PDF(Pubmed)
Abstract：
BACKGROUND: Aggressive vertebral hemangioma (VH) is an uncommon lesion in the adult population. The vast majority of aggressive VHs have typical radiographic features. However, preoperative diagnosis of atypical aggressive VH may be difficult. Aggressive VHs are likely to recur even with en bloc resection.
METHODS: A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity. Physical examination showed sacral tenderness and limited mobility, and the muscle strength was grade 4 in the right digital flexor. Computed tomography revealed osteolytic bone destruction from S1 to S2. Magnetic resonance imaging (MRI) showed that the mass was compressing the dural sac; it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI, and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1. The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively, and MRI examination showed recurrence of the mass. The mass was larger in size than before the operation, and it was extending into the spinal canal.
CONCLUSIONS: The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction, extension of the mass into the spinal canal, and heterogeneous signal intensity on T1-, T2-, and enhanced T1-weighted MRI. These characteristics make preoperative diagnosis difficult, and biopsy is necessary to verify the lesion. Surgical decompression and gross total resection are recommended for treatment of aggressive VH. However, recurrence is inevitable in some cases.
METHODS: A 52-year-old woman presented with a 3-mo history of numbness and pain in her right lower extremity. Physical examination showed sacral tenderness and limited mobility, and the muscle strength was grade 4 in the right digital flexor. Computed tomography revealed osteolytic bone destruction from S1 to S2. Magnetic resonance imaging (MRI) showed that the mass was compressing the dural sac; it was heterogeneously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI, and gadolinium contrast enhancement showed that the tumor was heterogeneously enhanced and invading the vertebral endplate of S1. The patient developed progressive back pain and numbness in the bilateral extremities 6 mo postoperatively, and MRI examination showed recurrence of the mass. The mass was larger in size than before the operation, and it was extending into the spinal canal.
CONCLUSIONS: The radiographic findings of atypical aggressive VH include osteolytic vertebral bone destruction, extension of the mass into the spinal canal, and heterogeneous signal intensity on T1-, T2-, and enhanced T1-weighted MRI. These characteristics make preoperative diagnosis difficult, and biopsy is necessary to verify the lesion. Surgical decompression and gross total resection are recommended for treatment of aggressive VH. However, recurrence is inevitable in some cases.
摘要：
背景：侵袭性椎体血管瘤（VH）在成年人群中并不常见。绝大多数侵袭性VHs具有典型的射线照相特征。然而,术前诊断非典型侵袭性VH可能比较困难.即使进行整块切除，侵略性的VHs也可能复发。
方法：一名52岁女性，有3个月的右下肢麻木和疼痛病史。体格检查显示骶骨压痛和活动受限，右指屈肌力为4级.计算机断层扫描显示从S1到S2的溶骨性骨破坏。磁共振成像（MRI）显示肿块正在压迫硬脑膜囊；它在T1加权MRI上是异质低的，在T2加权MRI上是高强度的，钆对比增强显示肿瘤不均匀增强并侵入S1椎体终板。患者在术后6个月出现进行性背痛和双侧四肢麻木，MRI检查显示肿块复发。质量比手术前大，它延伸到椎管。
结论：非典型侵袭性VH的影像学发现包括溶骨性椎体骨破坏，肿块延伸到椎管，和T1-上的异质信号强度，T2-,和增强的T1加权MRI。这些特点使术前诊断困难,活检是必要的，以验证病变。建议对侵袭性VH进行手术减压和全切。然而,在某些情况下，复发是不可避免的。
方法：一名52岁女性，有3个月的右下肢麻木和疼痛病史。体格检查显示骶骨压痛和活动受限，右指屈肌力为4级.计算机断层扫描显示从S1到S2的溶骨性骨破坏。磁共振成像（MRI）显示肿块正在压迫硬脑膜囊；它在T1加权MRI上是异质低的，在T2加权MRI上是高强度的，钆对比增强显示肿瘤不均匀增强并侵入S1椎体终板。患者在术后6个月出现进行性背痛和双侧四肢麻木，MRI检查显示肿块复发。质量比手术前大，它延伸到椎管。
结论：非典型侵袭性VH的影像学发现包括溶骨性椎体骨破坏，肿块延伸到椎管，和T1-上的异质信号强度，T2-,和增强的T1加权MRI。这些特点使术前诊断困难,活检是必要的，以验证病变。建议对侵袭性VH进行手术减压和全切。然而,在某些情况下，复发是不可避免的。
