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Spine and Back Health

Atypical Hemangioma vs Lesion



My recent MRI indicated a focal area of high T2 weighted signal noted within the L2 vertebral body. The report stated this may represent an atypical hemangioma, however, the report goes on to state that a bone scan could be considered to rule out a metabolically active lesion. What does this mean and plese define the term atypical hemangioma. Thank you!


Hello, thank you for your question. A hemangioma is a benign growth that is often found in the bones of the spine. They are almost never related to the person’s symptoms, but usually found by accident when the person gets an MRI for some other reason. They often have a very typical “color” on MRI scans, but some of them can look a little odd, either too dark or too bright compared to what they normally look like. It’s well known that these unusual colored (“atypical”) hemangiomas are nothing to worry about. However, they can sometime look a little bit like what other, more serious lesions (like a tumor, or even cancer) might look like. It can be hard to tell the difference by the MRI, so radiologists often comment on these things and recommend things like bone scans to make sure it’s not something bad.

Benign things like hemangiomas usually don’t “light up” on a bone scan, whereas cancers or other tumors usually will. In the end, it’s up to your doctor to decide whether to order further tests or not. Usually these turn out to be nothing. Good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University