History: 46 yo male with headaches.
Solution: Melanoma metastases
The findings in this case include multiple T1 bright lesions near the grey-white matter interface that have associated edema seen on the T2 weighted images and apparent enhancement on the post-contrast images. Things that are bright on T1 include: fat, subacute hemorrhage, melanin, protein-rich fluid, slowly flowing blood, paramagnetic substances: gadolinium, manganese, copper, rarely calcification, and laminar necrosis of cerebral infarction. If you review these options, you can see that none of them really make sense based upon the imaging and history other than the possibility of melanin containing metastases.
Melanoma is known to metastasize to pretty much anywhere, including bowel, gallbladder, pancreas, subcutaneous tissues, lung, and brain. Metastases are not infrequently identified prior to the primary lesion because it can metastasize relatively early in and once metastatic, the prognosis is dismal with no truly effective therapies at this time. These patients are generally referred to a clinical trial.
The findings in this case include multiple T1 bright lesions near the grey-white matter interface that have associated edema seen on the T2 weighted images and apparent enhancement on the post-contrast images. Things that are bright on T1 include: fat, subacute hemorrhage, melanin, protein-rich fluid, slowly flowing blood, paramagnetic substances: gadolinium, manganese, copper, rarely calcification, and laminar necrosis of cerebral infarction. If you review these options, you can see that none of them really make sense based upon the imaging and history other than the possibility of melanin containing metastases.
Melanoma is known to metastasize to pretty much anywhere, including bowel, gallbladder, pancreas, subcutaneous tissues, lung, and brain. Metastases are not infrequently identified prior to the primary lesion because it can metastasize relatively early in and once metastatic, the prognosis is dismal with no truly effective therapies at this time. These patients are generally referred to a clinical trial.
MR Images
