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MRI diagnosis and preoperative evaluation for pure epidural cavernous hemangiomas
1Department of Diagnostic Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong 510515, China.
Introduction:
The aims of the study were to summarize the characteristics of the spinal epidural cavernous hemangioma, especially for the MRI, and to improve the accurate rate of the preoperative diagnosis.
Methods:
The clinical and medical imaging data of six patients with pure spinal epidural cavernous hemangioma proved by operation and pathology were analyzed retrospectively.
Results:
The level was thoracic (n = 2), thoracolumbar (n = 1), lumbar (n = 1), and sacral (n = 2). The tumor showed lobulated contour, and the areas the tumors appeared were dorsal side of spinal cord (n = 2), ventral side (n = 1), and lateral side (n = 3). In all six patients, the lesions were isointense to the spinal cord on T(1)-weighted images and hyperintense on T(2)-weighted images and showed homogeneously strong enhancement on contrast-enhanced T(1)-weighted images. The characteristic MRI features were named as the "wafting-silk" sign. Widening of the intervertebral neural foramen (n = 4) and erosion of the adjacent bones (n = 3) can be observed.
Conclusions:
MRI of the epidural cavernous hemangioma showed the characteristic lobulated contour, which encircled the spinal cord. T(1)WI on the MRI presented as isointense and T(2)WI presented as hyperintense and a homogeneously strong enhancement, so we first proposed the sign of wafting silk. The widening of the intervertebral neural foramen and erosion of the adjacent bones can easily be observed. MR imaging has an important role in the detection and diagnosis of pure spinal epidural cavernous hemangioma.
Insights
Spinal epidural cavernous hemangiomas exhibit a distinct lobulated contour on MRI, appearing isointense on T1 and hyperintense on T2. This study introduces the "wafting-silk" sign to aid in preoperative diagnosis.
Area of Science:
- Neurosurgery
- Radiology
- Pathology
Background:
- Spinal epidural cavernous hemangiomas are rare vascular malformations.
- Accurate preoperative diagnosis is crucial for effective treatment planning.
Purpose of the Study:
- To characterize spinal epidural cavernous hemangiomas using Magnetic Resonance Imaging (MRI).
- To improve the accuracy of preoperative diagnosis for these lesions.
Main Methods:
- Retrospective analysis of clinical and imaging data from six surgically and pathologically confirmed cases.
- Detailed evaluation of MRI features, including signal intensity and enhancement patterns.
Main Results:
- Lesions showed a lobulated contour, encircling the spinal cord.
- MRI revealed isointensity on T1-weighted images (T1WI) and hyperintensity on T2-weighted images (T2WI).
- Homogeneously strong enhancement was observed post-contrast, leading to the proposed "wafting-silk" sign. Associated findings included neural foramen widening and bone erosion.
Conclusions:
- The "wafting-silk" sign on MRI is a characteristic feature of spinal epidural cavernous hemangioma.
- MRI plays a vital role in the detection and diagnosis of spinal epidural cavernous hemangioma.
- Characteristic MRI findings aid in differentiating these lesions from other spinal tumors.
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