Article Figures & Data
Figures
- Fig 1.
Case 3, a cystlike mass with T1 hyperintensity (type A).
A, The transverse T2-weighted spin-echo MR image demonstrates a well-defined mass at the anterior epidural space of L5. The mass shows bright high signal intensity, same as that of CSF. There is a rim of low signal intensity.
B, On the transverse noncontrast T1-weighted image, the mass shows heterogeneous high signal intensity with a rim of low signal intensity. Signal intensity of the anterior portion of the mass is lower than that of the posterior portion.
C, On the transverse fat-suppressed, postcontrast T1-weighted image, the anterior portion of the mass also shows strong enhancement.
D, On the sagittal T2-weighted image, the mass is located at the anterior epidural space of the L5 spinal level. The mass shows bright high signal intensity with a rim of low signal intensity.
E, On the sagittal noncontrast T1-weighted image, the mass (arrow) shows higher signal intensity than that of the intervertebral disk. We can see the rim of low signal intensity in the distal margin of the mass.
F, On the sagittal fat-suppressed, postcontrast T1-weighted image, the mass shows strong heterogeneous enhancement.
G, On microscopic examination, there is a vascular tumor composed of variable-sized, thick-walled, muscularized vessels, suggestive of an arteriovenous hemangioma. There is a focus of an organized hematoma with pigments of hemosiderin (H&E, × 100).
- Fig 2.
Case 2, a cystlike mass with T1 isointensity (type B).
A, Transverse T2-weighted gradient-echo MR image demonstrates a well-defined mass with high signal intensity at the left posterior epidural space of C7-T1.
B, On transverse noncontrast T1-weighted MR image, the mass (arrow) shows homogeneous isointensity.
C, On sagittal noncontrast T1-weighted MR image, the signal intensity of the mass (arrow) is isointense to that of the intervertebral disk.
D, On coronal postcontrast T1-weighted image, the mass shows peripheral thick enhancement with inner septumlike enhancement.
E, Histologic section shows cystic dilated vessels with smooth muscle in the walls, suggestive of a venous hemangioma (H&E, × 100). There is no evidence of an organized hematoma.
- Fig 3.
Case 6, a solid hypervascular mass (type C).
A, Sagittal T2-weighted spin-echo MR image demonstrates the mass at the posterior epidural space of T9-T11. The mass shows homogeneous high signal intensity. The spinal cord is severely compressed by the mass and shows high signal intensity, suggestive of compressive myelopathy.
B, On noncontrast transverse T1-weighted spin-echo MR image, the mass shows heterogeneous isointensity with area of high signal intensity (arrow) at the posterior portion of the mass. The mass extends to the left neural foramen.
C, On sagittal postcontrast T1-weighted image, the mass shows homogeneous strong enhancement. A dural tail sign is also seen (arrows).
D, Photomicrograph reveals the formation of large cavernous vascular channels separated by a scant connective stroma. The spaces are lined by a flattened monolayer of endothelial cells (H&E, × 100).
- Fig 4.
Case 10, an epidural hematoma (type D).
A, Sagittal T2-weighed spin-echo MR image demonstrates an ill-defined lesion with heterogeneous low and high signal intensity at the posterior epidural space of C5-C7.
B, On sagittal noncontrast T1-weighed spin-echo MR image, there is high signal intensity in that lesion, suggestive of a hematoma.
C, On sagittal postcontrast T1-weighed spin-echo MR image, the lesion shows heterogeneous enhancement.
D, On histologic examination, most of the area is an organized thrombus. There are scattered small foci of large, dilated, blood-filled vessels lined by flattened endothelium, which represents a cavernous hemangioma (H&E, × 100).
Tables
- Table 1:
Summary of MR imaging features of spinal epidural hemangiomas—location, level, and signal characteristics
Case No. Location Level Epidural T1WI T2WI CE MR Type 1 L5-S1 1 Ant High Bright high with rim NA A 2 C7-T1 2 Post Iso High with rim Peripheral strong B 3 L5 1 Ant HT high Bright high with rim HT strong A 4 T11-T12 2 Post Iso HM high HM strong C 5 T2-T4 4 Post Iso HM bright high HM strong C 6 T9-T11 4 Post Iso with bright foci HT high HM strong C 7 C6-T2 4 Post Iso HM high HM strong C 8 C5-T4 7 Both High HT high and low HT strong D 9 T6–7 2 Post Iso HM high HM strong C 10 C5-C7 4 Post High with bright foci HT high and low HT strong D 11 T3-T4 2 Post Iso HM high HM strong C 12 L4–5 1 Ant Iso Bright high with rim Peripheral strong B 13 L3 1 Ant Iso Bright high with rim Peripheral strong B 14 C6-T1 5 Ant Iso HM high HM strong C Note:—Level indicates craniocaudal extension described as the number of vertebrae where mass was present; Epidural, location of masses either anterior (Ant) or posterior (Post) epidural space; T1WI, T1-weighted MR image; T2WI, T2-weighted MR image; CE, contrast-enhanced MR image; A, cystlike mass with T1 hyperintensity; B, cystlike mass with T1 isointensity; C, solid hypervascular mass; D, epidural hematoma; Iso, isointense; HM, homogeneous signal intensity; HT, heterogeneous signal intensity; Peripheral, peripheral enhancement.
- Table 2:
Summary of MR imaging features of spinal epidural hemangiomas—low signal rim, dural tail sign, and mass effect
Case No. MR Type Contour Low Signal Rim on T1WI Low Signal Rim on T2WI Low Signal Rim on CE Dural Tail Sign Cord Comp NF Widen Vertebral Body 1 A Smooth Yes Yes NA NA No No Intact 2 B Lobular No Yes No No No No Intact 3 A Lobular Yes Yes Yes No No No Intact 4 C Smooth Yes Yes No Yes No No Intact 5 C Lobular No No No No No Yes Intact 6 C Lobular No No No Yes Yes Yes Intact 7 C Lobular Yes Yes No Yes Yes Yes Erosion 8 D Ill-defined No No No Yes Yes Yes Intact 9 C Smooth Yes Yes Yes No Yes No Intact 10 D Ill-defined No No No No Yes No Intact 11 C Lobular No Yes Yes No Yes Yes Erosion 12 B Lobular No Yes No No No No Intact 13 B Smooth No No No No No No Intact 14 C Lobular Yes Yes No No Yes Yes Erosion Note:—T1WI indicates T1-weighted MR image; T2WI, T2-weighted MR image; CE, contrast-enhanced MR image; Cord comp, cord compression; NF widen, neural foraminal widening; Vertebral body, involvement of vertebral body.
Case No. MR Type Histological Feature Hematoma Location Epidural Level CC 1 A Arteriovenous Yes Lumbosacral Ant 1 Radiculopathy 2 B Venous No Cervicothoracic Post 2 Radiculopathy 3 A Arteriovenous Yes Lumbar Ant 1 Radiculopathy 4 C Cavernous No Thoracic Post 2 Radiculopathy 5 C Cavernous No Thoracic Post 4 Axial pain 6 C Cavernous No Thoracic Post 4 Myelopathy 7 C Cavernous No Cervicothoracic Post 4 Myelopathy 8 D Cavernous Yes Cervicothoracic Post 7 Myelopathy 9 C Cavernous No Thoracic Post 2 Myelopathy 10 D Cavernous Yes Cervical Post 4 Radiculopathy 11 C Cavernous No Thoracic Post 2 Myelopathy 12 B Venous No Lumbar Ant 1 Radiculopathy 13 B Venous No Lumbar Ant 1 Radiculopathy 14 C Cavernous No Cervicothoracic Ant 5 Myelopathy Note:—A indicates cystlike mass with T1 hyperintensity; B, cystlike mass with T1 isointensity; C, solid hypervascular mass; D, epidural hematoma; Epidural, location of masses either anterior (Ant) or posterior (Post) epidural space; Level, craniocaudal extension described as the number of vertebrae where mass was present; CC, chief complaint.
