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A systematic approach to vertebral hemangioma.

Simona Gaudino1, Matia Martucci, Raffaella Colantonio

  • 1Department of Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168, Rome, Italy, simona.gaudino@gmail.com.

Skeletal Radiology
|October 29, 2014
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Summary

Vertebral hemangiomas (VHs) are common spinal lesions. This review guides differentiating typical, atypical, and aggressive VHs using imaging like CT and MR, crucial for diagnosis and treatment.

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Area of Science:

  • Radiology
  • Spinal Imaging
  • Oncology

Background:

  • Vertebral hemangiomas (VHs) are frequent incidental findings on spinal CT and MR imaging.
  • Typical VHs have characteristic imaging features, allowing straightforward diagnosis.
  • Atypical and aggressive VHs pose diagnostic challenges, mimicking malignancies.

Purpose of the Study:

  • To review the clinical, pathological, and imaging features of vertebral hemangiomas.
  • To provide a practical guide for differential diagnosis of VHs.
  • To outline treatment options for VHs.

Main Methods:

  • Review of radiography, computed tomography (CT), and magnetic resonance (MR) imaging findings.
  • Analysis of histological features influencing imaging appearance.
  • Integration of angiography in evaluating aggressive VHs.

Main Results:

  • Typical VHs show coarsened vertical trabeculae and T1/T2 hyperintensity.
  • Atypical VHs present varied MR appearances due to histological composition.
  • Aggressive VHs can invade surrounding spaces, mimicking malignancy, requiring CT and MR.

Conclusions:

  • Accurate differentiation of VH subtypes is essential for appropriate management.
  • CT is key for identifying the 'polka-dot' appearance of atypical VHs.
  • Multimodality imaging (CT, MR, angiography) aids in diagnosing and managing aggressive VHs.