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Spine
Diagnosis
Neoplasms, Cysts, and Other Masses
Neoplasms
Extradural
Hemangioma
Hemangioma
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Common benign venous malformation within vertebrae
              • Usually intraosseous, may have epidural component
              • Rare: Purely epidural spinal hemangioma
            • Typically, incidental lesion identified on imaging performed for unrelated reasons

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Parekh AD et al: Long-term tumor control with radiotherapy for symptomatic hemangioma of a vertebral body. Spine (Phila Pa 1976). 44(12):E731-4, 2019
                                            2. Peckham ME et al: Imaging of vascular disorders of the spine. Radiol Clin North Am. 57(2):307-18, 2019
                                            3. Wang B et al: Atypical radiographic features of aggressive vertebral hemangiomas. J Bone Joint Surg Am. 101(11):979-86, 2019
                                            4. Acosta FL Jr et al: Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature. J Spinal Disord Tech. 24(4):268-75, 2011
                                            5. Ropper AE et al: Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery. 69(6):1171-80, 2011
                                            6. Singh P et al: Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study. Neurosurgery. 68(1):78-84; discussion 84, 2011
                                            7. Alexander J et al: Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions. Spine (Phila Pa 1976). 35(18):E917-20, 2010
                                            8. Hurley MC et al: Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol. 29(6):1095-7, 2008
                                            9. Bandiera S et al: Symptomatic vertebral hemangioma: the treatment of 23 cases and a review of the literature. Chir Organi Mov. 87(1): 1-15, 2002
                                            10. Gabal AM: Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord. Cardiovasc Intervent Radiol. 25(6): 494-500, 2002
                                            11. Murugan L et al: Management of symptomatic vertebral hemangiomas: review of 13 patients. Neurol India. 50(3): 300-5, 2002
                                            12. Bas T et al: Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years. Spine. 26(14): 1577-82, 2001
                                            13. Baudrez V et al: Benign vertebral hemangioma: MR-histological correlation. Skeletal Radiol. 30(8): 442-6, 2001
                                            14. Miszczyk L et al: The efficacy of radiotherapy for vertebral hemangiomas. Neoplasma. 48(1):82-4, 2001
                                            15. Cross JJ et al: Imaging of compressive vertebral haemangiomas. Eur Radiol. 10(6):997-1002, 2000
                                            16. Doppman JL et al: Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol. Radiology. 214(2): 341-8, 2000
                                            17. Lee S et al: Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression. Spine. 24(20): 2111-4, 1999
                                            18. Pastushyn AI et al: Vertebral hemangiomas: diagnosis, management, natural history and clinicopathological correlates in 86 patients. Surg Neurol. 50(6): 535-47, 1998
                                            19. Griffith JF et al: Clinics in diagnostic imaging (25). Aggressive vertebral haemangioma. Singapore Med J. 38(5): 226-30, 1997
                                            20. Jayakumar PN et al: Symptomatic vertebral haemangioma: endovascular treatment of 12 patients. Spinal Cord. 35(9): 624-8, 1997
                                            21. Sakata K et al: Radiotherapy of vertebral hemangiomas. Acta Oncol. 36(7):719-24, 1997
                                            22. Ide C et al: Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology. 38(6): 585-9, 1996
                                            23. Guedea F et al: The role of radiation therapy in vertebral hemangiomas without neurological signs. Int Orthop. 18(2): 77-9, 1994
                                            24. Fox MW et al: The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 78(1): 36-45, 1993
                                            25. Laredo JD et al: Vertebral hemangiomas: fat content as a sign of aggressiveness. Radiology. 177(2):467-72, 1990
                                            26. Nguyen JP et al: Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol. 27(4):391-7, 1987
                                            27. Nicola N et al: Vertebral hemangioma: retrograde embolization-stabilization with methyl methacrylate. Surg Neurol. 27(5):481-6, 1987
                                            28. Ross JS et al: Vertebral hemangiomas: MR imaging. Radiology. 165(1):165-9, 1987
                                            29. Laredo JD et al: Vertebral hemangiomas: radiologic evaluation. Radiology. 161(1):183-9, 1986
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Common benign venous malformation within vertebrae
                                                        • Usually intraosseous, may have epidural component
                                                        • Rare: Purely epidural spinal hemangioma
                                                      • Typically, incidental lesion identified on imaging performed for unrelated reasons

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Parekh AD et al: Long-term tumor control with radiotherapy for symptomatic hemangioma of a vertebral body. Spine (Phila Pa 1976). 44(12):E731-4, 2019
                                                                                      2. Peckham ME et al: Imaging of vascular disorders of the spine. Radiol Clin North Am. 57(2):307-18, 2019
                                                                                      3. Wang B et al: Atypical radiographic features of aggressive vertebral hemangiomas. J Bone Joint Surg Am. 101(11):979-86, 2019
                                                                                      4. Acosta FL Jr et al: Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature. J Spinal Disord Tech. 24(4):268-75, 2011
                                                                                      5. Ropper AE et al: Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors. Neurosurgery. 69(6):1171-80, 2011
                                                                                      6. Singh P et al: Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study. Neurosurgery. 68(1):78-84; discussion 84, 2011
                                                                                      7. Alexander J et al: Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions. Spine (Phila Pa 1976). 35(18):E917-20, 2010
                                                                                      8. Hurley MC et al: Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol. 29(6):1095-7, 2008
                                                                                      9. Bandiera S et al: Symptomatic vertebral hemangioma: the treatment of 23 cases and a review of the literature. Chir Organi Mov. 87(1): 1-15, 2002
                                                                                      10. Gabal AM: Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord. Cardiovasc Intervent Radiol. 25(6): 494-500, 2002
                                                                                      11. Murugan L et al: Management of symptomatic vertebral hemangiomas: review of 13 patients. Neurol India. 50(3): 300-5, 2002
                                                                                      12. Bas T et al: Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years. Spine. 26(14): 1577-82, 2001
                                                                                      13. Baudrez V et al: Benign vertebral hemangioma: MR-histological correlation. Skeletal Radiol. 30(8): 442-6, 2001
                                                                                      14. Miszczyk L et al: The efficacy of radiotherapy for vertebral hemangiomas. Neoplasma. 48(1):82-4, 2001
                                                                                      15. Cross JJ et al: Imaging of compressive vertebral haemangiomas. Eur Radiol. 10(6):997-1002, 2000
                                                                                      16. Doppman JL et al: Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol. Radiology. 214(2): 341-8, 2000
                                                                                      17. Lee S et al: Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression. Spine. 24(20): 2111-4, 1999
                                                                                      18. Pastushyn AI et al: Vertebral hemangiomas: diagnosis, management, natural history and clinicopathological correlates in 86 patients. Surg Neurol. 50(6): 535-47, 1998
                                                                                      19. Griffith JF et al: Clinics in diagnostic imaging (25). Aggressive vertebral haemangioma. Singapore Med J. 38(5): 226-30, 1997
                                                                                      20. Jayakumar PN et al: Symptomatic vertebral haemangioma: endovascular treatment of 12 patients. Spinal Cord. 35(9): 624-8, 1997
                                                                                      21. Sakata K et al: Radiotherapy of vertebral hemangiomas. Acta Oncol. 36(7):719-24, 1997
                                                                                      22. Ide C et al: Vertebral haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology. 38(6): 585-9, 1996
                                                                                      23. Guedea F et al: The role of radiation therapy in vertebral hemangiomas without neurological signs. Int Orthop. 18(2): 77-9, 1994
                                                                                      24. Fox MW et al: The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 78(1): 36-45, 1993
                                                                                      25. Laredo JD et al: Vertebral hemangiomas: fat content as a sign of aggressiveness. Radiology. 177(2):467-72, 1990
                                                                                      26. Nguyen JP et al: Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol. 27(4):391-7, 1987
                                                                                      27. Nicola N et al: Vertebral hemangioma: retrograde embolization-stabilization with methyl methacrylate. Surg Neurol. 27(5):481-6, 1987
                                                                                      28. Ross JS et al: Vertebral hemangiomas: MR imaging. Radiology. 165(1):165-9, 1987
                                                                                      29. Laredo JD et al: Vertebral hemangiomas: radiologic evaluation. Radiology. 161(1):183-9, 1986