Vertebral Hemangioma and Angiomatous Neoplasms

Vertebral hemangiomas and angiomatous neoplasms consist of a group of vascular tumors that arise from the abnormal proliferation of blood vessels within the bone. Vertebral hemangiomas are common, benign vascular tumors and are often discovered incidentally during routine imaging studies. These tumors are typically slow-growing and asymptomatic. Conventional radiography (CR) and computed tomography (CT) typically show a well-demarcated mass-like lesion of reduced bone density with thickened trabeculae. CR is not sensitive in the detection of these lesions. Thickened trabeculae are best seen on CT. On magnetic resonance imaging (MRI), the thickened trabeculae appear as low signal foci. Typical vertebral hemangiomas are of high signal intensity (SI) on T1- and T2-weighted images (WI). Atypical vertebral hemangiomas have a lower fat content and are of low SI on T1-WI and of high SI on T2-WI. Aggressive vertebral hemangiomas display aggressive behavior on imaging causing pain and neurological deficit. In general, aggressive vertebral hemangiomas are of low SI on T1-WI and of high SI on T2-WI. Epithelioid hemangioma is a rare mesenchymal tumor of vascular origin. CT shows well-defined, septate, lytic lesions with cortical destruction and bony expansion. On MRI, lesions are hypointense or iso-intense to muscle on T1-WI, and hyperintense on T2-WI. Epithelioid hemangioendothelioma is an intermediate-grade malignant vascular neoplasm. It presents as a mild expansile osteolysis, with ill-defined boundaries and a surrounding soft-tissue mass and uncommonly a sclerotic rim. Angiosarcoma is a rare, aggressive, vascular malignancy with only rare cases reported in the spine. Angiosarcoma and epithelioid hemangioendothelioma show similar features radiologically.