Korean J Radiol.  2013 Apr;14(2):287-293. 10.3348/kjr.2013.14.2.287.

Accuracy of Preoperative MRI with Microscopy Coil in Evaluation of Primary Tumor Thickness of Malignant Melanoma of the Skin with Histopathologic Correlation

• Kang Y
• Choi JA
• Chung JH
• Hong SH
• Kang HS

• KMID: 1482789
• DOI: http://doi.org/10.3348/kjr.2013.14.2.287

Abstract

OBJECTIVE
The purpose of this study was to evaluate the accuracy of a preoperative MRI with microscopy coils in determining the primary tumor thickness of malignant melanoma with histopathologic correlation.
MATERIALS AND METHODS
Eleven patients with histopathologically confirmed malignant melanoma were included in this study. MR images of the tumors were obtained with a 47-mm microscopy coil on 1.5T MR scanners and were evaluated by two radiologists, who assessed the thickness of the primary tumor on T2-weighted images (T2WI) and gadolinium-enhanced T1-weighted images with fat suppression (Gd-T1WI) and compared the results with the histopathologic findings as the reference standard. Correlations between tumor thickness on MRI and histopathologic examination were assessed using concordance correlation coefficients (CCCs). Inter- and intraobserver variabilities of tumor measurements were also assessed by intraclass correlation coefficient (ICC).
RESULTS
Among the 11 cases included in the study, 10 cases from the same number of patients were managed with surgical excision and one case was confirmed with punch biopsy. The primary tumor thickness measured on T2WI showed better correlation with histopathologic results, as compared with measurements taken on Gd-T1WI: the CCC of measurements on T2WI ranged from 0.64 to 0.78, indicating a substantial agreement, whereas the CCC of measurements on Gd-T1WI ranged from 0.50 to 0.61, indicating a moderate to substantial agreement. Inter- and intraobserver agreements of readers 1 and 2 were excellent for both T2WI and Gd-T1WI, with ICC ranging from 0.86 to 0.99.
CONCLUSION
MR imaging with microscopy coils may be an accurate technique in the preoperative assessment of tumor thickness in malignant melanoma, especially on T2-weighted images.

Keyword

Magnetic resonance; Magnetic resonance, high resolution; Magnetic resonance, surface coils; Melanoma; Skin, MR; Soft tissues, neoplasms

MeSH Terms

Aged
Aged, 80 and over
Biopsy
Contrast Media/diagnostic use
Female
Gadolinium DTPA/diagnostic use
Humans
Magnetic Resonance Imaging/*instrumentation
Male
Melanoma/*pathology
Middle Aged
Reproducibility of Results
Retrospective Studies
Skin Neoplasms/*pathology
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Tumor thickness measurement on MR images. Maximum vertical tumor thickness was measured by drawing (B) line perpendicular to (A) horizontal line connecting two tumor-skin interfaces.

• 

  Fig. 2 Scatterplots of tumor thickness measurements made on basis of MR images versus pathologic measurements. Tumor thickness measured on contrast enhanced T1-weighted images (CE T1WI) by (A) reader 1 and (C) reader 2, and T2-weighted images (T2WI) by (B) reader 1 and (D) reader 2. Note 45° line, corresponding to CCC value of 1. CCC = concordance correlation coefficient

• 

  Fig. 3 Melanoma on sole in 60-year-old woman. A. Sagittal T2-weighted image obtained with microscopy coil (TR/TE, 3500/100, in-plane resolution, 0.23 × 0.23 mm) shows T2-hyperintense lesion (arrow), with thickness of 0.45 cm. Scale bar respresents 1 cm. B. Photomicrograph (H-E stain) at low power shows abundant melanin pigment in dermal layer along with proliferation of atypical melanocyte (arrowheads). TR = repetition time, TE = echo time

• 

  Fig. 4 Malignant melanoma located on toe of 62-year-old man. Scale bar represents 1 cm (A, B). A. Axial T2-weighted MR image obtained with microscopy coil (TR/TE, 4116/100, in-plane resolution, 0.35 × 0.35 mm) shows superficial mass (arrow) limited to dermis with and tumor thickness of 4.0 mm. B. Axial contrast-enhanced fat suppressed T1-weighted MR image obtained with microscopy coil (TR/TE 587/9) shows thicker region of enhancement (arrow), resulting in overestimation of tumor thickness. C. Photomicrograph (H-E stain) at low power shows proliferation of uniformly atypical melanocytes with tumor thickness of 4.0 mm (arrowheads). TR = repetition time, TE = echo time

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