Vertebral Hemangioma Research Articles

Pregnancy and Aggressive Angioma: A Very Rare Entity: Case Report and Literature Review

Vertebral hemangiomas (VH) are common benign tumors, often asymptomatic. Their clinical presentation during pregnancy is rare. We report the case of a 38-year-old woman at 37 weeks of pregnancy, admitted for progressive paraplegia caused by an aggressive VH at the D5 level. MRI revealed spinal cord compression, necessitating a cesarean section followed by laminectomy and cementoplasty. The growth of VH during pregnancy is facilitated by hemodynamic and hormonal changes. Treatment involves surgery, with embolization as an option to reduce bleeding, and radiotherapy in the postpartum period. This rare case highlights the importance of early diagnosis and multidisciplinary management.

Surgical Outcomes for Vertebral Body Hemangiomas With Compressive Symptoms: An Institutional Experience

Surgical Outcomes for Vertebral Body Hemangiomas With Compressive Symptoms: An Institutional Experience

SPIN-04 PAEDIATRIC SPINAL HEMANGIOMA PRESENTING WITH MYELOPATHY – HELPING A CHILD TO WALK AGAIN

Abstract OBJECTIVES To highlight the adaptations in management of spinal tumour patients with available resources. To emphasize on the importance of neurorehabilitation post spinal tumour surgery. INTRODUCTION Vertebral/Spinal hemangiomas are benign lesions and often asymptomatic. They are more common in the thoracic spine where they may become symptomatic with varying presentations. Only a small percentage of these tumours are symptomatic, and this can be attributed to several factors which include epidural expansion of tumour tissue, expansion of bony elements, compression by vessels feeding or draining the lesion or rarely by compression fracture of the vertebra. CASE: This is a case of an 11-year-old girl who was managed at Parirenyatwa hospital. She had presented with a 2-month history of progressive backache associated with paraparesis and numbness in the legs. Had normal bowel and bladder control. No history of trauma or other comorbidities such as Tuberculosis, HIV, or known malignancies. An MRI done revealed a contrast enhancing extradural compressive mass at the level of T5, also involving parts of T5 vertebral body. RESULTS The patient was taken to theatre for thoracic spine decompression and biopsy, without instrumentation. Histology revealed that the lesion was a hemangioma. Patient recovered well over 2months on a corset and physiotherapy, 4 months later she was able to mobilise by herself and to run around. CONCLUSION The main stay of treating symptomatic vertebral hemangiomas remains surgery, with or without instrumentation. It is often rewarding though may be challenging to both the patient and the surgeon even in the best of centers. As exemplified by this case, we have managed to yield a satisfying outcome in the face of ‘adaptive’ measures. Neurorehabilitation enhanced the chances for the child to be able to walk again.

Commentary: Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery.

Commentary: Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery.

Aggressive giant dumbell-shaped thoracic vertebral hemangioma: illustrative case.

Vertebral hemangioma is the most common benign tumor of the spine, diagnosed incidentally in most cases. In 0.4% of patients, the lesion is considered aggressive, causing neurological deficits. This subtype of hemangioma is characterized by strong postcontrast enhancement, cortical lysis, and epidural extension causing myelopathy and/or radiculopathy. A 52-year-old man presented with myelopathy symptoms, namely lower-limb hypoesthesia up to the T4-5 sensory level, right leg hyposthenia, and urinary incontinence. Imaging studies revealed a giant dumbbell-shaped lesion causing spinal cord compression, associated with signal alteration of the T3 vertebral body. The diagnosis of schwannoma was not certain given the radiological features, so a biopsy was planned and confirmed the diagnosis of vertebral hemangioma. Preoperative embolization, spinal fusion, and gross-total resection of the extravertebral component of the lesion were performed. This report should raise awareness of the differential diagnosis of dumbbell-shaped spinal tumors and the therapeutic strategies available for aggressive vertebral hemangiomas, a rare lesion that should be managed in a multidisciplinary setting. https://thejns.org/doi/10.3171/CASE24190.

Effective and Successful Control of Symptomatic Vertebral Hemangiomas With Epidural Extension Using Stereotactic Spine Radiosurgery.

We present our experience in the management of symptomatic vertebral hemangiomas with epidural extension (SVHEE) using spine stereotactic radiosurgery (SSRS). An Institutional Review Board approved retrospective review of all SVHEE patients treated with SSRS at our institution (2007-2022) was performed. Baseline patient demographics, clinical presentation, lesion volume, and Bilsky grade (to directly evaluate the epidural component) were determined. Clinical and radiographic response and treatment outcomes were subsequently evaluated at first (∼6 months) and final follow-up. Fourteen patients with SVHEE underwent SSRS (16-18 Gy/1-fraction); the mean follow-up was 24 months. The median lesion volume (cc) was 36.9 (range: 7.02-94.1), 31.5 (range: 6.53-69.7), and 25.15 (range: 6.01-52.5) at pre-SSRS, first, and final follow-up, respectively. Overall volume reduction was seen in the last follow-up in all 14 patients, median 29.01% (range: 6.58%-71.58%). Bilsky score was stable or improved in all patients at the last follow-up when compared with pre-SSRS score. Patients who underwent both surgical decompression and SSRS (n = 9): 8 had improved myelopathic symptoms and pain and 1 had stable radiculopathy postintervention. In the 5 patients treated with SSRS monotherapy, 2 had stable radicular pain and the other 3 improved pain and numbness. No patients experienced adverse outcomes. To our knowledge, this represents the largest series of SVHEE patients treated with SSRS, either as monotherapy or part of a multimodal/separation surgery treatment approach. We demonstrate that SSRS represents a potentially safe and effective treatment option in these patients. However, larger prospective studies and longer follow-ups are necessary to further assess the role, durability, and toxicity of SSRS in the management of these patients.

Aggressive Thoracic Spine Hemangioma Treated by Total En Bloc Spondylectomy: A Case Report

Introduction: Vertebral hemangioma (VH) is the most widely faced tumor in the vertebral column. It is generally asymptomatic and slowly growing. Moreover, the appearance of extraosseous extensions in vertebral hemangiomas is locally aggressive, causing neurological deficits, and should be distinguished from other vertebral hemangiomas based on its prognosis and treatment. Here we present a rare case of vertebral hemangioma caused by thoracic cord compression and healed by total en block spondylectomy.Objectives: We present a case of VH with extraskeletal expansion that caused the progressive neurologic deficit and was medicated by resection of the entire tumor.Methods: A 33-year-old female came to the Soetomo General Hospital outpatient clinic with the main complaints of back pain and being unable to move her legs since September 2021. In July 2021, the patient felt tingling in her lower extremities. The patient was still able to walk, but she felt the weakness develop. She still can urinate, but she has a defecation problem. There is no history of a palpable mass in some places. The patient is a housewife and she has no previous history of any disease.Results: The patient felt tingling in her lower limbs. She didn’t lose her to walk, but she felt the weakness develop. On the physical examination, there was a neurological deficit at the lower extremity. According to radiographic and histopathologic examination, the patient was diagnosed with VH at the T5 level. We then performed total en-block spondylectomy and posterior stabilization. As a result, the motoric part improved but sensory deficits still occurred. Neurological improvement happened during the follow-up in three months. An inevitable challenge awaits in terms of the medication of VH with extraskeletal expansion that causes neurologic deficits. Pre-operative diagnosis including radiologic and pathologic findings is essential for the strategy and decision for combative hemangioma. An unjustified diagnosis may lead to an inappropriate surgical strategy or the emergence of various complications.Conclusions: Vertebral hemangiomas with extraosseous extension causing spinal cord compression should be considered an aggressive benign tumor, and total excision that includes a tumor margin is indicated.

Role of external radiation in benign tumors: A clinical outcome and safety audit of 7 years from a tertiary care center in India.

Radiotherapy (RT) is a well-established modality for treating malignancies, but its role in treatment of benign lesions has not been well explored. Herein, we present a retrospective analysis of a 7-year data regarding the benefit and the safety profile of RT for treating benign tumors in our institute. Data of 23 patients who received RT for benign tumors from January 2015 to April 2022 were retrieved, and a retrospective analysis was conducted. All the pertinent demographic data, treatment and follow-up data were retrieved. The most common presentations were nasopharyngeal angiofibroma, vertebral hemangioma, paraganglioma, and others. The most common sites of occurrence were head and neck (43%) and paravertebral region (22%). Volumetric modulated arc therapy was the most commonly employed RT technique (39%), followed by three-dimensional conformal RT (34%) and two-dimensional conventional radiotherapy (26%). The median RT dose delivered was 36 Gy (range: 20-54 Gy). The median follow-up duration was 53 months (range: 3-120 months). Nine (39%) patients had progressive disease with a median time to progression of 8 months (range: 1-30 months). The median disease-free survival (DFS) was 70 months, while the 1-, 3-, and 5-year DFS rates were 97%, 88%, and 62%, respectively. Four patients (17%) died, all due to disease progression. The 1-, 3-, and 5-year overall survival rates was 97%, 85%, and 50%, respectively. The rate of radiation-induced cancer (RIC) was 0% as none of the patients had developed RIC secondary to radiation. RT is a safe and an effective option to manage benign tumors either in an adjuvant setting or in inoperable patients requiring definitive treatment, as well as in a setting to alleviate symptoms, providing excellent survival benefits. However, further prospective studies with much higher sample size are required to establish the absolute benefit and to estimate the risk of RIC, which will further direct for a better utilization of RT in treating benign tumors.

Symptomatic and aggressive vertebral hemangiomas in children: features of modern interpretation and treatment tactics

Objective. To analyze the features of clinical-radiological manifestations of symptomatic vertebral hemangiomas in children and the possibility of algorithmizing their treatment.Material and Methods. As part of a monocenter cohort, 24 children aged 4 to 17 years received treatment for symptomatic vertebral hemangiomas. The clinical-radiological manifestations of the tumor and the effectiveness of various methods of invasive treatment were evaluated.Results. Symptomatic uncomplicated and complicated vertebral hemangiomas, corresponding to stages S2 and S3 of the Enneking classification for benign tumors, occur in children with almost equal frequency. For tumors without extravertebral spread, a closed percutaneous vertebroplasty provides stable relief of complaints. For aggressive hemangiomas with extravertebral, including epidural, spread, various treatment methods are used. An algorithm for choosing therapeutic tactics is proposed.Conclusion. Surgical treatment of symptomatic vertebral hemangiomas should be carried out using a tactical algorithm that takes into account the stage of the tumor (S2 or S3) and the possibility of performing closed or open vertebroplasty, selective arterial embolization and decompression and stabilization operations on the spine.

Vertebral Hemangiomas: Yucesoy-Yilmaz Classification System with Corresponding Therapeutic Options

Vertebral hemangiomas (VHs) are relatively common, symptomatic benign tumors of the spine with a reported estimated incidence up to 11%. They usually appear in the body of the vertebrae; however, they can extend into pedicles, laminae, and epidural space. They may cause pain, neurologic deficits. and fractures. In this retrospective, single-center study, we reviewed our cases with VH and we propose the novel classification system that evaluates these lesions per their views on magnetic resonance imaging and clinical findings under 4 main categories. Our novel classification system proposes that grade I lesions occupy less than 50% of the vertebral body, whereas grade II lesions occupy more than 50% and grade III lesions occupy the whole corpus. Grade IV lesions show an epidural and pedicular extension. We propose that grade I lesions may not be worthwhile for follow-up, whereas asymptomatic grade II (a) lesions to be worthy for a biannual imaging and symptomatic thoracolumbar grade II (b) and thoracolumbar grade III lesions to be considered for percutaneous vertebroplasty. We imply that decompression, posterior spinal instrumentation, and open vertebroplasty may be performed for thoracolumbar grade IV lesions. We further consider cervical grade IIb, III, and grade IV lesions as operable because of the disadvantages of percutaneous vertebroplasty. We suggest that our novel classification system may be useful for the determination of diagnostic and therapeutic procedures in the management of VH. Further multicentric trials on larger series are warranted to validate this system and popularize its utility in larger populations.

Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications

PurposePreoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty.MethodsThree elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters.ResultsWith its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH’s epidural components thanks to XperCT-guidance.ConclusionWhen facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH’s angioarchitecture, significantly reducing tumor.

Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review.

(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.

Sclerotherapy for Aggressive Vertebral Hemangioma with Severe Bone Destruction: A 5-Year Analysis.

Sclerotherapy for Aggressive Vertebral Hemangioma with Severe Bone Destruction: A 5-Year Analysis.

Cobb Syndrome, A Rare Disease – Case Report

Cobb syndrome is a rare genetic disorder characterized by dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). It is also known as spinal arteriovenous metameric syndrome (SAMS) and cutaneous meningospinal angiomatosis. We present a case of a 36 years old male presented to OPD with Complain of progressive weakness of Right upper limb for 5 years. On examination, Patient had large cutaneous port wine stain on the right side of the chest, nape of neck, and along the whole right upper limb in a dermatomal distribution with ulnar claw hand wasting of thenar muscles on right side. MRI cervical spine with contrast showed aggressive vertebral hemangioma involving anterior and posterior arch of C1 vertebra, vertebral body of C2 to C5, right half of vertebral body of C2 and C6 and right pedicle of C2 to C5 vertebra. Abnormal thickened and T2WI /STIR hyperintense skin and subcutaneous tissue involving right half of scalp and right half of neck which showing post contrast enhancement, possibility of subcutaneous hemangioma. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. Treatment decision is guided by the patient’s symptoms and imaging features.

Medullary and Foraminal Stenosis by Lumbar Vertebral Hemangioma: Case Report

Vertebral hemangiomas can be defined as benign vascular bone tumors, accounting for only about 3% of spinal tumors. In general, they may demonstrate an asymptomatic clinical presentation, being found accidentally on imaging tests. They have an incidence of about 2.0-27% in the general population and do not require intervention in incidental cases.

Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome—case report and literature review

Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome—case report and literature review

Epidural mass in a 37-year-old male with progressive neurologic symptoms

Abstract Introduction/Objective A 37 yo male with progressive thoracic myelopathy (bilateral lower extremity weakness, hyperreflexia, left foot drop and bowel/bladder incontinence) visited our hospital. MRI of the thoracic spine revealed an intradural-extramedullary mass measuring 3.3 x 2.1 x 1.1 cm with severe compression and leftward and anterior displacement of the spinal cord suggestive of spinal nerve sheath tumor versus less likely meningioma. Surgery was done and an extradural mass was found which was resected via T5/6 laminectomy. Methods/Case Report Pathology received a red black irregular mass measuring 2.9 x 1.1 x 1.0 cm. H&E showed predominantly distended vascular channels lined by a single layer of flat endothelial cells and filled with red blood cells. Immunohistochemical stains CD34, S100, SOX10 and EMA were performed. CD34 was positive in endothelial cells lining the ectatic channels. S100 and SOX10 are negative ruling out spinal nerve sheath tumor. EMA was negative effectively ruling out a meningioma. The diagnosis of cavernous hemangioma was made. Results (if a Case Study enter NA) NA Conclusion Hemangiomas are benign tumors of circumscribed proliferating blood vessels and are most often found superficially in head and neck region. Cavernous hemangiomas have markedly dilated vessels as in our case. Cavernous hemangiomas of the spine are very rare and represent 5-12% of vascular lesions in the spine, with majority being an extensions from a vertebral hemangioma extending into spinal canal. Only 1-2 % are purely extradural spinal locations. Out of 54 cases, 36 were male and18 female, ages 5-78 showed 80% in the thoracic spine and 93% on the dorsal side. Patients typically present with insidious back pain, radiculopathy and myelopathy suspicious for disc herniation. They are most commonly found on the dorsal side of the thoracic spine. Epidural cavernous hemangiomas on MRI would often present as a mass and should be considered in the differential diagnosis along with nerve sheath tumors, meningiomas, abscess, and extradural hematoma.

Surgical Options for Aggressive Vertebral Hemangiomas：A case series, literature review and treatment recommendations

PurposeWe retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. MethodsPatients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. ResultsTwenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100–550 mL) in group A and 635.3 (200–1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. ConclusionDecompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.

Lymphoplasmacytic Lymphoma: An Atypical Presentation with IgG Monoclonal Gammopathy

Introduction Lymphocytic lymphoma (LPL) is a rare type of low-grade mature B-cell non-Hodgkin lymphoma, characterized by a monoclonal population of B lymphocytes, lymphoplasmacytic cells, and plasma cells. In around 95% of LPL cases, the serum immunoglobulin M (IgM) paraprotein is increased, which is correlated to Waldenstrom's Macroglobulinemia (WM), a clinicopathological disease. Only around 5% of LPL cases are associated with the serum paraproteins immunoglobulin G (IgG) or immunoglobulin A (IgA), or light chains alone, or are not linked to a paraprotein. Non-IgM LPLs have a wide range of clinical and pathological features, and MYD88 L265P mutations can occur, though at a lower frequency than WM. Hence, MYD88 testing is advised for prospective therapeutic purposes. Case Presentation A 69-year-old male was referred to a hematologist for uncontrolled epistaxis and periorbital edema. On initial workup, he had high total protein, elevated globulin, hypoalbuminemia, anemia, and proteinuria. Further investigation revealed a high IgG level with low IgM, IgA, and complement levels. Serum Protein Electrophoresis (SPEP): Increased total protein, decreased alpha two and beta globulins with a large monoclonal protein peak migrating in the gamma region, which accounts for 4.77 g/dl of the total 5.38g/dl gamma. Elevated Kappa Quantitative Free Light Chains of 355.39 (3.30 - 19.40mg/L), Decreased Lambda Quantitative Free Light Chains of 1.51 (5.71 - 26.30mg/L), Elevated Kappa Lambda Free Light Chains Ratio of 235.36 (0.26 - 1.65). Serum ImmunoFixation Electrophoresis demonstrated IgG-type kappa monoclonal protein with an additional faint band in IgG kappa. X-Ray skeletal survey showed a possible small lytic area in the inferior aspect of the C2 vertebral body, prompting him to have a cervical spine MRI which revealed no lytic lesions but an 18 mm vertebral body hemangioma inside T2. Molecular testing was positive for MYD88 Mutation c.794T>C (p. L265P) and negative for CXCR4 mutation. Plasma cell myeloma prognostic panel and chromosome analysis were normal. Flow cytometry of bone marrow aspirate showed a kappa light chain restricted plasma cell population (1.6% of total cells) with the following immunophenotype: positive for CD138, CD38, CD45, and negative for CD19, CD20, CD56, CD 117, and lambda light chains. The B-cell population showed kappa light chain restriction with the following immunophenotype: positive for CD19, CD20, and kappa light chains and negative for CD5, CD10, CD11c, CD23, and lambda light chains (Image 2). PET-CT of the whole body was negative for the extension of the disease. Transfusion with the two least incompatible PRBCs had little effect. However, plasmapheresis significantly improved his hemoglobin level by less than 7g/dl. A bone marrow biopsy revealed he had LPL with IgG Monoclonal Gammopathy (Image 1). He received one cycle of CyBorD (Cyclophosphamide, Bortezomib, Dexamethasone), followed by seven cycles of KCD (Carfilzomib, Cyclophosphamide, Dexamethasone) and Rituximab. The patient was diagnosed with low-grade B cell lymphoma with plasmocytic differentiation/lymphoplasmacytic lymphoma, with MYD88 mutation c.794T>C (p. L265P) positivity and CXCR4 mutation negativity. After plasmapheresis, the IgG level dropped to 1958. Follow-up SPEP revealed decreased alpha2 and beta globulins, decreased free lambda light chains, and increased K/L ratio. The patient was treated with Acalabrutinib, and his anemia, epistaxis, and coagulopathy resolved. Repeat PET-CT scan revealed no evidence of illness progression. Discussion LPL is not always linked with IgM monoclonal gammopathy; it can also be associated with IgG or IgA monoclonal gammopathy, light chains alone, or no monoclonal paraprotein. Non-IgM LPL has a high prevalence of extramedullary involvement, a lower rate of MYD88 mutation, and few hyper viscosity symptoms. The MYD88 mutation does not allow WM and Non-IgM LPL to be distinguished from other lymphoproliferative disorders with similar clinical and immunophenotypic features. The case described is unique as the patient has high levels of IgG (11,200) at presentation. In contrast to our patient, who has LPL with IgG Monoclonal gammopathy, approximately 95 percent of LPL patients have IgM Monoclonal gammopathy, which corresponds with WM. As a result, clinicians should be on the lookout for LPL that lacks an IgM Monoclonal Paraprotein.

Increased 18F-FAPI-04 Uptake in Vertebral Hemangioma.

A 54-year-old man with a history of colectomy for colorectal cancer and subsequent liver metastasectomy underwent 18F-FDG PET/CT and 18F-FAPI-04 PET/CT scans to evaluate possible hepatic metastasis revealed by contrast-enhanced MRI. Both studies showed similarly increased uptake in liver metastases, and 18F-FDG detected a metastatic lung nodule. Furthermore, the images showed an incidental finding of increased uptake of 18F-FAPI-04 in the L3 vertebral, which was not 18F-FDG-avid. A review of the patient's previous CT and MRI scans suggests vertebral hemangioma.