1. The Radiologic Diagnosis and Treatment of Typical and Atypical Bone Hemangiomas: Current Status 
Sum Leong, FFRRCSI, Hong Kuan Kok, MRCP, FFRRCSI, Holly Delaney, FFRRCSI, John Feeney, FFRRCSI, Iain Lyburn, FRCR, Peter Munk, MDCM, FRCPC, FSIR, William Torreggiani, FFRRCSI, FRCR 
Canadian Association of Radiologists Journal 
Volume 67, Issue 1, Pages 2-11 (February 2016)
DOI: /j.carj
Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

2. Figure 1
A 75-year-old man presented with lower back pain after a mechanical fall. Thoracic spine radiographs in the lateral projection, showing a typical hemangioma (arrow) at the T12 vertebral body with classic corduroy appearances.
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3. Figure 2
(A, B) A 45-year-old man presented with renal colic underwent a non contrast computed tomography of the abdomen, showing an incidental hemangioma at the L1 vertebral body, with characteristic polka dot (arrow in A) and corduroy and/or honeycomb appearance (arrow in B).
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4. Figure 3
A 60-year-old woman presented with lower back pain for 6 months and underwent magnetic resonance imaging of the lumbar spine, showing an incidental typical appearing hemangioma (arrows in A and B) in the L3 vertebral body that was (A) T1 and (B) T2 hyperintense. A 49-year-old man with intermittent radicular pain for 2 years underwent magnetic resonance imaging of the lumbar spine, showing an incidental hemangioma in the T12 vertebral body, which demonstrates loss of signal intensity on the (C) out-of-phase compared with the (D) in-phase acquisition.
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5. Figure 4
A 70-year-old man with upper back pain underwent an isotope bone scan with Technetium 99m Methyl Diphosphonate. A photopenic defect was detected at the T11 vertebral body on both (A) anterior and (B) posterior planar images, which on computer tomography (not shown) had typical features of a hemangioma. Also evident are right humeral head uptake due to previous avascular necrosis, T9 vertebral body uptake due to wedge compression fracture, and right 10th rib uptake due to an old traumatic fracture.
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6. Figure 5
(A) A 63-year-old man underwent positron emission tomography (PET) computed tomography (CT) as part of staging for lymphoma before chemotherapy. (A) The punctate sclerotic foci on transversal axial CT in the vertebral body of T10 are classic vertebral hemangioma. This lesion is not fluorodeoxyglucose avid on the (B) PET and (C) PET-CT images. This lesion also showed typical hemangioma findings on magnetic resonance imaging.
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7. Figure 6
(A) Frontal and (B) lateral plain radiographs of the skull of a 56-year-old man, showing a coarse expansion of the diploic space that affects the outer and inner tables. The lesion shows a mixed lytic lesion with trabecular thickening that appears as a radiating-like pattern (arrow in B). Magnetic resonance imaging of the brain of a different patient, a 68-year-old healthy man who presented with intermittent headaches, showing (C) an incidental T1 isointense and (D) FLAIR hyperintense 2-cm flat lesion (arrow in C and in D) in the left parietal bone between the inner and outer tables. (E) Mild enhancement (arrow in E) is seen after gadolinium enhancement. This lesion has been stable over a 5-year interval, which confirmed a nonaggressive calvarial hemangioma.
Canadian Association of Radiologists Journal  , 2-11DOI: ( /j.carj )
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8. Figure 7
(A) A 39-year-old man initially presented with lower back pain. (A) A magnetic resonance image of the lumbar spine, showing a lesion (arrow) confined to the L1 vertebral body posterior superiorly, which was predominantly hypointense on T1 with an outer hyperintense component. (B) On T2-weighted images, this lesion appeared isointense to mildly hyperintense, with punctate hypointense areas within. (C) On the short-time inversion recovery images, this lesion appears hyperintense; atypical hemangioma was considered most likely at this stage. (D) A computed tomography, showing the typical corduroy appearance, which confirms the lesion to be a hemangioma.
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9. Figure 8
A 61-year-old man with a newly diagnosed gastrointestinal stromal tumour was found to have an abnormal lesion that involved the T10 vertebral body on magnetic resonance imaging. This lesion appeared T1 and T2 hyperintense but had an extradural component, which appears (A) T1 hypointense and (B) T2 hyperintense. Signal characteristics and an extradural component were atypical for a hemangioma. However, the patient had a computed tomography of the thorax (C, D) performed 2 years earlier, which showed a stable well-defined lucent lesion with a corduroy pattern to the T10 vertebral body component, as well as an enhancing extradural component (arrow in C). There was also enhancement of extradural component after gadolinium administration (arrow in E).
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10. Figure 9
(A) A 45-year-old man presented with left-sided chest pain and underwent a chest radiograph, which demonstrated a left fifth rib based exophytic lesion (arrow in A). (B) On computed tomography, there is lytic expansion of the underlying rib, and the exophytic component showed mixed lucent areas with coarsened trabeculation. A biopsy of this lesion was performed and proved to be a hemangioma.
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11. Figure 10
A 37-year-old man presented with right arm pain. (A) Initial plain radiographs, demonstrating a cortical lytic lesion (arrow) in the mid portion of the right humerus. (B) This lesion was markedly short-time inversion recovery (STIR) hyperintense, (C) T1 hypointense (arrow in C), and (D) T2 mildly hyperintense. There was evidence of intramedullary extension and a large soft tissue component. After the biopsy, this was proven to be a hemangioma.
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12. Figure 11
A 32-year-old healthy man presented with lower back pain and underwent magnetic resonance imaging, showing an expansile aggressive-appearing lesion that involved the T8 vertebral body and posterior elements. There was extension into the spinal canal and also a pathologic fracture that involved this vertebral body. (A) The lesion was hypointense on T1, (B) hyperintense on T2, and (C) showed homogenous enhancement after gadolinium administration. (D) There were mixed aggressive features with lytic destruction of the vertebral body cortex and some coarsened trabeculae on computed tomography. After percutaneous biopsy, this lesion was confirmed histologically to represent a hemangioma.
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13. Figure 12
A 33-year-old man presented with a symptomatic hemangioma in the T9 vertebral body. Before preoperative excisional biopsy and internal fixation, the patient underwent transarterial embolization to devascularize the tumour, which reduced the risk of bleeding intraoperatively. (A, B) Atypical biopsy-proven vertebral hemangioma, showing a lytic expansile posterior element and hypervascular spinal canal components on computed tomography on bone and soft tissue windows, (C) pre-embolization spinal angiogram (with arrow), showing blush of spinal canal component of hemangioma, (D) after embolization, with coils in the right intercoastal artery (arrow).
Canadian Association of Radiologists Journal  , 2-11DOI: ( /j.carj )
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14. Figure 13
A 39-year-old man presented with a mid back pain and his symptoms were found to be caused by a symptomatic hemangioma at the L2 vertebral body. He subsequently underwent cement vertebroplasty by using a bipedicular approach, with marked improvement of clinical symptoms.
Canadian Association of Radiologists Journal  , 2-11DOI: ( /j.carj )
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