AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplemental Online Tables
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, J.W.
Right arrow Articles by Kang, H.S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lee, J.W.
Right arrow Articles by Kang, H.S.

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

J.W. Leea, E.Y. Choc, S.H. Honge, H.W. Chungd, J.H. Kima, K.-H. Change, J.-Y. Choie, J.-S. Yeomb and H.S. Kanga

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


Figure 1
View larger version (112K):
[in this window]
[in a new window]

  		Fig 1. Case 3, a cystlike mass with T1 hyperintensity (type A).

A, The transverse T2-weighted spin-echo MR image demonstrates a well-defined mass at the anterior epidural space of L5. The mass shows bright high signal intensity, same as that of CSF. There is a rim of low signal intensity.

B, On the transverse noncontrast T1-weighted image, the mass shows heterogeneous high signal intensity with a rim of low signal intensity. Signal intensity of the anterior portion of the mass is lower than that of the posterior portion.

C, On the transverse fat-suppressed, postcontrast T1-weighted image, the anterior portion of the mass also shows strong enhancement.

D, On the sagittal T2-weighted image, the mass is located at the anterior epidural space of the L5 spinal level. The mass shows bright high signal intensity with a rim of low signal intensity.

E, On the sagittal noncontrast T1-weighted image, the mass (arrow) shows higher signal intensity than that of the intervertebral disk. We can see the rim of low signal intensity in the distal margin of the mass.

F, On the sagittal fat-suppressed, postcontrast T1-weighted image, the mass shows strong heterogeneous enhancement.

G, On microscopic examination, there is a vascular tumor composed of variable-sized, thick-walled, muscularized vessels, suggestive of an arteriovenous hemangioma. There is a focus of an organized hematoma with pigments of hemosiderin (H&E, x 100).


Figure 2
View larger version (105K):
[in this window]
[in a new window]

  		Fig 2. Case 2, a cystlike mass with T1 isointensity (type B).

A, Transverse T2-weighted gradient-echo MR image demonstrates a well-defined mass with high signal intensity at the left posterior epidural space of C7-T1.

B, On transverse noncontrast T1-weighted MR image, the mass (arrow) shows homogeneous isointensity.

C, On sagittal noncontrast T1-weighted MR image, the signal intensity of the mass (arrow) is isointense to that of the intervertebral disk.

D, On coronal postcontrast T1-weighted image, the mass shows peripheral thick enhancement with inner septumlike enhancement.

E, Histologic section shows cystic dilated vessels with smooth muscle in the walls, suggestive of a venous hemangioma (H&E, x 100). There is no evidence of an organized hematoma.


Figure 3
View larger version (64K):
[in this window]
[in a new window]

  		Fig 3. Case 6, a solid hypervascular mass (type C).

A, Sagittal T2-weighted spin-echo MR image demonstrates the mass at the posterior epidural space of T9-T11. The mass shows homogeneous high signal intensity. The spinal cord is severely compressed by the mass and shows high signal intensity, suggestive of compressive myelopathy.

B, On noncontrast transverse T1-weighted spin-echo MR image, the mass shows heterogeneous isointensity with area of high signal intensity (arrow) at the posterior portion of the mass. The mass extends to the left neural foramen.

C, On sagittal postcontrast T1-weighted image, the mass shows homogeneous strong enhancement. A dural tail sign is also seen (arrows).

D, Photomicrograph reveals the formation of large cavernous vascular channels separated by a scant connective stroma. The spaces are lined by a flattened monolayer of endothelial cells (H&E, x 100).


Figure 4
View larger version (71K):
[in this window]
[in a new window]

  		Fig 4. Case 10, an epidural hematoma (type D).

A, Sagittal T2-weighed spin-echo MR image demonstrates an ill-defined lesion with heterogeneous low and high signal intensity at the posterior epidural space of C5-C7.

B, On sagittal noncontrast T1-weighed spin-echo MR image, there is high signal intensity in that lesion, suggestive of a hematoma.

C, On sagittal postcontrast T1-weighed spin-echo MR image, the lesion shows heterogeneous enhancement.

D, On histologic examination, most of the area is an organized thrombus. There are scattered small foci of large, dilated, blood-filled vessels lined by flattened endothelium, which represents a cavernous hemangioma (H&E, x 100).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X