Diagnosis of Metastatic Melanoma to the Heart With an Intrinsic Contrast Approach Using Melanin Inversion Recovery Imaging

Melanoma not infrequently metastasizes to the heart where it either remains occult or produces a very variable clinical picture. Recognition of metastatic lesions can be difficult on echocardiography because they are frequently intramural rather than intracavity. Magnetic resonance imaging with gadolinium contrast enhancement has previously been reported as the optimum method for identification of cardiac melanoma. This article presents an alternative approach that exploits the intrinsic paramagnetic properties of melanin to provide inherent contrast without the need for intravenous gadolinium injection. This approach is reported here in 3 patients with cardiac melanoma, and its accuracy is compared with a traditional gadolinium-enhanced method. We demonstrated that there were no significant differences among number, location, and volume of detected lesions using an inversion recovery sequence with or without intravenous gadolinium contrast.