Imaging features of hemangioma in long tubular bones

Abstract

Background: To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis.

Methods: Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5].

Results: Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI.

Conclusions: The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.

Keywords: Computed tomography; Hamangioma; Long bone; Magnetic resonance imaging.; Plain radiography.

Fig. 1

Medullary hemangioma in the proximal end of tibia. Plain radiograph of the anteroposterior (a) and lateral view (b) of the proximal tibia and fibula showed an eccentric, expansile, osteolytic lesion at the proximal end of the tibia, with coarse bone ridges inside the lesion like a honeycomb. The cortical bone was thinned, periosteal reaction was presented, and tortuous vascular structures were seen in the interior soft tissue

Fig. 2

Periosteal hemangioma. a. Plain radiograph of the lateral view of distal humerus showed an expansile lesion at the lateral humerus with radial bone crest perpendicular to the bone cortex inside the lesion. Coarse ridges were also seen inside the lesion. b & c. Pain radiograph of the anteroposterior view of the middle and upper fibula revealed that the middle and upper segments of the right fibula were enlarged with irregular osteosclerosis and low-density lesions inside. Local bone cortex was depressed, forming a pressure trace, and punctate calcification was demonstrated inside the adjacent soft tissue

Fig. 3

Imaging of intracortical hemangioma. a & b. Plain radiograph of the anteroposterior view of the proximal femur (a) and computed tomography imaging in transverse view (b) demonstrated an intracortical hemangioma lesion below the right femoral trochanter. The lesion was fusiform with the long axis parallel to the long axis of the femur and was expansile and osteolytic with osteodermic sclerosis at the edge. c & d. Plain radiographs of the anteroposterior (c) and lateral view (d) of the distal femur revealed an osteolytic bone defect with septa inside the lesion at the distal interior end of the left femur. The medullary side of the lesion was osteoslerotic with discontinuation of the interior bone cortex

Fig. 4

Medullary and intracortical hemangiomas. a. Coronal reconstruction of computed tomography (CT) imaging showed that the medullary hemangioma lesion was located inside the medullary cavity in the intertrochanteric femur with bone septations and osteosclerotic rims. b & c. Sagittal reconstruction of CT imaging (b) and axial T2WI magnetic resonance imaging (c) showed local wedge bone destruction with tortuous vessels in adjacent soft tissue. Enhancement scanning (b) displayed uneven enhancement in the vessels and adjacent medullary cavity

Fig. 5

Medullary hemangioma. Coronal T1WI (a) and T2WI (b) showed that the medullary hemangioma lesion was located inside the medullary cavity, extending downwards to the upper and middle segments of the femur, in hypointense signal on T1WI and hyperintense signal on T2WI. The lesion was like expanded vessels with clear margins