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Hemangioma from Head to Toe: MR Imaging with Pathologic Correlation¹

¹ From the Departments of Magnetic Resonance (J.C.V., J.B., M.V.) and Pathology (J.M., F.M.), Clínica Girona, Lorenzana 36, 17002 Girona, Spain; the Department of Radiology, Uniformed Services University, Bethesda, Md (J.G.S.); the Department of Radiology, Hospital Universitari "Germans Trias i Pujol," Badalona, Spain (R.P.A., J.C.); and the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (P.R.R.). Recipient of an Excellence in Design award for an education exhibit at the 2002 RSNA scientific assembly. Received March 24, 2003; revision requested May 14 and received June 19; accepted June 19. All authors have no financial relationships to disclose. Address correspondence to J.C.V. (e-mail: rmgirona@comg.es).

View larger version (155K): [in a new window]   Figure 1a. AVM. (a) Axial T2-weighted MR image shows multiple serpentine flow voids. (b) Photograph of the gross specimen demonstrates dilated arteries and veins (arrows).

View larger version (146K): [in a new window]   Figure 1b. AVM. (a) Axial T2-weighted MR image shows multiple serpentine flow voids. (b) Photograph of the gross specimen demonstrates dilated arteries and veins (arrows).

View larger version (119K): [in a new window]   Figure 2. AVM. Axial maximum-intensity-projection MR angiogram from a time-of-flight sequence shows a dilated feeding left middle cerebral artery (thin arrow) and draining veins (thick arrows).

View larger version (148K): [in a new window]   Figure 3a. Cavernous angioma. (a) Axial T2-weighted MR image of the brain shows a left frontal periventricular nodular lesion with a thick hypointense rim (arrow). (b) High-power photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows multiple vascular spaces of varying size. The vessels are stacked on top of each other with no intervening brain tissue.

View larger version (168K): [in a new window]   Figure 3b. Cavernous angioma. (a) Axial T2-weighted MR image of the brain shows a left frontal periventricular nodular lesion with a thick hypointense rim (arrow). (b) High-power photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) shows multiple vascular spaces of varying size. The vessels are stacked on top of each other with no intervening brain tissue.

View larger version (163K): [in a new window]   Figure 4. Venous malformation. Axial spin-echo T2-weighted MR image of the brain shows a tubular flow void with a radiating "crown of voids" in the left side of the pons.

View larger version (111K): [in a new window]   Figure 5a. Vein of Galen malformation. (a) Sagittal spin-echo T1-weighted MR image shows a flow void in the vein of Galen (*). (b) Sagittal two-dimensional phase-contrast MR angiogram shows high-signal-intensity flow related to a venous malformation.

View larger version (112K): [in a new window]   Figure 5b. Vein of Galen malformation. (a) Sagittal spin-echo T1-weighted MR image shows a flow void in the vein of Galen (*). (b) Sagittal two-dimensional phase-contrast MR angiogram shows high-signal-intensity flow related to a venous malformation.

View larger version (101K): [in a new window]   Figure 6a. Intradural capillary hemangioma. (a) Sagittal T2-weighted MR image shows a high-signal-intensity nodular extramedullary lesion (arrow) with serpiginous retromedullary areas of signal void (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows the intradural extramedullary lesion (*) compressing the spinal cord to the right (arrow). (c) Coronal multiplanar reformatted MR angiogram shows the multilobular nodular lesion (arrow) with septa and serpiginous vessels. (d) Photomicrograph (original magnification, x200; H-E stain) reveals small vessels lined by flattened mature endothelium (arrows).

View larger version (131K): [in a new window]   Figure 6b. Intradural capillary hemangioma. (a) Sagittal T2-weighted MR image shows a high-signal-intensity nodular extramedullary lesion (arrow) with serpiginous retromedullary areas of signal void (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows the intradural extramedullary lesion (*) compressing the spinal cord to the right (arrow). (c) Coronal multiplanar reformatted MR angiogram shows the multilobular nodular lesion (arrow) with septa and serpiginous vessels. (d) Photomicrograph (original magnification, x200; H-E stain) reveals small vessels lined by flattened mature endothelium (arrows).

View larger version (116K): [in a new window]   Figure 6c. Intradural capillary hemangioma. (a) Sagittal T2-weighted MR image shows a high-signal-intensity nodular extramedullary lesion (arrow) with serpiginous retromedullary areas of signal void (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows the intradural extramedullary lesion (*) compressing the spinal cord to the right (arrow). (c) Coronal multiplanar reformatted MR angiogram shows the multilobular nodular lesion (arrow) with septa and serpiginous vessels. (d) Photomicrograph (original magnification, x200; H-E stain) reveals small vessels lined by flattened mature endothelium (arrows).

View larger version (117K): [in a new window]   Figure 6d. Intradural capillary hemangioma. (a) Sagittal T2-weighted MR image shows a high-signal-intensity nodular extramedullary lesion (arrow) with serpiginous retromedullary areas of signal void (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows the intradural extramedullary lesion (*) compressing the spinal cord to the right (arrow). (c) Coronal multiplanar reformatted MR angiogram shows the multilobular nodular lesion (arrow) with septa and serpiginous vessels. (d) Photomicrograph (original magnification, x200; H-E stain) reveals small vessels lined by flattened mature endothelium (arrows).

View larger version (88K): [in a new window]   Figure 7a. AVM of the spinal cord. (a) Sagittal T2-weighted MR image shows flow voids along the surface of the spinal cord (arrowheads) and a serpentine vascular structure with flow voids at the C6-7 level (arrow). (b) Sagittal contrast-enhanced three-dimensional MR angiogram demonstrates a nidus (thick arrow) with a large feeding vessel (thin arrow).

View larger version (60K): [in a new window]   Figure 7b. AVM of the spinal cord. (a) Sagittal T2-weighted MR image shows flow voids along the surface of the spinal cord (arrowheads) and a serpentine vascular structure with flow voids at the C6-7 level (arrow). (b) Sagittal contrast-enhanced three-dimensional MR angiogram demonstrates a nidus (thick arrow) with a large feeding vessel (thin arrow).

View larger version (120K): [in a new window]   Figure 8a. Hepatic cavernous hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lobulated tumor with central necrosis (*). (b) Axial contrast-enhanced T1-weighted MR image shows the tumor with the typical centripetal pattern of peripheral enhancement (arrows). (c) Photograph of the gross specimen shows the vascular cystic spaces (arrows) of the tumor (hemangioma). (d) Photomicrograph (original magnification, x200; H-E stain) shows dilated vascular spaces filled with blood and lined by a single layer of endothelial cells (arrows).

View larger version (119K): [in a new window]   Figure 8b. Hepatic cavernous hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lobulated tumor with central necrosis (*). (b) Axial contrast-enhanced T1-weighted MR image shows the tumor with the typical centripetal pattern of peripheral enhancement (arrows). (c) Photograph of the gross specimen shows the vascular cystic spaces (arrows) of the tumor (hemangioma). (d) Photomicrograph (original magnification, x200; H-E stain) shows dilated vascular spaces filled with blood and lined by a single layer of endothelial cells (arrows).

View larger version (106K): [in a new window]   Figure 8c. Hepatic cavernous hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lobulated tumor with central necrosis (*). (b) Axial contrast-enhanced T1-weighted MR image shows the tumor with the typical centripetal pattern of peripheral enhancement (arrows). (c) Photograph of the gross specimen shows the vascular cystic spaces (arrows) of the tumor (hemangioma). (d) Photomicrograph (original magnification, x200; H-E stain) shows dilated vascular spaces filled with blood and lined by a single layer of endothelial cells (arrows).

View larger version (140K): [in a new window]   Figure 8d. Hepatic cavernous hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lobulated tumor with central necrosis (*). (b) Axial contrast-enhanced T1-weighted MR image shows the tumor with the typical centripetal pattern of peripheral enhancement (arrows). (c) Photograph of the gross specimen shows the vascular cystic spaces (arrows) of the tumor (hemangioma). (d) Photomicrograph (original magnification, x200; H-E stain) shows dilated vascular spaces filled with blood and lined by a single layer of endothelial cells (arrows).

View larger version (156K): [in a new window]   Figure 9. Splenic epithelioid hemangioma. Axial T2-weighted MR image shows a heterogeneous, low-signal-intensity splenic mass (solid arrow) with hypointense radial lines due to fibrosis, similar to the spokes of a wheel (open arrows).

View larger version (86K): [in a new window]   Figure 10a. Bone hemangioma. Sagittal T1-weighted (a) and T2-weighted (b) MR images demonstrate a bone hemangioma with the typical trabecular high-signal-intensity pattern (arrow).

View larger version (93K): [in a new window]   Figure 10b. Bone hemangioma. Sagittal T1-weighted (a) and T2-weighted (b) MR images demonstrate a bone hemangioma with the typical trabecular high-signal-intensity pattern (arrow).

View larger version (137K): [in a new window]   Figure 11a. Vertebral hemangioendothelioma. (a) Axial T1-weighted MR image shows a vertebral hemangioendothelioma with the typical trabecular low-signal-intensity pattern (arrow). (b) High-power photomicrograph (original magnification, x400; H-E stain) shows endothelial cells (arrows) and inflammatory cells (arrowheads).

View larger version (142K): [in a new window]   Figure 11b. Vertebral hemangioendothelioma. (a) Axial T1-weighted MR image shows a vertebral hemangioendothelioma with the typical trabecular low-signal-intensity pattern (arrow). (b) High-power photomicrograph (original magnification, x400; H-E stain) shows endothelial cells (arrows) and inflammatory cells (arrowheads).

View larger version (78K): [in a new window]   Figure 12a. Intramuscular hemangioma of the calf. (a) Sagittal T1-weighted MR image shows a soft-tissue mass with intermediate signal intensity relative to muscle, along with an overgrowth of fat (arrow) and punctate low-signal-intensity areas (arrowheads). (b) Radiograph demonstrates phleboliths (arrow), which account for the punctate low-signal-intensity areas seen at T1-weighted MR imaging. (c) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with septa (arrows). (d) High-power photomicrograph (original magnification, x400; H-E stain) demonstrates muscle fibers with proliferation of vessels of different sizes (arrows), along with prominent endothelium and adipocytes (arrowheads).

View larger version (72K): [in a new window]   Figure 12b. Intramuscular hemangioma of the calf. (a) Sagittal T1-weighted MR image shows a soft-tissue mass with intermediate signal intensity relative to muscle, along with an overgrowth of fat (arrow) and punctate low-signal-intensity areas (arrowheads). (b) Radiograph demonstrates phleboliths (arrow), which account for the punctate low-signal-intensity areas seen at T1-weighted MR imaging. (c) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with septa (arrows). (d) High-power photomicrograph (original magnification, x400; H-E stain) demonstrates muscle fibers with proliferation of vessels of different sizes (arrows), along with prominent endothelium and adipocytes (arrowheads).

View larger version (145K): [in a new window]   Figure 12c. Intramuscular hemangioma of the calf. (a) Sagittal T1-weighted MR image shows a soft-tissue mass with intermediate signal intensity relative to muscle, along with an overgrowth of fat (arrow) and punctate low-signal-intensity areas (arrowheads). (b) Radiograph demonstrates phleboliths (arrow), which account for the punctate low-signal-intensity areas seen at T1-weighted MR imaging. (c) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with septa (arrows). (d) High-power photomicrograph (original magnification, x400; H-E stain) demonstrates muscle fibers with proliferation of vessels of different sizes (arrows), along with prominent endothelium and adipocytes (arrowheads).

View larger version (142K): [in a new window]   Figure 12d. Intramuscular hemangioma of the calf. (a) Sagittal T1-weighted MR image shows a soft-tissue mass with intermediate signal intensity relative to muscle, along with an overgrowth of fat (arrow) and punctate low-signal-intensity areas (arrowheads). (b) Radiograph demonstrates phleboliths (arrow), which account for the punctate low-signal-intensity areas seen at T1-weighted MR imaging. (c) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with septa (arrows). (d) High-power photomicrograph (original magnification, x400; H-E stain) demonstrates muscle fibers with proliferation of vessels of different sizes (arrows), along with prominent endothelium and adipocytes (arrowheads).

View larger version (121K): [in a new window]   Figure 13a. Submandibular hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lesion with flow voids representing vessels of different sizes (arrows), along with multiple low-signal-intensity foci (arrowheads). (b) CT scan demonstrates phleboliths (arrowheads), which account for the low-signal-intensity foci seen at MR imaging.

View larger version (122K): [in a new window]   Figure 13b. Submandibular hemangioma. (a) Axial T2-weighted MR image shows a high-signal-intensity lesion with flow voids representing vessels of different sizes (arrows), along with multiple low-signal-intensity foci (arrowheads). (b) CT scan demonstrates phleboliths (arrowheads), which account for the low-signal-intensity foci seen at MR imaging.

View larger version (130K): [in a new window]   Figure 14a. Cavernous hemangioma of the foot. (a) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with low-signal-intensity foci (arrowheads) that represent thrombosis. (b) Low-power photomicrograph (original magnification, x40; H-E stain) shows dilated intraluminal vessels with thrombosis (arrows).

View larger version (123K): [in a new window]   Figure 14b. Cavernous hemangioma of the foot. (a) Axial T2-weighted MR image demonstrates a high-signal-intensity lesion with low-signal-intensity foci (arrowheads) that represent thrombosis. (b) Low-power photomicrograph (original magnification, x40; H-E stain) shows dilated intraluminal vessels with thrombosis (arrows).

View larger version (173K): [in a new window]   Figure 15a. Capillary hemangioma of the thigh. (a) Coronal maximum-intensity-projection MR angiogram shows a contrast-enhanced microlobular lesion in the left thigh (arrow). (b) Graph of a time-signal intensity curve demonstrates a fast perfusion-enhancement pattern. (c) Low-power photomicrograph (original magnification, x40; H-E stain) shows capillaries of varying sizes (arrows).

View larger version (107K): [in a new window]   Figure 15b. Capillary hemangioma of the thigh. (a) Coronal maximum-intensity-projection MR angiogram shows a contrast-enhanced microlobular lesion in the left thigh (arrow). (b) Graph of a time-signal intensity curve demonstrates a fast perfusion-enhancement pattern. (c) Low-power photomicrograph (original magnification, x40; H-E stain) shows capillaries of varying sizes (arrows).

View larger version (90K): [in a new window]   Figure 15c. Capillary hemangioma of the thigh. (a) Coronal maximum-intensity-projection MR angiogram shows a contrast-enhanced microlobular lesion in the left thigh (arrow). (b) Graph of a time-signal intensity curve demonstrates a fast perfusion-enhancement pattern. (c) Low-power photomicrograph (original magnification, x40; H-E stain) shows capillaries of varying sizes (arrows).

View larger version (108K): [in a new window]   Figure 16a. Synovial hemangioma of the knee. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity lesion in the suprapatellar pouch (arrow) containing areas of high signal intensity. (b) On a corresponding axial fat-suppressed T2-weighted MR image, the lesion demonstrates the characteristic circular-linear pattern (arrow). (c) Photomicrograph (original magnification, x200; H-E stain) depicts the synovial membrane with vascular proliferation (arrows) and vacuoles in the subjacent tissue (arrowheads).

View larger version (116K): [in a new window]   Figure 16b. Synovial hemangioma of the knee. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity lesion in the suprapatellar pouch (arrow) containing areas of high signal intensity. (b) On a corresponding axial fat-suppressed T2-weighted MR image, the lesion demonstrates the characteristic circular-linear pattern (arrow). (c) Photomicrograph (original magnification, x200; H-E stain) depicts the synovial membrane with vascular proliferation (arrows) and vacuoles in the subjacent tissue (arrowheads).

View larger version (172K): [in a new window]   Figure 16c. Synovial hemangioma of the knee. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity lesion in the suprapatellar pouch (arrow) containing areas of high signal intensity. (b) On a corresponding axial fat-suppressed T2-weighted MR image, the lesion demonstrates the characteristic circular-linear pattern (arrow). (c) Photomicrograph (original magnification, x200; H-E stain) depicts the synovial membrane with vascular proliferation (arrows) and vacuoles in the subjacent tissue (arrowheads).

View larger version (134K): [in a new window]   Figure 17a. Hemangiopericytoma of the neck. (a) Axial T2-weighted MR image shows a mildly hyperintense lesion in the right multifidus muscle (arrow). (b) High-power photomicrograph (original magnification, x400; reticulin stain) shows a reticulin meshwork surrounding packed pericytes (arrows).

View larger version (132K): [in a new window]   Figure 17b. Hemangiopericytoma of the neck. (a) Axial T2-weighted MR image shows a mildly hyperintense lesion in the right multifidus muscle (arrow). (b) High-power photomicrograph (original magnification, x400; reticulin stain) shows a reticulin meshwork surrounding packed pericytes (arrows).

View larger version (164K): [in a new window]   Figure 18a. Epithelioid hemangioendothelioma of the hand. (a, b) Axial T2-weighted (a) and sagittal T1-weighted (b) MR images show a nodular lesion of the hypothenar region (arrow). The lesion demonstrates moderately high signal intensity on the T2-weighted image and intermediate signal intensity on the T1-weighted image. (c) High-power photomicrograph (original magnification, x400; H-E stain) shows strands of fusiform endothelial cells (arrows) and canalized vascular channels (*).

View larger version (80K): [in a new window]   Figure 18b. Epithelioid hemangioendothelioma of the hand. (a, b) Axial T2-weighted (a) and sagittal T1-weighted (b) MR images show a nodular lesion of the hypothenar region (arrow). The lesion demonstrates moderately high signal intensity on the T2-weighted image and intermediate signal intensity on the T1-weighted image. (c) High-power photomicrograph (original magnification, x400; H-E stain) shows strands of fusiform endothelial cells (arrows) and canalized vascular channels (*).

View larger version (172K): [in a new window]   Figure 18c. Epithelioid hemangioendothelioma of the hand. (a, b) Axial T2-weighted (a) and sagittal T1-weighted (b) MR images show a nodular lesion of the hypothenar region (arrow). The lesion demonstrates moderately high signal intensity on the T2-weighted image and intermediate signal intensity on the T1-weighted image. (c) High-power photomicrograph (original magnification, x400; H-E stain) shows strands of fusiform endothelial cells (arrows) and canalized vascular channels (*).

View larger version (135K): [in a new window]   Figure 19a. Glomus tumor of the finger. (a) Sagittal T2-weighted MR image shows a nodular soft-tissue mass with high signal intensity (*) in the palmar aspect of the distal phalanx. (b) Photomicrograph (original magnification, x200; H-E stain) shows glomic arterioles (*) separated by hyalinized fibers.

View larger version (153K): [in a new window]   Figure 19b. Glomus tumor of the finger. (a) Sagittal T2-weighted MR image shows a nodular soft-tissue mass with high signal intensity (*) in the palmar aspect of the distal phalanx. (b) Photomicrograph (original magnification, x200; H-E stain) shows glomic arterioles (*) separated by hyalinized fibers.

View larger version (108K): [in a new window]   Figure 20a. Cystic angiomatosis. (a) Sagittal contrast-enhanced T1-weighted MR image shows multiple enhancing lesions (arrows) attached to the dura mater and eroding the inner table. (b) Coronal T1-weighted MR image of the sacrum shows the iliac bones with diffuse low signal intensity (arrows). (c) Photomicrograph (original magnification, x100; H-E stain) demonstrates multiple dilated vascular canals in the bone marrow (arrows). These canals are indistinguishable from cavernous or capillary hemangiomas.

View larger version (162K): [in a new window]   Figure 20b. Cystic angiomatosis. (a) Sagittal contrast-enhanced T1-weighted MR image shows multiple enhancing lesions (arrows) attached to the dura mater and eroding the inner table. (b) Coronal T1-weighted MR image of the sacrum shows the iliac bones with diffuse low signal intensity (arrows). (c) Photomicrograph (original magnification, x100; H-E stain) demonstrates multiple dilated vascular canals in the bone marrow (arrows). These canals are indistinguishable from cavernous or capillary hemangiomas.

View larger version (110K): [in a new window]   Figure 20c. Cystic angiomatosis. (a) Sagittal contrast-enhanced T1-weighted MR image shows multiple enhancing lesions (arrows) attached to the dura mater and eroding the inner table. (b) Coronal T1-weighted MR image of the sacrum shows the iliac bones with diffuse low signal intensity (arrows). (c) Photomicrograph (original magnification, x100; H-E stain) demonstrates multiple dilated vascular canals in the bone marrow (arrows). These canals are indistinguishable from cavernous or capillary hemangiomas.

View larger version (99K): [in a new window]   Figure 21. Klippel-Trénaunay-Parkes-Weber syndrome. Maximum-intensity-projection subtraction MR angiogram shows an AVM of the left calf (thin arrow) that drains into a persistent sciatic vein (thick arrow).

View larger version (128K): [in a new window]   Figure 22a. Intradural hemangioblastoma. (a) Sagittal T1-weighted MR image shows a small intradural hemangioblastoma with the typical homogeneous nodular enhancement pattern. (b) High-power photomicrograph (original magnification, x400; H-E stain) reveals a proliferation of fusiform cells (arrows) with interlaced blood material (arrowheads).

View larger version (190K): [in a new window]   Figure 22b. Intradural hemangioblastoma. (a) Sagittal T1-weighted MR image shows a small intradural hemangioblastoma with the typical homogeneous nodular enhancement pattern. (b) High-power photomicrograph (original magnification, x400; H-E stain) reveals a proliferation of fusiform cells (arrows) with interlaced blood material (arrowheads).