intraspinales epidurales Angiolipom

Epidural
spinal angiolipoma: a case series. Case 1. Sagittal T2-weighted (a), sagittal fat suppressed T2-weighted (b), sagittal fat suppressed T1-weighted post-contrast (c) images showing an epidural mass at L3–L4 level. The mass is T2 hyperintense, hypointense in fat suppressed T2 and showed no enhancement in post-contrast images. The mass is low signal in DWI (d) and high signal in ADC (e), axial image of dynamic contrast enhanced image (f) showing no obvious diffusion restriction (f) and time-intensity curve (g) showed no enhancement. A grey yellowish mass was resected after surgery (h). Histological sections (i) shows tumor is composed of abundant vascular channel filled with red blood cells and fibrin thrombi and mature adipose tissue
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Epidural
spinal angiolipoma: a case series. Case 2. Sagittal T1-weighted (a), sagittal T2-weighted (b), sagittal fat suppressed T2-weighted (c) MRI images showing a spindle shaped epidural mass extending from T2 to T4. The mass is hypointense in T1, with inhomogenous fat signals in peripheral region, hyperintense in T2 weighted imaging. The fat signals were suppressed in fat suppressed T2. Signs of thoracic and lumbar degeneration including thickening of ligamentum flavum in T10–T12 sections and disc herniation in multiple lumbar disc. Axial T2-weighted (d, e) images showed the tumor extends into bilateral neural foramen and compresses the spinal cord anteriorly. The mass is low signal in DWI (f) and high signal in ADC (g), no obvious diffusion restriction was observed. In sagittal fat suppressed T1-weighted post-contrast (h) image, the mass was significantly enhanced. The dynamic contrast enhanced curve (i) showed the rapid rising wash-in phase and wave-like washout phase without obvious decline. A grey reddish mass was resected after surgery (j). Histological sections (k) shows tumor is composed of abundant vascular channel filled with red blood cells and fibrin thrombi and mature adipose tissue
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Epidural
spinal angiolipoma: a case series. Case 3. Sagittal T1-weighted (a), sagittal T2-weighted (b), sagittal fat suppressed T2-weighted (c) MRI images showing a spindle shaped epidural mass extending from T4 to T6. The mass is hypointense in T1, with inhomogenous fat signals in both ends, hyperintense in T2 weighted imaging. The fat signals were suppressed in fat suppressed T2. Thin-strips or spots of vessels can be seen inside the tumor. Axial T2-weighted (d, e) images showed the tumor extends into bilateral neural foramen and compresses the spinal cord anteriorly. The mass is low signal in DWI (f) and high signal in ADC (g), no obvious diffusion restriction was observed. ADC value is 1.971 × 10−3mm2/s. In sagittal fat suppressed T1-weighted post-contrast (h) image, the mass is significantly and homogenously enhanced. The dynamic contrast enhanced curve (i) showed the rapid rising and slow decline phases, indicating the vascular component is predominating. Histological sections (j) shows tumor is composed of abundant vascular channel filled with red blood cells and fibrin thrombi and mature adipose tissue
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Spinal
extradural angiolipoma manifested after normal vaginal delivery. a Non-contrast T1-weighted sagittal MRI of the mid thoracic spine showing a very inhomogeneous mass, extending from D5 to D8. The tumor shows a large component hypointense to fat. b T2-weighted sagittal MRI showing the mass as hyperintense relative to spinal cord and nearly isointense with normal fat and myelopathic changes in the cord. c Post-contrast T1-weighted sagittal MRI showing diffuse, slightly inhomogeneous enhancement of the mass. Non contrast T1-weighted axial MRI (d) T2-weighted axial MRI (e) and post-contrast T1-weighted axial MRI (f) the mass along the posterior epidural spinal canal of the dorasl spine, compressing and displacing the spinal cord anteriorly
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Radiopaedia • CC-by-nc-sa 3.0 • de

Epidural angiolipomas are rare benign tumors composed of mature adipocytes and abnormal vessels.

Epidemiology

Epidural angiolipomas are more frequently encountered in women, and typically in middle age (40-50 years of age) .

Clinical presentation

In keeping with the slow growth of these tumors, clinical presentation is usually gradual with symptoms often present over a number of months/years. Signs and symptoms include:

  • paraparesis
  • back pain
  • sensory changes (lower limbs) 
  • hyper-reflexia (lower limbs) 

Radiographic features

Angiolipomas can be divided into infiltrating and non-infiltrating varieties, and both as seen in the epidural space. Non-infiltrating angiolipomas are more common and are usually located in the dorsal epidural space, typically in the thoracic region . Infiltrating angiolipomas are more common in the anterior epidural space, and can infiltrate not only adjacent soft tissues, but also adjacent vertebrae .

CT

CT demonstrates a mixture of soft tissue density and fatty components.

MRI

Signal characteristics are as expected from the composition of this tumor:

  • T1
    • high signal fatty component
    • intermediate signal vascular component
  • T2
    • high signal
    • flow voids are usually absent but enlarged vessels in the region may be visible
  • T1 C+ (Gd)
    • vivid enhancement of non-fatty components

Treatment and prognosis

Surgical resection is the treatment of choice, particularly for non-infiltrating tumors, in which case complete resection is possible and curative .

Malignant transformation has not been reported .

Differential diagnosis

Differential diagnosis includes other epidural masses :

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu intraspinales epidurales Angiolipom:
epidurale
intraspinale Raumforderung
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