Typical (asymptomatic) hemangioma: Bone remodeling
Asymptomatic vertebral hemangioma (Asymptomatic Vertebral Haemangioma) forms specific radiological patterns. They occur because normal cancellous bone within the vertebra is replaced by thickened bone trabeculae. These trabeculae are surrounded on all sides by fatty bone marrow or vascular lacunae. Such structural remodeling is perfectly visualized by diagnostic imaging methods.
On computed tomography (CT), we look for two classic signs:
- 'Polka-dot' sign ('polka-dot' pattern). Evaluated on axial slices. Multiple punctate high-density foci are visualized within the vertebral bone marrow.
- 'Corduroy' sign ('corduroy sign'). Detected on sagittal reconstruction. It appears as distinct, vertically oriented, thickened bone trabeculae resembling the texture of corduroy fabric.
MRI presentation of a typical hemangioma
During magnetic resonance imaging (MRI) (specifically on sagittal slices in T1W and T2W sequences), the presentation is also quite characteristic. Lesions at the Th11 and L4 vertebral levels are frequently cited as classic examples.
Key findings:
- The body of the affected vertebra demonstrates a hyperintense (high) signal. This occurs exclusively due to the abundant fatty component within the lesion.
- Against the background of this bright high signal, linear striation is clearly visible. It has a hypointense (low) signal and corresponds to the same thickened bone trabeculae seen on CT.
Aggressive variant of hemangioma
The aggressive variant of vertebral hemangioma (Aggressive Variant of Vertebral Haemangioma) differs fundamentally from the typical form in its behavior. The main features are expansile growth and the ability to invade surrounding structures.
In a typical example (e.g., at the L1 vertebral level), the tumor may affect the posterior elements of the vertebra while leaving the pedicles (pedicles) and the vertebral body itself intact (undamaged).
MRI semiotics of aggressive hemangioma:
- T1W (sagittal slice): Unlike the typical form, the lesion demonstrates a hypointense (low) signal.
- T2W (sagittal slice): This sequence is considered the most informative for accurately assessing tumor spread, especially when invasion into the posterior epidural space (posterior epidural space) is suspected.
- Fat-suppressed contrast-enhanced T1W (Fat-suppressed gadolinium-enhanced T1): Following gadolinium administration, intense contrast enhancement (strong enhancement) of the lesion tissue is observed.
Briefly: answers to topical questions
Which anatomical structures of the vertebra are affected in aggressive hemangioma?
In aggressive vertebral hemangioma (Aggressive Variant of Vertebral Haemangioma), primarily the posterior elements of the vertebra are affected, along with invasion into surrounding structures. The tumor is characterized by expansile growth and is capable of invading the posterior epidural space (posterior epidural space). At the same time, despite the aggressive growth pattern, the pedicles (pedicles) and the vertebral body itself may remain intact (undamaged).
What surgical treatment methods are used for aggressive spinal hemangiomas?
Minimally invasive interventional procedures are used to treat aggressive spinal hemangiomas.
The main methods include:
- Percutaneous vertebroplasty (Percutaneous Vertebroplasty) — injection of bone cement into the hemangioma cavity via a transpedicular approach (transpedicular route) under CT guidance to relieve pain syndrome.
- Ablation — used to achieve local control over the growth of aggressive vertebral hemangiomas.
Picture a fashionable student: on an axial slice, they wear a 'polka-dot' tie, and on a sagittal slice, 'corduroy' pants. This is the CT classic of an asymptomatic hemangioma!
Class and exam questions
Why do we see a hyperintense signal on T1W and T2W in typical hemangioma?
The high (hyperintense) signal on these sequences is due to the prominent fatty component surrounding the thickened bone trabeculae.
How do thickened bone trabeculae appear on MRI in the typical form?
Against the high signal from the fat, they appear as linear striations with a hypointense (low) signal.
Which MRI sequence is best suited for assessing aggressive hemangioma invasion?
The most informative sequence for assessing tumor extension into the posterior epidural space is T2W (on sagittal slices).
How does an aggressive hemangioma respond to contrast agents?
On fat-suppressed T1W, the lesion demonstrates intense gadolinium enhancement (strong enhancement).
What else to study on this topic
- Features of vascular lacunae formation in typical hemangioma
- Anatomy of the pedicles and posterior vertebral elements in the context of invasion
- Differential diagnosis of hypointense signal on T1W in aggressive lesions
- Mechanism of fat signal suppression during gadolinium contrast enhancement
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