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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1242-1248, August 2007
DOI 10.3174/ajnr.A0563
© 2007 American Society of Neuroradiology

SPINE

Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation

J.W. Lee^a, E.Y. Cho^c, S.H. Hong^e, H.W. Chung^d, J.H. Kim^a, K.-H. Chang^e, J.-Y. Choi^e, J.-S. Yeom^b and H.S. Kang^a

^a Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-Do, Korea
^b Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeongi-Do, Korea
^c Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^d Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^e Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea

Address correspondence to Eun Yoon Cho, MD, Department of Pathology, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-gu, Seoul 135-710, Korea; e-mail: eycmd{at}lycos.co.kr

BACKGROUND AND PURPOSE: Because of the high vascularization of hemangiomas, preoperative misinterpretation may result in unexpected intraoperative hemorrhage and incomplete resection, which results in the persistence of clinical symptoms or recurrence. Our purpose was to analyze various MR imaging features of a spinal epidural hemangioma with histopathologic correlation.

MATERIALS AND METHODS: After searching through the pathology data bases in 3 hospitals, we included 14 patients (9 male and 5 female; mean age, 38 years; age range, 2–62 years) with spinal epidural hemangiomas confirmed by surgical resection after MR imaging. Three radiologists reviewed the MR imaging in consensus and categorized the features into subtypes on the basis of histopathologic findings.

RESULTS: We categorized the MR imaging features as follows: type A for a cystlike mass with T1 hyperintensity (2 cases, arteriovenous type with an organized hematoma), type B for a cystlike mass with T1 isointensity (3 cases, venous type), type C for a solid hypervascular mass (7 cases, cavernous type), and type D for an epidural hematoma (2 cases, cavernous type with hematoma). Types A and B had frequent single segmental involvement (4/5), whereas types C and D had multisegmental involvement in all. Regardless of MR types, lobular contour (8/14) and a rim of low T2 signal intensity (8/14) of the mass were common. T1 hyperintensity of the mass was occasionally seen (5/14).

CONCLUSIONS: Spinal epidural hemangiomas can have various MR imaging features according to their different histopathologic backgrounds. In addition to common features such as solid hypervascularity, lobular contour, and a rim of low T2 signal intensity, T1 hyperintensity or multisegmental involvement may also be a clue in the differential diagnosis of a spinal epidural hemangioma.

This article has been cited by other articles:

				D.B. Orbach and J.B. Mulliken Spinal Epidural Hemangiomas: Various Types of MR Imaging Features With Histopathologic Correlation AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): e31 - e31. [Full Text] [PDF]

				E.Y. Cho Reply: AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): e32 - e32. [Full Text] [PDF]