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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleSpine Imaging and Spine Image-Guided Interventions
Open Access

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

K.A. Morales, J. Arevalo-Perez, K.K. Peck, A.I. Holodny, E. Lis and S. Karimi
American Journal of Neuroradiology April 2018, DOI: https://doi.org/10.3174/ajnr.A5630
K.A. Morales
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
cUniversity of Puerto Rico Medical Sciences Campus (K.A.M.), San Juan, Puerto Rico.
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J. Arevalo-Perez
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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K.K. Peck
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
bMedical Physics (K.K.P.), Memorial Sloan Kettering Cancer Center, New York, New York
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A.I. Holodny
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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E. Lis
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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S. Karimi
aFrom the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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Abstract

BACKGROUND AND PURPOSE: Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance, and they can mimic metastases on routine MR imaging. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately additional imaging, biopsy, and unnecessary costs. Our objective was to assess the utility of dynamic contrast-enhanced MR imaging perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesized that permeability and vascular density will be increased in metastases compared with atypical hemangiomas.

MATERIALS AND METHODS: Consecutive patients from 2011 to 2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinomas with available dynamic contrast-enhanced MR imaging were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume, and permeability constant were quantified using an extended Tofts 2-compartment pharmacokinetic model. Statistical significance was tested using the Mann-Whitney U test.

RESULTS: Qualitative inspection of dynamic contrast-enhanced MR imaging time-intensity curves demonstrated differences in signal intensity and morphology between metastases and atypical hemangiomas. Quantitative analysis of plasma volume and permeability constant perfusion parameters showed significantly higher values in metastatic lesions compared with atypical hemangiomas (P < .001).

CONCLUSIONS: Our data demonstrate that plasma volume and permeability constant perfusion parameters and qualitative inspection of contrast-enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This work highlights the benefits of adding perfusion maps to conventional sequences to improve diagnostic accuracy.

ABBREVIATIONS:

DCE
dynamic contrast-enhanced
Ktrans
permeability constant
VH
vertebral hemangioma
Vp
plasma volume

Footnotes

  • Krystal A. Morales and Julio Arevalo-Perez contributed equally to the work as coauthors.

  • Disclosures: Krystal A. Morales—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748, National Cancer Institute R25CA020449, Comments: Medical Student Summer Fellowship Program of the Memorial Sloan Kettering Cancer Center is a research program for first- and second-year students at US medical schools who are interested in careers as physician-scientists in the field of oncology and/or related biomedical sciences. Funded since 1977 by the National Cancer Institute, this program grants students the opportunity to conduct basic laboratory or clinical research under the mentorship of Memorial Sloan Kettering faculty. Julio Arevalo-Perez—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748.* K.K. Peck—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748. A.I. Holodny—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748. Eric Lis—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748; UNRELATED: Payment for Lectures Including Service on Speakers Bureaus: Medtronic. S. Karimi—RELATED: Grant: NIH/NCI Cancer Center Support Grant P30 CA008748. *Money paid to the institution.

  • This research was funded, in part, through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748 and the National Cancer Institute of the National Institutes of Health under award No. R25CA020449.

  • Paper previously presented as an electronic presentation at: Annual Meeting of the American Society of Neuroradiology and the Foundation of the ASNR Symposium, May 21–26, 2016; Washington, DC.

  • The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • © 2018 by American Journal of Neuroradiology

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K.A. Morales, J. Arevalo-Perez, K.K. Peck, A.I. Holodny, E. Lis, S. Karimi
Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI
American Journal of Neuroradiology Apr 2018, DOI: 10.3174/ajnr.A5630

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Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI
K.A. Morales, J. Arevalo-Perez, K.K. Peck, A.I. Holodny, E. Lis, S. Karimi
American Journal of Neuroradiology Apr 2018, DOI: 10.3174/ajnr.A5630
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