Cool Imaging Pathology, Imaging, MRI Pathology

Hemangioma in the Spine

By Chris Faubel, M.D. —

There are two very important things to know about benign hemangiomas in the spine

1.  Distinguishing from cancer metastasis to the spine

2.  Knowing the sequelae of a benign hemangioma in the spine

Distinguishing from Spinal Metastasis

When you look at a patient’s MRI and spot lesions that have an increased signal intensity on T2-weighted images (the most commonly viewed sequences by interventional pain physicians), you may get worried that these could be cancerous, especially if your patient also has a history of prostate / breast / lung / renal / GI cancer.

Before you get too worried, look at the same slices on the T1-weighted images.  Both osteoblastic and osteolytic metastatic lesions are typically hypo-intense on both T1 and T2.  For more detail, check out this site:  http://radiopaedia.org/articles/vertebral-metastases

On the other hand, spinal hemangioma “light up” (hyper-intense) on both T1 and T2.

Hemangioma in the spine are WHITE on both T1 & T2

Sequelae of Benign Hemangioma

Pathologic Fracture:  If these vertebral hemangioma get large enough and weaken the vertebral body integrity enough, a pathologic compression fracture can occur.  So if a patient has a known large vertebral hemangioma at L1 and develops pain in that area months or years later, suspect a compression fracture and re-image them with an MRI with STIR sequences.

Patient and Location Characteristics

Benign (and usually asymptomatic) lesions located mostly in the lower thoracic or upper lumbar spine.  Females > males.  Peak incidence in 40’s.

Check out this article from LearningRadiology.com for more information on spinal hemangioma:  http://www.learningradiology.com/archives2008/COW%20317-Hemangioma%20spine/hemangiomacorrect.htm

Treatment

Observation (wait and see).  If a compression fracture occurs, consider a vertebroplasty or kyphoplasty.

 

Hemagioma in L1 vertebral body - The Pain Source

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