Vertebral hemangiomas: common lesions with still many unknown aspects

Bone Metastasis from Renal Cancer Coinciding with the Same Anatomical Position as a Vertebral Hemangioma: A Collision Lesion Case Report

Collisions lesions are rare neoplasms where two histologically distinct tumors coexist in the same organ or anatomical site. Vertebral hemangiomas (VHs) are the most common lesions involving the vertebral bodies and imaging findings of typical and atypical hemangiomas, variant forms of hemangioma such as aggressive hemangiomas are well known, but collision lesions involving VHs are extremely rare. This article presents a case report of a 73-year-old male patient diagnosed with clear cell renal cancer in a rare presentation of a bone metastasis coinciding with the same anatomical position as a VH (collision lesion). This required a multidisciplinary approach involving various diagnostic techniques to determine the best therapeutic management.

Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery

BACKGROUND AND OBJECTIVES

We present our experience in the management of symptomatic vertebral hemangiomas with epidural extension (SVHEE) using spine stereotactic radiosurgery (SSRS).

METHODS

An Institutional Review Board approved retrospective review of all SVHEE patients treated with SSRS at our institution (2007-2022) was performed. Baseline patient demographics, clinical presentation, lesion volume, and Bilsky grade (to directly evaluate the epidural component) were determined. Clinical and radiographic response and treatment outcomes were subsequently evaluated at first (∼6 months) and final follow-up.

RESULTS

Fourteen patients with SVHEE underwent SSRS (16-18 Gy/1-fraction); the mean follow-up was 24 months. The median lesion volume (cc) was 36.9 (range: 7.02-94.1), 31.5 (range: 6.53-69.7), and 25.15 (range: 6.01-52.5) at pre-SSRS, first, and final follow-up, respectively. Overall volume reduction was seen in the last follow-up in all 14 patients, median 29.01% (range: 6.58%-71.58%). Bilsky score was stable or improved in all patients at the last follow-up when compared with pre-SSRS score. Patients who underwent both surgical decompression and SSRS (n = 9): 8 had improved myelopathic symptoms and pain and 1 had stable radiculopathy postintervention. In the 5 patients treated with SSRS monotherapy, 2 had stable radicular pain and the other 3 improved pain and numbness. No patients experienced adverse outcomes.

CONCLUSION

To our knowledge, this represents the largest series of SVHEE patients treated with SSRS, either as monotherapy or part of a multimodal/separation surgery treatment approach. We demonstrate that SSRS represents a potentially safe and effective treatment option in these patients. However, larger prospective studies and longer follow-ups are necessary to further assess the role, durability, and toxicity of SSRS in the management of these patients.

Vertebral Hemangiomas: Prevalence, new classification and natural history. magnetic resonance imaging-based retrospective longitudinal study

BACKGROUND AND PURPOSE

To determine the prevalence of vertebral hemangiomas (VHs), establish a new classification of VHs based on their MRI-signal pattern, and study their natural history.

METHODS

MRI of 1000 consecutive patients who underwent at least two MRI with an interval of at least 3 years. Growth rate and change of MRI-signal pattern during the follow-up period were the parameters included in studying the natural history of VHs.

RESULTS

The prevalence of VHs was 41%. VHs were classified as type I-IV with fat-rich VHs (type I), constituted 79% of all VHs. VHs were more common among females 43% versus males 39%, p = .22. The most affected vertebra was L1. Occurrence rates for cervical (1%), thoracic (7%), and lumbar spine (10%) differed significantly (p < .001). The prevalence of VHs increased with age regardless of gender or spinal part involved (p < .001). Only 26% of VHs changed their size and 4% changed their signal during the average follow-up of 7 years. All VHs were slowly growing lesions (average expected growth of <3 mm/10 years). No significant difference between growth rate of VHs type I (0.25 mm/year) and other types of VHs. None of the VHs that were initially reported as "metastases cannot be rule out" showed alarming change in signal or size.

CONCLUSIONS

VH can be classified into four types based on their MRI-signal pattern. Regardless of their type, VHs are slowly growing lesions. The presence of typical morphological pattern should enable radiologists to confidently differentiate them from vertebral metastases.

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases - A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVES

Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them.

METHODS

Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article.

RESULTS

Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them.

CONCLUSION

Management of AVH can be based on the patient's clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy.

GRADE PRACTICE RECOMMENDATION

C.

[Spinal neoplasms]

Spinal neoplasms are generally rare disorders but play an important role in the differential diagnosis of space-occupying masses of the spinal axis. Although there are several different classification criteria (histological origin, dignity, positional relationship to the spine), the standard classification of spinal neoplasms based on the relationship to the dura mater into extraspinal, intraspinal extramedullary and intraspinal intramedullary is used. Magnetic resonance imaging is the gold standard for the morphological imaging of spinal neoplasms, followed by computed tomography. In addition to localization and symptoms, the patient's age is essential with respect to the diagnosis of the possible tumor entity.

Challenges regarding rehabilitation treatment in a case of postpartum spastic paraparesis, secondary to a T9 vertebral fracture on the pathologicallybone operated -case report

Introduction. Pregnancy is a well-known risk factor for asymptomatic hemangiomas discovered incidentally, becoming aggressive or symptomatic, most often in the third trimester of pregnancy, related to hemodynamic and endocrine changes that occur during pregnancy. Many patients experience incomplete spontaneous remission after birth. Material and method. We report the case of a 24-year-old woman, who presented for incomplete paraplegia, pain in the spine, instability of walking of the left lower limb, bilateral plantar paresthesia, possible walking with metal support. Results and discussions. The MRI performed identifies T9 vertebral fracture-compression on pathological bone, T10-T12 vertebral hemangiomas. Conclusions. In order to obtain favorable results, the patient benefited from the support and treatment of a multidisciplinary team: neurosurgeons, imagers, physical and rehabilitation medicine doctors and physiotherapists, and represented a real challenge regarding the complexity of the factors involved. Keywords: hemangioma, rehabilitation, multidisciplinary team

Differentiating atypical hemangiomas and vertebral metastases: a field-of-view (FOV) and FOCUS intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) study

PURPOSE

Some atypical vertebral hemangiomas (VHs) may mimic metastases on routine MRI and can result in misdiagnosis and ultimately to additional imaging, biopsy and unnecessary costs. The purpose of this study is to assess the utility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) on account of field-of-view optimized and constrained undistorted single shot (FOCUS) in distinguishing atypical VHs and vertebral metastases.

METHODS

A total of 25 patients with vertebral metastases and 25 patients with atypical VHs were confirmed by clinical follow-up or pathology. IVIM-DWI imaging was performed at different b values (0, 30, 50, 100, 150, 200, 400, 600, 800, 1000 mm²/s). IVIM parameters [the true diffusion coefficient (D), pseudodiffusion coefficient (D*), standard apparent diffusion coefficient (ADC), and perfusion fraction (f)] were calculated and compared between two groups by using Student's t test. A receiver operating characteristic analysis was performed.

RESULTS

Quantitative analysis of standard ADC and D parameters showed significantly lower values in vertebral metastases when compared to atypical hemangiomas [ADC value: (0.70 ± 0.12) × 10^-3 mm²/s vs (1.14 ± 0.28) × 10^-3 mm²/s; D value: (0.47 ± 0.07) × 10^-3 mm²/s vs (0.76 ± 0.14) × 10^-3 mm²/s, all P < 0.01]. The sensitivity and specificity of D value were 93.8% and 92.3%, respectively.

CONCLUSION

The standard ADC value and D value may be used as an indicator to distinguish vertebral metastases from atypical VHs. FOCUS IVIM-derived parameters provide potential value in the quantitatively differentiating vertebral metastases from vertebral atypical hemangiomas.