PET/CT and MRI of intra-osseous haemangioma of the tibia

Abstract

ABSTRACT. Intra-osseous haemangioma is a rare, benign neoplasm that usually involves the vertebrae and craniofacial bones. Furthermore, its occurrence in the long bones is extremely rare. We report the findings of fluorine-18-fludeoxyglucose ( F-FDG PET/CT showed a well-marginated osteolytic lesion with abnormal FDG uptake. The mass demonstrated low signal intensity on T 1 weighted MRI. On T 2 weighted images, the lesion appeared as a cluster of high signal intensity lobules and showed strong enhancement on contrast-enhanced T 1 weighted images. Surgical curettage was performed and histopathological examination of the excised tissue confirmed a cavernous haemangioma.

Cavernous Hemangioma of the Ilium Mimicking Aggressive Malignant Bone Tumor with Increased Activity on18F-FDG PET/CT

“…Sakurai et al (14), and Higashiyama et al (15) had described that 18 F-FDG PET may provide useful information to differentiate hemangioma from malignant soft tissue tumors owing to the tendency of low 18 F-FDG uptake in soft tissue hemangiomas. However, contrary to soft tissue and vertebral hemangiomas, osseous hemangiomas in the peripheral and flat bones can show high 18 F-FDG uptake on PET/CT as in our case and the case from Cha et al (7). To our knowledge, there was no radiologic report describing osseous hemangiomas of the ilium which demonstrated an increased 18 F-FDG uptake on PET/CT.…”

“…On MR, osseous hemangiomas usually show a variety of signals from low to very high signal intensities on T1- and T2-weighted images within the lesion according to the internal components such as dilated vessels, hemorrhage, blood clots, fibrosis, bony trabeculations, fat, and smooth muscles (1-7). Osseous hemangiomas can show variable degrees of enhancement related to internal contents, as we mentioned above, after contrast administration.…”

“…Hatayama et al (12) have described the SUVs for 18 F-FDG in 16 hemangiomas as ranging from 0.73 to 1.67, and Tian et al (13) have described the SUVs for 18 F-FDG in 4 hemangiomas as ranging from 1.6 to 2.3. However, Cha et al (7) recently reported the case of an intra-osseous hemangioma of the tibia which showed increased 18 F-FDG uptake (SUV = 3.9) on PET/CT. Similar to the case reported from Cha et al (7), our case of the osseous hemangioma of the ilium showed heterogeneously increased 18 F-FDG uptake (SUV max = 5.1) on PET/CT.…”

“…However, Cha et al (7) recently reported the case of an intra-osseous hemangioma of the tibia which showed increased 18 F-FDG uptake (SUV = 3.9) on PET/CT. Similar to the case reported from Cha et al (7), our case of the osseous hemangioma of the ilium showed heterogeneously increased 18 F-FDG uptake (SUV max = 5.1) on PET/CT. Sakurai et al (14), and Higashiyama et al (15) had described that 18 F-FDG PET may provide useful information to differentiate hemangioma from malignant soft tissue tumors owing to the tendency of low 18 F-FDG uptake in soft tissue hemangiomas.…”

“…Osseous hemangiomas may have a wide variety of radiologic appearances, and the lesions occurred in the tubular or flat bones can be demonstrated as aggressive tumors showing cortical destruction with extraosseous mass formation and osteolytic lesions mimicking a malignant bone tumor (1-6). On 2-fluoro [fluorine-18]-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography (PET), hemangioma has been classified as a metabolically stable tumor with low 18 F-FDG uptake, but a recently reported case of hemangioma of the tibia showed high 18 F-FDG uptake on PET/CT (7). …”