Advanced magnetic resonance imaging in the diagnosis of primary intracranial malignant melanoma

MR perfusion (using T2 dynamic susceptibility contrast-enhanced perfusion technique) revealed that relative cerebral blood volume of the tumor was 2.4 times that of the normal brain parenchyma [Figure 1]d. Heterogeneous enhancement was seen following contrast administration [Figure 1]e and [Figure 1]f. Initial MR spectroscopy (MRS) of the tumor was interpreted as increased choline (Cho) and reduced N-acety aspartate (NAA) with Cho/NAA ratio of 1.13 with a large lipid lactate peak (1.32ppm). According to Hayward's criteria, a solitary lesion in the leptomeninges, the pineal gland, or the intramedullary region is more likely to be a primary CNS melanoma, provided that there is no melanoma elsewhere in the body. Primary malignant melanoma is a rare aggressive dural-based tumor commonly occurring in the cerebellopontine angle, pineal gland, cerebrum, and spine.