Vertebral hemangioma is a benign vascular tumor, usually affecting the vertebral body.
The typical benign (ones with fatty stroma) shows T1 and T2 hyperintense signal in MRI. In CT these show the pathognomonic 'Polka dot' appearance and 'corduroy' / 'jail house stripe' appearance in axial and coronal/sagittal sections.
The aggressive ('malignant') hemangiomas are T1 isointense to hypointense and T2 hyperintense with intense post-contrast enhancement. Pathologic fractures and epidural extension are common with aggressive hemangiomas. Cord compression can occur in the presence of epidural extension.
Aggressive Hemangioma features :
Location common in D3 to D9 vertebrae, with extension into posterior elements, expansion, indistinct cortex, irregular honeycomb pattern and associated soft tissue mass.Differential considerations in Aggressive Hemangioma include :
1. Metastases : Can be difficult, Correlative CT sections will be helpful.2. Paget's Disease : Can also present with vertebral body expansion, but will not have soft tissue component.
T2 WI Sagittal image showing hyperintense lesion of L3 vertebra, with vertebral body expansion and soft tissue component. Marked spinal canal stenosis with cauda equina compression seen.
Unlike simple hemangioma with predominantly fatty stroma, which gets suppressed in STIR images, aggressive hemangiomas consists of more vascular tissue and usually remains hyperintense in STIR.
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T1 WI Sagittal and Axial Images, showing heterogeneous reduced signal intensity.
Intense enhancement in the post contrast images.
(1)Post contrast T1 FS Axial image. (2&3) correlative CT sections
showing the irregular honeycomb appearance and indistinct cortex.
References :
1. Diagnostic Imaging - Spine (Jeffrey.R.Ross), Ist Edition, 2004.
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