Vertebral Hemangioma

Introduction

Vertebral hemangiomas (VHs) are benign vascular tumors frequently encountered as incidental findings on computed tomography (CT) or magnetic resonance imaging (MRI). The vast majority are quiescent, with classic imaging features that are reassuring to radiologists and patients, and are called typical hemangiomas. VHs that are clinically quiescent but do not demonstrate classic imaging features are frequently referred to as atypical hemangiomas. These may produce a diagnostic challenge, requiring additional diagnostic tests and potentially even confirmatory biopsy but incur little risk to the patient. A small percentage of VHs can display active behavior, demonstrating aggressive imaging features that can mimic primary bone malignancies or metastases. These “aggressive hemangiomas” are frequently clinically symptomatic, resulting in pain or neurologic compromise. Treatment options vary by patient and institution, but most commonly include radiotherapy and/or surgery.