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Vertebral hemangioma

Vertebral hemangioma is benign vascular tumor composed of vascular channels that are cavernous, capillary, or venous in type. It is most common spinal axis tumor often identified as an incidental finding. Hemangiomas are usually identified in middle-aged patients, particularly those in the fourth and fifth decades of life. Women are affected about twice as frequently as men. Some, however, on rare occasions, vertebral hemangiomas ("aggressive hemangioma") may be accompanied by symptoms and signs of spinal cord compression owing to extension of the lesions into the epidural space, leading to narrowing of the spinal canal.
Radiographically, a coarse, vertical trabecular pattern, the corduroy appearance, is identified in the vertebral body. The trabeculae and their vertical orientation differs from the subchondral, horizontally arranged trabecular condensation that typifies Paget's disease (the picture-frame vertebral body) or renal osteodystrophy (the rugger-jersey vertebral body).

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Vertebral hemangioma is benign vascular tumor composed of vascular channels that are cavernous, capillary, or venous in type. It is most common spinal axis tumor often identified as an incidental finding. Hemangiomas are usually identified in middle-aged patients, particularly those in the fourth and fifth decades of life. Women are affected about twice as frequently as men. Many hemangiomas are insignificant clinically. Some, however, on rare occasions, vertebral hemangiomas ("aggressive hemangioma") may be accompanied by symptoms and signs of spinal cord compression owing to extension of the lesions into the epidural space, leading to narrowing of the spinal canal. In those cases epidural hemorrhage arising from the lesions and compression fractures may be seen.
Radiographically, a coarse, vertical trabecular pattern, the corduroy appearance, is identified in the vertebral body and may extend into the pedicles and laminae. The trabeculae are more prominent than those that accompany osteoporosis, and their vertical orientation differs from the subchondral, horizontally arranged trabecular condensation that typifies Paget's disease (the picture-frame vertebral body) or renal osteodystrophy (the rugger-jersey vertebral body). On CT hemangioma is low density lesion centered in vertebral body with coarse trabeculae surrounded by fat ("spotted" appearance on axial images). On MRI hemangioma typically demonstrates "benign" fatty stroma. It is bright on T1 and T2 weighted sequences and avidly enhances. Sometimes it is difficult to distinguish from vertebral metastasis, which usually extends into pedicles and are low signal lesions on T1 weighted sequences. Focal fatty marrow also can be confused with heamgiomas, then STIR sequences are diagnostic because hemangioma will retain some signal due to vascular components. Additionaly focal fatty marrow does not enhances.

Suggested reading:

Resnik D, eds. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: Saunders, 2002.
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