Aggressive vertebral hemangioma

Aggresive
Vertebral Body Haemangioma. Axial T1 post contrast: intense enhancement
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Atypisches /
aggressives Wirbelkörperhämangiom BWK 10 mit typischer, vertikal verstärkter Trabekulierung (axiale CT), deutlicher Unterbrechung der Hinterkante welche durch die fettreiche Neoplasie bis in den Spinalkanal hinein überragt wird. Mitbeteiligung der dorsalen Wirbelanteile (axiale MRT T2 untere 3. Bild von links). Oben sagittal MRT T1, T2, STIR und seitliches Röntgen. Unten axiale CT im Weichteilfenster (Fettgehalt !) und Knochenfenster, axiale MRT T2 und Röntgen a.p.
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Cement
leakage in a symptomatic vertebral hemangioma: a case report and review of the literature. MRI Sagittal and Transverse T2-W images reveal the extraosseous extension in the anterior epidural space compressing the spinal cord.
casesjournal.biomedcentral.com • CC-by-2.0
Aggressive
vertebral haemangioma. CT-guided core-needle biopsy of left paravertebral soft-tissue, confirming the presence of a vascular lesion.
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Aggressive
vertebral hemangioma • Agressive vertebral hemangioma in pregnancy - Ganzer Fall bei Radiopaedia
Sofiane, Z. Agressive vertebral hemangioma in pregnancy. Case study, Radiopaedia.org. (accessed on 21 Oct 2022) https://doi.org/10.53347/rID-150791 • CC by-nc-sa 3.0 (modified)
Aggresive
Vertebral Body Haemangioma. Axial T1: vertebral expansion, cortical destruction, spinal and foraminal compromise, cord compression, hypointense signal and striations
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Cement
leakage in a symptomatic vertebral hemangioma: a case report and review of the literature. Transaxial and MPR Sagittal CT images reveal the partially collapsed vertebra with typical findings of an hemangioma (thickening of some of the vertical trabeculae with dissolution of horizontal trabeculae) involving both the vertebral body and the posterior elements. Note the small paraspinal mass and focal cortical erosions.
casesjournal.biomedcentral.com • CC-by-2.0
Aggressive
vertebral haemangioma. Vertically-oriented striations which represent reinforced trabeculae. This typical feature is called the polka-dot pattern (yellow arrow, vertebral body). Note the extension to posterior elements (green arrow).
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Aggressive
vertebral hemangioma • Aggressive vertebral hemangioma with compressive myelopathy - Ganzer Fall bei Radiopaedia
Haouimi, A. Aggressive vertebral hemangioma with compressive myelopathy. Case study, Radiopaedia.org. (accessed on 21 Oct 2022) https://doi.org/10.53347/rID-64617 • CC by-nc-sa 3.0 (modified)
Aggressive
vertebral haemangioma. The lesion shows cortical destruction with soft-tissue expansion (yellow arrows).
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Aggressive
vertebral haemangioma. The lesion spreads to posterior elements as the transverse process (green arrow).
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Aggressive
vertebral haemangioma. It also spreads to other posterior elements as the transverse process and the right lamina (white arrow).
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Aggressive
vertebral haemangioma. Here we can observe a loss of vertebral body height.
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Aggressive
vertebral haemangioma. Hypointense vertebral lesion on T1-weighted image. Predominantly hyperintense on T2 image. Note the upper and lower discs" altered signal on T2 (hypointense and no distinction between nucleus and annulus disc). Their height is decreased.
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Aggressive
vertebral haemangioma. The lesion enhances strongly after contrast administration. Low-signal-intensity vertical striations can be seen within it. Note how this lesion spreads to posterior elements of the vertebral body.
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Aggressive
vertebral haemangioma. Note its remarkable ability to invade the vertebral canal and compress the spinal cord (aggressive behaviour).
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Aggressive
vertebral haemangioma. Predominant left vascularization, depending on the 5th left lumbar artery. Embolisation of this left predominant artery was achieved using PVA particles. The result was a reduction of the vascularization, a key step before performing surgery.
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Aggressive
vertebral haemangioma. Due to a clinical worsening, core-needle biopsy was required to confirm the suspected diagnosis. Red arrow: Paravertebral soft-tissue component.
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Aggressive
vertebral haemangioma. Prominent soft-tissue expansion of the lesion (yellow arrows). Note the destruction of the posterior wall and invasion of the vertebral canal (blue arrows), causing spinal cord compression (aggressive behaviour).
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Bone up on
spinal osseous lesions: a case review series. Compressive vertebral venous vascular malformation. Sagittal (a) and axial (b) CT images in the bone window of the thoracic spine demonstrate decreased attenuation of the T4 vertebral body, as well as the left pedicle and transverse process. A characteristic “polka-dot” sign is seen in the vertebral body on the axial image, with high attenuation dots representing replacement of normal cancellous bone by thick, vertical trabeculae (orange arrows) surrounded by vascular lacunes and fatty marrow. Sagittal MR images demonstrate a heterogenous, predominantly high signal lesion on both T1 (c) and T2 (d) weighted sequences involving the T4 vertebral body (orange arrows), with lobular extension into the spinal canal (white arrows). Axial T1 pre- (e) and post-contrast (f) images demonstrate avid enhancement of the lesion. Again, there is extension of the lesion from the vertebral body into the spinal canal, with resulting compression of the spinal cord
insightsimaging.springeropen.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Aggressive vertebral hemangiomata are a rare form of vertebral hemangiomata where significant vertebral expansion, extra-osseous component with epidural extension, disturbance of blood flow, and occasionally compression fractures can be present causing spinal cord and/or nerve root compression .

Epidemiology

It can occur at any age, with peak prevalence in young adults. They represent approximately 1% of spinal hemangiomas and are usually symptomatic . 75% of these lesions occur in the thoracic spine between T3 and T9 vertebral segments .

Clinical presentation

Unlike typical vertebral hemangiomas which are almost always asymptomatic, aggressive type 'always' present with neurological manifestations due to the mass effect of the epidural component upon the spinal cord, nerve roots or both, leading to compressive myelopathy and/or radiculopathy .

Pathology

They are composed of blood vessels with slow flowing, dilated venous channels surrounded by fat, infiltrating the medullary cavity .

Radiographic features

CT

They appear as hypodense expansile vertebral masses, with cortical defects and soft tissue extension and spinal cord/nerve root compression. The classic “polka dot” and “corduroy” signs of the vertebral body due to thickened vertebral trabeculae are also helpful . They generally occupy the entire vertebral body, extend into the neural arch, expand the osseous margins, and contain a soft tissue component .

MRI

Thickened trabeculae appear as low signal areas in both T1 and T2 images. The extraosseous component typically follows usual hemangioma in all pulse sequences with high T1 and T2 signals as well as uniform post-contrast enhancement. MRI is excellent at the assessment of cord or nerve root compression .

Chemical shift imaging can be helpful to look for signal drop out to indicate intralesional fat.

Treatment and prognosis

Accurate preoperative diagnosis is essential because they are highly vascular with high tendency of intraoperative bleeding. Surgery is required in cases of rapid or progressive neurological symptoms like compressive myelopathy or radiculopathy. Endovascular embolization prior to surgery to minimize intraoperative blood loss. Radiotherapy can be used in patients with slow progressive neurological deficits. Other emerging options in cases of aggressive hemangiomas include radiofrequency ablation with a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement . Minimally-invasive procedures may be successful in smaller lesions .

Differential diagnosis

  • plasmacytoma can sometimes mimic the appearances of an aggressive hemangioma.
  • metastases: usually have decreased signal intensity on T1 and increased signal intensity on T2
  • lymphoma: epidural component appears hypointense on T1 and less hyperintense on T2
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu atypisches Hämangiom Wirbelkörper:
Hämangiom
der Wirbelsäule
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vertebrale
Metastasen
Wikipedia • CC BY-SA 4.0
Fibröse
Dysplasie der Wirbelsäule
insightsimaging.springeropen.com • Open Access
vertebral
haemangioma with epidural extension and cord compression
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