Abstract
Objective
Most vertebral hemangiomas contain high signal intensity on T1-weighted MRI images. Atypical vertebral hemangiomas, which are defined as showing low-signal intensity on T1-weighted images, have been described as lesions which are prone to aggressive behavior. This study was performed to assess behavior of atypical hemangiomas.
Materials and methods
Thoracic and lumbar spine MRI reports for the year 2012 were reviewed for diagnosis of atypical hemangioma. Images were reviewed by two independent observers, and cases which showed atypical vertebral hemangioma, and had imaging or clinical follow-up, were included in our study.
Results
Thirty atypical hemangiomas which had follow-up data were identified out of 2784 thoracic and lumbar MR examinations performed during 2012 at a single institution. Imaging follow-up was available for 23 lesions (mean follow-up 32 months), while there was clinical follow-up for the remaining seven lesions (mean 43.6 months). Twenty-two lesions were stable on imaging, while one demonstrated significant growth over approximately 6 years, developing MRI signal characteristics of a typical hemangioma. Eleven lesions had CT scans showing typical features of hemangioma. Two of the index lesions could not be identified on follow-up CT examinations, which showed normal-appearing spines. The remaining seven lesions were followed clinically; none of the patients reported symptoms in the region of the index lesions.
Conclusions
Atypical hemangiomas are uncommon lesions. The cases in our population did not show aggressive behavior. A more appropriate designation for these lesions may be lipid-poor hemangioma, to distinguish them from aggressive hemangiomas.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
27 December 2019
Unfortunately in Volume 49, Issue 1 had been published online with an incorrect date (2001 instead of 2020).
References
Baker ND, Klein MJ, Greenspan A, Neuwirth M. Symptomatic vertebral hemangiomas: a report of four cases. Skelet Radiol. 1986;15(6):458–63.
Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E, Leone A, et al. A systematic approach to vertebral hemangioma. Skelet Radiol. 2015;44(1):25–36.
Friedman DP. Symptomatic vertebral hemangiomas: MR findings. AJR Am J Roentgenol. 1996;167(2):359–64.
Laredo JD, Assouline E, Gelbert F, Wybier M, Merland JJ, Tubiana JM. Vertebral hemangiomas: fat content as a sign of aggressiveness. Radiology. 1990;177(2):467–72.
Cross JJ, Antoun NM, Laing RJ, Xuereb J. Imaging of compressive vertebral haemangiomas. Eur Radiol. 2000;10(6):997–1002.
Cloran FJ, Pukenas BA, Loevner LA, Aquino C, Schuster J, Mohan S. Aggressive spinal haemangiomas: imaging correlates to clinical presentation with analysis of treatment algorithm and clinical outcomes. Br J Radiol. 2015;88(1055):20140771.
Wenger DE, Wold LE. Benign vascular lesions of bone: radiologic and pathologic features. Skelet Radiol. 2000;29(2):63–74.
Baudrez V, Galant C, Vande Berg BC. Benign vertebral hemangioma: MR-histological correlation. Skelet Radiol. 2001;30(8):442–6.
Jiang L, Liu XG, Yuan HS, Yang SM, Li J, Wei F, et al. Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. Spine J. 2014;14(6):944–54.
Shah LM, Salzman KL. Imaging of spinal metastatic disease. Int J Surg Oncol. 2011;2011:769753.
Unni KK, Inwards C, Bridge J, Kindblom LG, Wold LE. Vascular tumors. AFIP Atlas of Tumor Pathology: 4th series, Fascicle 2, Tumors of the Bones and Joints. Washington, DC: American Registry of Pathology; 2005. p. 261–4.
Layfield LJ, Baloch Z, Elsheikh T, Litzky L, Rekhtman N, Travis WD, et al. Standardized terminology and nomenclature for respiratory cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol. 2016;44(5):399–409.
Pitman MB, Centeno BA, Ali SZ, Genevay M, Stelow E, Mino-Kenudson M, et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology Guidelines. Cytojournal. 2014;11(Suppl 1):3.
Nayar R, Wilbur DC. The pap test and Bethesda 2014. "The reports of my demise have been greatly exaggerated." (after a quotation from Mark Twain). Acta Cytol. 2015;59(2):121–32.
Ramaswamy AS, Vijitha T, Kumarguru BN, Mahalingashetti PB. Atypical parathyroid adenoma. Indian J Pathol Microbiol. 2017;60(1):99–101.
Requena L, Kutzner H, Mentzel T, Duran R, Rodriguez-Peralto JL. Benign vascular proliferations in irradiated skin. Am J Surg Pathol. 2002;26(3):328–37.
Scheithauer BWWJ, Erlandson RA. Tumors of the peripheral nervous system. Atlas of tumor pathology. Washington, DC: American Registry of Pathology; 1999.
Acknowledgements
The authors would like to thank Patricia Gamez, MD, and Alexander Levy for their assistance with medical record search.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hoyle, J., Layfield, L. & Crim, J. The lipid-poor hemangioma: an investigation into the behavior of the “atypical” hemangioma. Skeletal Radiol 49, 93–100 (2020). https://doi.org/10.1007/s00256-019-03257-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-019-03257-2