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Beware the Hypervascular Spinal Lesion: A Guide to Imaging Clues to Consider Before Spinal Surgery or Percutaneous Spine Biopsy 2007

General Spine

John L. Ritter, M.D.
Puneet Pawha, M.D., Non ASSR Member
Jonathan N. Grauer, M.D., Non ASSR Member
John G. Strugar, M.D., Non ASSR Member
Michele H. Johnson, M.D., Non ASSR Member

Scientific Poster

Exhibit Panels: 3

Purpose

A variety of benign and malignant hypervascular lesions can involve the spinal cord and/or vertebral bodies. These lesions represent a significant risk of bleeding at the time of surgery or biopsy, may require transfusions, or may
otherwise complicate surgical resection. Additionally if recognized prospectively, some benign hypervascular lesions may be better evaluated through additional noninvasive imaging rather than intervention. Through a retrospective review of known hypervascular spinal masses, we demonstrate the imaging characteristics of vertebral and spinal cord hypervascular masses as well as clues to guide selection of biopsy/intervention versus noninvasive imaging.

Lesions demonstrated include arteriovenous malformation, hemangioma, angiosarcoma, cavernoma, ependymoma, paraganglioma, schwannoma, meningioma, aneurysmal bone cyst, eosinophillic granuloma, and hypervascular metastasis. Correlation with cross-sectional imaging, angiography, intraoperative photographs, and pathology is emphasized.

Conclusion

Learning Points:
1. To identify the imaging characteristics of spinal lesions that correlate with hypervascularity.
2. To review the cross-sectional imaging, angiographic, intraoperative, and pathologic appearances of hypervascular spinal lesions.
3. To recognize imaging clues useful in guiding the choice of biopsy and/or surgery versus those requiring additional noninvasive imaging for diagnosis.

References

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