Histological types and localization
According to their histological structure, intraosseous hemangiomas are divided into four main types: capillary (capillary), cavernous (cavernous), arteriovenous (arteriovenous), and venous (venous).
The most common capillary and cavernous forms have a predilection for certain sites. Most frequently, they are discovered in the vertebral bodies and the bones of the cranial vault. These neoplasms are much less common in the bones of the appendicular skeleton (extremities). A distinctive feature of hemangiomas compared to most other primary bone tumors is the predominance of female patients.
Diagnostic radiology
The diagnosis of intraosseous hemangiomas relies on a combination of imaging modalities, each of which reveals specific signs of vascular involvement.
- Radiography: In long tubular bones (epiphyses and metaphyses), as well as in vertebrae, fine or coarse vertical striation (trabeculation) is identified. This direction coincides with the longitudinal axis of the bone. Sometimes the contours of vascular channels are visible. Bone expansion and extension of the process beyond its borders may be noted.
- CT (Computed Tomography): Thickened bony trabeculae located against the background of a fat matrix are clearly visualized.
- MRI (Magnetic Resonance Imaging): In flat and long bones, the lesion predominantly produces an intermediate signal on T1-WI and a hyperintense signal on T2-WI. Vascular lesions with slow flow appear bright on T2-WI, whereas rapid blood flow results in a "flow void" effect (flow voids).
- Scintigraphy: Characterized by a three-phase radiopharmaceutical uptake, which confirms the abundant blood supply of the lesion.
Epithelioid hemangioma
Epithelioid hemangioma (epithelioid haemangioma) is distinguished separately as a benign neoplasm that, in its clinical and histological manifestations, may resemble a malignant vascular tumor.
In a quarter of cases, the lesion is multifocal. Radiologically, these are well-demarcated foci of osteolysis with a preserved cortical layer. The disease can lead to bone expansion, extension beyond the bone borders, as well as metastasis and lymph node involvement. On MRI (STIR and PD-WI), epithelioid hemangioma appears as an aggressive lesion with pronounced reactive edema of the surrounding bone marrow.
Briefly: answers to topical questions
What conditions require differential diagnosis with intraosseous vertebral hemangioma?
- Osteoporosis (osteoporosis) is a pathology characterized by vertical striation of the vertebral bodies; however, unlike hemangioma, which usually affects a single vertebra, osteoporosis involves multiple or all vertebrae.
What clinical symptoms are characteristic of aggressive vertebral hemangioma?
- Pain syndrome — sources describe aggressive hemangioma as symptomatic/painful, specifically as an indication for vertebroplasty in aggressive painful hemangioma.
What surgical treatment methods are used for symptomatic intraosseous hemangiomas?
- Vertebroplasty (percutaneous vertebroplasty) — percutaneous injection of bone cement under CT guidance to stabilize the vertebra in aggressive painful hemangiomas.
What imaging methods are used for the comprehensive examination of patients with intraosseous hemangioma?
- Radiography — reveals vertical trabeculation, bone expansion, and extraosseous extension.
- Scintigraphy — demonstrates three-phase radiopharmaceutical uptake.
- Computed Tomography (CT) — visualizes thickened trabeculae, the "polka-dot" sign, and the "corduroy" sign.
- Magnetic Resonance Imaging (MRI) — determines a high-intensity signal due to the fatty component on T1-WI and T2-WI in typical forms, or a low signal on T1-WI in aggressive variants.
Class and exam questions
Who is most commonly affected by intraosseous hemangioma?
Unlike most primary bone tumors, hemangiomas occur twice as often in women as in men.
What is the main radiographic sign of hemangioma in the vertebrae and long bones?
The primary sign is coarse or fine vertical trabeculation (striation) running along the longitudinal axis of the bone.
How does hemangioma appear on CT?
Computed tomography scans show thickened bony trabeculae located within a fat matrix.
What else to study on this topic
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- MRI findings in aneurysmal bone cyst (fluid-fluid level sign)
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