Vertebral hemangiomas: fat content as a sign of aggressiveness.

Abstract

Thirty-two vertebral hemangiomas (VHs) were evaluated with nonenhanced computed tomography (CT), T1-weighted magnetic resonance (MR) imaging, CT enhanced with contrast material, and selective spinal arteriography. The stroma between the osseous trabeculae was found to correspond to either fatty tissue or soft tissue or both. All 11 asymptomatic VHs showed complete fatty stroma at CT and increased signal intensity at MR imaging. In contrast, all four compressive VHs had soft-tissue attenuation at CT. Three compressive VHs showed low signal intensity on MR images. Predominantly fatty stroma at CT and increased signal intensity at MR imaging were associated with normal or only slightly increased vascularization at selective spinal arteriography or contrast-enhanced CT, while soft-tissue stroma at CT and low signal intensity at MR imaging were associated with distinct hypervascularization. The authors' experience suggests that fatty VHs may represent inactive forms of VH, while soft-tissue content at CT and low signal intensity at MR imaging may indicate a more active vascular lesion with potential to compress the spinal cord. CT and MR imaging may be especially valuable for evaluating patients with clinical signs or symptoms of uncertain origin and findings compatible with VH at plain radiography.

Symptomatic T2 Vertebral Hemangioma in a Pregnant Woman Treated by One Stage Combination Surgery; Posterior Stabilization and Anterior Subtotal Tumor Resection -Case Report-

“…Since vertebral hemangiomas are generally well vascularized, 1,2,5,6,8) embolization is required for safe operation. In the present case, angiography demonstrated significant tumor staining fed by various upper thoracic vessels, so preoperative embolization was performed.…”

Pre and Post Radiotherapy Imaging findings of Aggressive Vertebral Haemangioma of the Thoracic Spine

“…Aggressive hemangiomas characteristically have reduced fat content and more vascular component causing hypointensity on T1-weighted MRI [9,10]. Mixed signal on T1 Wtd images compared to hypointense signal and presence of coarse trabeculae help to differentiate between vertebral metastasis and aggressive haemangioma [8].…”

Pain pattern in multiple vertebral hemangiomas involving non-adjacent levels: report of two cases

“…CT is the procedure of choice for patients with symptomatic hemangiomas, as it determines the extent of the lesion and the site of compression, if present, and it reveals lesions in other vertebrae that an X-ray may have failed to demonstrate [26,32,38]. Magnetic resonance imaging (MRI) is useful, especially in differentiating a hemangioma from other tumors; it is valuable in pre-operative planning and it can provide additional information regarding the aggressiveness of the lesion [14,27]. Spinal angiography is a useful diagnostic tool, especially in pre-operative planning, since it can demonstrate both the vascularity of the lesion and the origin of the feeding vessels [1,11,17,30].…”