Related Experiment Videos
Insights
Radiologists can identify vertebral hemangiomas (VH) that may compress the spinal cord by looking for specific features on imaging. Three or more concerning signs suggest a symptomatic VH requiring further investigation.
Area of Science:
- Radiology
- Neurosurgery
- Oncology
Background:
- Vertebral hemangiomas (VH) are common benign vascular tumors.
- Distinguishing asymptomatic from symptomatic VHs is crucial for patient management.
- Spinal cord compression by VHs can lead to neurological deficits.
Purpose of the Study:
- To identify radiographic and computed tomographic (CT) criteria differentiating asymptomatic from spinal cord-compressing vertebral hemangiomas (VH).
Main Methods:
- Retrospective review of radiologic studies (radiography and CT) for 57 solitary VHs.
- Analysis of imaging features associated with spinal cord compression.
- Correlation of imaging findings with clinical presentation.
Main Results:
- Six features were significantly more common in VHs causing cord compression: T3-T9 location, entire vertebral body involvement, neural arch extension, expanded/indistinct cortex, honeycomb pattern, and soft-tissue mass.
- Contrast-enhanced CT and spinal angiography confirmed intraspinal extension.
- Presence of ≥3 features suggested symptomatic VH.
Conclusions:
- Specific imaging findings on radiography and CT can predict VH-related spinal cord compression.
- Patients with suspected symptomatic VH and ≥3 identified features warrant further vascular imaging (angiography) and potential intervention (embolization).
Abstract:
Radiologic studies of 57 solitary vertebral hemangiomas (VHs) were reviewed to find radiographic and computed tomographic (CT) criteria by which to distinguish asymptomatic lesions from those compressing the spinal cord. Six features were seen significantly more often in those compressing the cord: location between T-3 and T-9, involvement of the entire vertebral body, extension to the neural arch, an expanded cortex with indistinct margins, an irregular honeycomb pattern, and soft-tissue mass. Contrast material-enhanced CT scans and selective spinal angiograms demonstrated extension into the spinal canal. In patients with a VH and back pain of uncertain origin, the presence of three or more of these signs may indicate a potentially symptomatic VH. In such patients, spinal angiography and, in some cases, embolization, are indicated.