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. 2011 Oct 1;5(10):7–13. doi: 10.3941/jrcr.v5i10.828

Table 2:

Differential diagnosis for aggressive vertebral hemangioma

CT MR T1 and T2 Weighted Gadolinium enhanced MRI
Hemangioma

  • Hypodense lesion centered in vertebral body. Sometimes expansile.

  • Sparse, thickened trabeculae surrounded by hypodense fat.

  • “Polka-dot” appearance on axial images.

  • “Corduroy” appearance on sagittal and coronal plane

  • Avid enhancement.

  • T1WI: Iso- to hypo-intense

  • T2WI: Hyperintense.

  • May have extraosseous soft tissue extension and/or pathologic fracture.

 Avid enhancement.
Osseous metastases

  • Can be lytic or blastic, usually differentiated from hemangioma by destruction of the trabeculae.

  • Variable enhancement

  • T1WI: Iso- to hypo-intense

  • T2WI: Usually hyper-intense.

  • May have extraosseous soft tissue extension and/or pathologic fracture.

 Variable enhancement.
Lymphoma

  • Homogeneous, slightly dense mass.

  • Permeative bone destruction.

  • Homogeneous enhancement

  • T1WI: Hypointense

  • T2WI: Hypo- to hyper-intense.

 Diffuse, uniform enhancement.
Paget disease

  • Expansile mass.

  • Disorganized trabeculae.

  • Cortical thickening

  • Significant marrow enhancement in active phase.

  • T1WI: Hypointense cortex. Hypointense marrow in active phase, hyperintense in mixed phase.

  • T2WI: Hypointense cortex. Hyperintense marrow in active and mixed phases.

 Enhancement in active phase.