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Hemangioma
Neoplasms, Cysts, and Other Masses
Hemangioma KEY FACTS
TERMINOLOGY • Common benign venous malformation within vertebrae • Usually intraosseous, may have epidural component • Typically incidental lesion identified on imaging performed for unrelated reasons
IMAGING • CT: Well-circumscribed, hypodense lesion with coarse vertical trabeculae (white polka dot appearance on axial CT) • MR: Circumscribed lesion, hyperintense on both T1 and T2WI with hypointense vertical striations ○ Atypical hemangiomas may have reduced T1 signal due to paucity of fat • Often multiple (20-30%)
PATHOLOGY • 11% of adult population • Complications in < 1% ○ Pathologic compression fracture
(Left) Sagittal graphic of the thoracolumbar junction shows the typical striated pattern of a hemangioma with thickened bony trabeculae. There is neither extraosseous extension nor thecal sac compromise. (Right) Lateral radiograph shows vertical striations within the L1 vertebral body , the socalled "corduroy vertebra," due to vertebral hemangioma.
(Left) Axial CECT shows fatty attenuation within the lower thoracic vertebral body with multiple punctate thickened trabeculae. (Right) Sagittal T1 C+ MR shows prominent vertical striations within the vertebral body consistent with a hemangioma ſt. There is extraosseous extension of the tumor into the ventral epidural space .
268
○ Epidural hemangioma component with cord compression • Histology ○ Thin-walled sinusoidal channels lined by vascular endothelium ○ Interspersed bony trabeculae with fat • Majority confined to vertebral body proper ○ Uncommon in posterior elements/pedicles (10-15%)
CLINICAL ISSUES • Bone CT may supplement MR evaluation in atypical hemangioma to look for typical osseous findings • No follow-up typically necessary with pathognomonic imaging with small lesions and no extraosseous extension • Aggressive hemangiomas ○ Vertebroplasty in conjunction with embolization may be considered if concern for pathologic fracture ○ Surgical resection (corpectomy) or radiation therapy
Hemangioma KEY FACTS
TERMINOLOGY • Common benign venous malformation within vertebrae • Usually intraosseous, may have epidural component • Typically incidental lesion identified on imaging performed for unrelated reasons
IMAGING • CT: Well-circumscribed, hypodense lesion with coarse vertical trabeculae (white polka dot appearance on axial CT) • MR: Circumscribed lesion, hyperintense on both T1 and T2WI with hypointense vertical striations ○ Atypical hemangiomas may have reduced T1 signal due to paucity of fat • Often multiple (20-30%)
PATHOLOGY • 11% of adult population • Complications in < 1% ○ Pathologic compression fracture
(Left) Sagittal graphic of the thoracolumbar junction shows the typical striated pattern of a hemangioma with thickened bony trabeculae. There is neither extraosseous extension nor thecal sac compromise. (Right) Lateral radiograph shows vertical striations within the L1 vertebral body , the socalled "corduroy vertebra," due to vertebral hemangioma.
(Left) Axial CECT shows fatty attenuation within the lower thoracic vertebral body with multiple punctate thickened trabeculae. (Right) Sagittal T1 C+ MR shows prominent vertical striations within the vertebral body consistent with a hemangioma ſt. There is extraosseous extension of the tumor into the ventral epidural space .
268
○ Epidural hemangioma component with cord compression • Histology ○ Thin-walled sinusoidal channels lined by vascular endothelium ○ Interspersed bony trabeculae with fat • Majority confined to vertebral body proper ○ Uncommon in posterior elements/pedicles (10-15%)
CLINICAL ISSUES • Bone CT may supplement MR evaluation in atypical hemangioma to look for typical osseous findings • No follow-up typically necessary with pathognomonic imaging with small lesions and no extraosseous extension • Aggressive hemangiomas ○ Vertebroplasty in conjunction with embolization may be considered if concern for pathologic fracture ○ Surgical resection (corpectomy) or radiation therapy