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Francis J Cloran Bryan A Pukenas Laurie A Loevner Christopher Aquino James Schuster Suyash Mohan 《The British journal of radiology》2015,88(1055)
Objective:
Aggressive spinal haemangiomas (those with significant osseous expansion/extraosseous extension) represent approximately 1% of spinal haemangiomas and are usually symptomatic. In this study, we correlate imaging findings with presenting symptomatology, review treatment strategies and their outcomes and propose a treatment algorithm.Methods:
16 patients with aggressive haemangiomas were retrospectively identified from 1995 to 2013. Imaging was assessed for size, location, CT/MR characteristics, osseous expansion and extraosseous extension. Presenting symptoms, management and outcomes were reviewed.Results:
Median patient age was 52 years. Median size was 4.5 cm. Lumbar spine was the commonest location (n = 8), followed by thoracic spine (n = 7) and sacrum (n = 2); one case involved the lumbosacral junction. 12 haemangiomas had osseous expansion; 13 had extraosseous extension [epidural (n = 11), pre-vertebral/paravertebral (n = 10) and foraminal (n = 6)]. On CT, 11 had accentuated trabeculae and 5 showed lysis. On MRI, eight were T1 hyperintense, six were T1 hypointense and all were T2 hyperintense. 11 symptomatic patients underwent treatment: chemical ablation (n = 6), angioembolization (n = 3, 2 had subsequent surgery), radiotherapy (n = 2, 1 primary and 1 adjuvant) and surgery (n = 4). Median follow-up was 20 months. Four of six patients managed only by percutaneous methods had symptom resolution. Three of four patients requiring surgery had symptom resolution.Conclusion:
Aggressive haemangiomas cause significant morbidity. Treatment is multidisciplinary, with surgery reserved for large lesions and those with focal neurological signs. Minimally invasive procedures may be successful in smaller lesions.Advances in knowledge:
Aggressive haemangiomas are rare, but knowledge of their imaging features and treatment strategies enhances the radiologist''s role in their management. 相似文献996.
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Anvesha Singh MBChB Christopher D. Steadman MBChB MD Jamal N. Khan MBChB BMedSci Mark A. Horsfield PhD Soliana Bekele BSc Sheraz A. Nazir MBChB Prathap Kanagala MBChB Nicholas G.D. Masca MSc Patrick Clarysse PhD Gerry P. McCann MBChB MD 《Journal of magnetic resonance imaging : JMRI》2015,41(4):1129-1137
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