Skip to content

Vertebral Haeangioma

Summary

  • Benign vascular tumour of the spine, composed of thin-walled blood vessels and fatty tissue
  • Usually asymptomatic, incidentally found on imaging
  • Characteristic "polka-dot" appearance on CT and hyperintense signal on T1-weighted MRI

Pathophysiology

  • Hamartomatous lesion of vascular origin
  • Composed of:
    • Thin-walled blood vessels
    • Fatty tissue
    • Fibrous stroma
  • Slow-growing, with potential for expansion and bone remodeling
  • Rarely causes vertebral body expansion or extraosseous extension

Demographics

  • Prevalence: 10-12% of the general population
  • Most common in adults aged 30-50 years
  • Slight female predominance
  • Can occur in any vertebra, but most common in:
    • Thoracic spine (60-70%)
    • Lumbar spine (20-30%)
    • Cervical spine (rarely affected)

Diagnosis

  • Often asymptomatic and incidentally discovered on imaging
  • Symptomatic cases may present with:
    • Local pain
    • Radiculopathy
    • Myelopathy (in cases of spinal cord compression)
  • Physical examination usually unremarkable
  • Differential diagnosis includes:
    • Metastatic disease
    • Multiple myeloma
    • Lymphoma
    • Eosinophilic granuloma

Imaging

X-ray

  • Coarse vertical trabeculation ("corduroy" appearance)
  • Thickened trabeculae may create a "honeycomb" pattern

CT

  • Characteristic "polka-dot" appearance on axial images
    • Represents thickened trabeculae surrounded by low-density fatty tissue
  • Coarse vertical trabeculation on sagittal and coronal reconstructions

MRI

  • T1-weighted: Hyperintense signal due to fat content
  • T2-weighted: Hyperintense signal
  • STIR: Variable signal suppression depending on fat content
  • Contrast enhancement: Usually present, may be intense and homogeneous

Nuclear Medicine

  • Bone scintigraphy: Usually photopenic ("cold") lesion
  • FDG-PET: Typically low uptake

panels-1

  • An incidental finding in the L2 vertebral body was T1- and T2-hyperintense, due to fat content, and hypointense on STIR. CT showed the classical trabecular thickening of a hemangioma.

Treatment

  • Asymptomatic lesions: Observation and follow-up
  • Symptomatic lesions:
    • Conservative management:
    • Pain medication
    • Bracing
    • Vertebroplasty or kyphoplasty for pain relief
    • Surgical intervention for cases with:
    • Neurological deficits
    • Spinal instability
    • Aggressive lesions
  • Treatment options include:
    • Embolization
    • Radiation therapy
    • Surgical excision and stabilization
  • Combination therapy may be necessary for aggressive or symptomatic lesions

Differential diagnosis

Differential Diagnosis Differentiating Feature
Metastatic disease Multiple lesions with destructive appearance; T1 hypointense and STIR hyperintense; no trabecular pattern
Multiple myeloma Diffuse osteopenia; punched-out lytic lesions without sclerotic rim; no characteristic trabecular pattern
Lymphoma Permeative pattern with soft tissue mass and epidural extension; no trabecular "polka-dot" appearance
Paget's disease Coarsened trabecular pattern with bone enlargement and cortical thickening; "picture frame" appearance on plain film
Enostosis (bone island) Smaller, dense sclerotic focus without trabecular pattern; no T2 signal change
Osteoblastoma Expansile lytic lesion typically in posterior elements; variable enhancement; no trabecular pattern
Aneurysmal bone cyst Multiple fluid-fluid levels on MRI; expansile thin-cortical shell; no trabecular pattern
Giant cell tumour Eccentric location with soap-bubble appearance; extends to articular surface; no trabecular "corduroy" pattern
Osteoid osteoma Small lesion with dense nidus and surrounding sclerosis; NaF PET avid; typically in posterior elements
Tuberculosis (Pott's disease) Disc space involvement with end-plate erosion; paraspinal and psoas abscess; no preserved disc height