
P. KALINA
Copyright © 2012 SciRes. OJMI
31
Pain often precedes neurological symptoms, most com-
monly thoracic myelopathy. Imaging findings have been
well characterized [2,3] Radiographs demonstrate course
vertical striations caused by thick trabeculae. CT in in-
dolent or inactive lesions demonstrates fat density while
in symptomatic compressive lesions CT will demonstrate
soft tissue density. Indolent lesions tend to follow fat
signal on MRI while symptomatic lesions are T1 isoin-
tense and T2 hyperintense.
Extraosseous tumor contains very little fat although
may demonstrate flow voids. Both types typically enhance.
Pathology reveals hamartomatous proliferation of endo-
thelial vascular tissue with secondary resorption of un-
derlying bone. Most trabeculae are atrophic due to the
abnormal blood vessels although some become thickened
and sclerotic. Cavernous hemangiomas have multiple
large thin walled vascular spaces while capillary heman-
giomas have multiple capillary channels se parated by reac-
tive fibrous tissue [4]. Work-up for aggressive heman-
giomas may include angiography to determine vascular-
ity, identify feeding an d draining vessels and identify the
blood supply to the cord. CT guided biopsy may be war-
ranted to differentiate hemangioma, lymphoma, myeloma
or metastasis. Management of symptomatic vertebral
hemangiomas can be very variable [5]. Vertebroplasty is
contemplated for patients with localized pain. Radiation
has been utilized for those with pain, pain and compres-
sion or pre-operatively. Post-op radiation may reduce the
recurrence risk in subtotal tumor removal. Decompres-
sive laminectomy is considered for resection of epidural
disease. Embolization of feeding vessels may be a pre-
operative measure or may be curative. However it is not
always necessary or possible if the feeding vessel also
supplies the anterior spinal artery. Ethanol embolization
has also been utilized. Compressive vertebral hemangioma
causing cord compression and neurologic symptoms by
extraosseous extension is much less common than benign
hemangioma. The CT and MR features may suggest the
potential for progresssion. An asymptomatic incidental
hemangioma does not need further evaluation unless pain
or neurological deficit develops at the appropriate level.
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