A minimally invasive vertebral hemangioma

Abstract

Vertebral hemangioma is a common skeletal angiomatous benign tumor. The one we describe shows an extraordinarily spiculated calcified intra-canalar extension. This gives a "sunburst" appearance to the lesion usually encountered in skull hemangiomas. The aim of this report is to highlight a poorly known sign which, despite its partial aggressive look, should not hinder the assessment of a typical benign hemangioma by the radiologist. Case reportA 51-year-old patient complaining of chronic neck pain was referred for a cervical spine MRI. Cervical findings were unspecific, but a wide lesion was found at the T5 level, extending from the vertebral body to both pedicles, with a posterior small epidural component that contains some calcifications.On sagittal T2 weighted images ( Fig. 1, 2), the bone marrow of the T5 body was hyperintense compared to the other vertebrae and was not collapsed. The lesion extended posteriorly in the ventral epidural space. The adjacent disks appeared normal.Whereas the vertebral body on T2 weighted images was homogenously hyperintense, it showed a dual appearance on T1 weighted images ( Fig. 3): isthmi and the anterior half body were hyperintense, relating a quiescent fatty marrow, while the posterior vertebral body was hypointense, due to a greater vascular soft tissue component and maybe some inflammatory process.Contrast enhancement (Fig. 4) was mainly seen in the posterior part of the lesion, but also in the compoat the posterior aspect of the lesion in the anterior epidural space (Fig. 5A,B). This appearance, often described for skull hemangioma, is quite rare in the vertebral ones. DiscussionThe vertebral hemangioma is a well known benign tumor found in 11% among a wide series of autopsy (1, 2). It is also acknowledged that the lesions of the spine are mostly located at the thoracic level (2).These hemangiomas are asymptomatic, excepted for 1% of them which are invasive. Less than five percent of asymptomatic hemangioma become neurologically relevant (3). The sex ratio is 3:2 favouring female (4). nents located in the anterior epi dural space and in the paravertebral lateral soft tissue. The enhancement also accentuated the mineral structure of the vertebral body presenting a diffuse coarse pattern, with fewer but thicker hypointense trabeculae.Computed tomography confirmed the thickened pathognomonic bone trabeculations throughout the hemangioma (Fig. 5A), but also showed speculated calcifications JBR-BTR, 2010, 93: 1-3. A MINIMALLY INVASIVE VERTEBRAL HEMANGIOMA S. Van den Broeck, P. Mailleux, J.P. JorisWe describe a very unusual vertebral hemangioma presenting with a mixture of aggressive-like pattern (epidural extension , T1 hyposignal) and quiescent, inactive lesion (fatty infiltration), in association with a spiculated calcified epidural component. This paper emphasizes that CT and/or MR findings are accurate enough to make formal assessment of vertebral hemangioma, preventing patient's anguish and moreover unnecessary treatment. Furthermore this attractive case proposes a p...