Spinal Epidural Cavernous Hemangioma: A Clinical Series of 7 Patients.

Objective: To investigate imaging characteristics of spinal epidural cavernous hemangiomas (ECHs) and improve understanding of this rare disease.

Methods: This retrospective study included 7 cases of ECH, confirmed with surgical pathology and imaging. All patients underwent computed tomography and conventional magnetic resonance imaging. One patient underwent diffusion-weighted imaging.

Results: ECH originated from vertebrae with coarsened trabeculae in 5 patients. Among these, 1 tumor was mainly in the intervertebral foramen and paravertebral space, 2 extended to the intraspinal and paravertebral spaces and appeared dumbbell-shaped, and 2 were located in the intraspinal space. Purely epidural hemangiomas were present in 2 patients; 1 of these patients had adjacent bony erosion. Epidural hemangiomas were isointense in 6 patients and hyperintense in 1 patient on T1-weighted images; lesions were hyperintense on T2-weighted images in all 7 patients. Peripheral fat was present in 4 ECHs; 2 were of vertebral origin, and 2 were of epidural space origin. In the patient who underwent diffusion-weighted imaging, the lesion showed restricted diffusion. The affected vertebra had coarsened trabeculae, which may be a critical finding for differentiating ECHs of vertebral origin from foraminal nerve sheath tumors. Peripheral fat around hemangiomas of vertebral origin and primary epidural space hemangiomas indicates chronicity.

Conclusions: ECHs are classified either as epidural hemangiomas of vertebral origin or as primary epidural hemangiomas. Awareness of imaging characteristics of ECHs may facilitate diagnosis and treatment of these lesions.