Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation.
OBJECTIVE
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.


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.
Lee
J W
JW
Department of Radiology, Seoul National University Bundang Hospital, Gyeongi-Do, Korea.
Cho
E Y
EY
Hong
S H
SH
Chung
H W
HW
Kim
J H
JH
Chang
K-H
KH
Choi
J-Y
JY
Yeom
J-S
JS
Kang
H S
HS
D000293:Adolescent; D002574:Cervical Vertebrae / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015174:Epidural Neoplasms / Q000473:pathology*; D005260:Female; D006391:Hemangioma / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013904:Thoracic Vertebrae / Q000473:pathology
Spine (Phila Pa 1976). 2000 Mar 1;25(5):629-31
10749642
J Comput Assist Tomogr. 2001 Mar-Apr;25(2):257-61
11242225
Surg Neurol. 1999 Aug;52(2):198-203
10447290
Neurosurgery. 1995 Aug;37(2):195-204; discussion 204-5
7477769
Eur Radiol. 2000;10(4):615-23
10795544
AJNR Am J Neuroradiol. 2003 Feb;24(2):190-2
12591632
Surg Neurol. 1998 Dec;50(6):535-47
9870814
Neurosurg Rev. 2003 Oct;26(4):292-6
14520522
Spinal Cord. 2002 Apr;40(4):200-2
11965560
Acta Neurochir (Wien). 2001 Dec;143(12):1293-7
11810396
AJNR Am J Neuroradiol. 1999 Aug;20(7):1365-72
10472999
AJNR Am J Neuroradiol. 1991 Mar-Apr;12(2):243-4
1902020
AJNR Am J Neuroradiol. 1991 Sep-Oct;12(5):1021-2
1950897
Surg Neurol. 1986 Feb;25(2):142-4
3941982
Surg Neurol. 2005 Jul;64(1):83-5; discussion 85
15993196
AJNR Am J Neuroradiol. 1996 Apr;17(4):713-9
8730192
Spine (Phila Pa 1976). 2004 Nov 15;29(22):E524-7
15543055
J Comput Assist Tomogr. 1990 Mar-Apr;14(2):250-4
2312854
AJNR Am J Neuroradiol. 1997 Feb;18(2):363-6
9111677
J Neurosurg. 1998 May;88(5):903-8
9576262
AJNR Am J Neuroradiol. 1991 Nov-Dec;12(6):1087-93
1763732
AJNR Am J Neuroradiol. 1999 Jan;20(1):27-31
9974054