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MR spectroscopy in differentiating spinal atypical hemangioma from metastasis: preliminary results

Anousheh Sayah¹, Ayat Sharif², Clark Restrepo¹

¹Department of Neuroradiology, Georgetown University Medical Center, Washington D.C, USA.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|February 9, 2026

Abstract

Objective:

To evaluate the accuracy of magnetic resonance (MR) spectroscopy in differentiating vertebral hemangiomas from spinal metastases.

Background:

MR spectroscopy (MRS) quantifies lesion composition, particularly lipid and water content. This study investigates the use of MRS-derived lipid-to-water ratios (LWRs) to distinguish typical and atypical vertebral hemangiomas (VHs) from spinal metastases.

Methods:

In this IRB-approved, HIPAA-compliant prospective study, 77 vertebral regions of interest were evaluated via MRS. Lesions included typical VHs, atypical VHs, metastases, and normal bone marrow. Lipid and water spectral peaks were analyzed to calculate LWRs. ANOVA with Bonferroni correction assessed statistical significance across lesion types.

Results:

Mean (SD) LWRs were control 0.98 (0.59), typical VH 3.37 (2.31), atypical VH 1.34 (1.77), and metastases 1.22 (1.58). ANOVA confirmed a significant effect of lesion type on LWR (p < .001). Pairwise comparisons showed significant differences between typical VH and all other groups, while atypical VH and metastases were not significantly different.

Conclusion:

MRS effectively differentiates typical VH from metastases and atypical VH based on LWR. The modality shows promise as a non-invasive tool in lesion characterization.

Keywords:

MR spectroscopy MRI spine Spinal metastasis Vertebral hemangioma

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