choroidal malignant melanoma: a case report

“…It can provide information not only about the vascularization of the lesions in different phases of contrast circulation but also the functional parameters in the delayed hepatobiliary phase. However, it is difficult to value the vascularity because of high-signal intensity in pre-contrast T1-weighted imaging [21]. In this regard, subtraction technique should be used to evaluate enhancement.…”

Iterative treatment with surgery and radiofrequency ablation of uveal melanoma liver metastasis: Retrospective analysis of a series of very long-term survivors

“…The efficacy of RFA was evaluated by MRI two months after the procedure. Image subtraction at all dynamic acquisition phases (T1 with injection minus T1 without injection) were used to sensitize the detection of residual contrast enhancement [22]. The treatment was considered complete when no residual contrast enhancement was present in an ablation zone with a diameter larger than the initial lesion size.…”