Vertebral hemangiomas: radiologic evaluation.

TLDR

Spinal angiography and, in some cases, embolization are indicated for patients with vertebral hemangiomas. The study reviewed radiologic data from 57 solitary vertebral hemangiomas to identify CT criteria that distinguish asymptomatic lesions from those compressing the spinal cord. Contrast‑enhanced CT scans and selective spinal angiograms were employed to demonstrate extension into the spinal canal. Six imaging features—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 a soft‑tissue mass—were significantly more common in cord‑compressing lesions, and the presence of three or more of these signs may indicate a potentially symptomatic vertebral hemangioma.

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.