The Radiologic Diagnosis and Treatment of Typical and Atypical Bone Hemangiomas: Current Status.

Hemangioma is the most common angiomatous lesion of the bone. Hemangiomas usually are discovered incidentally with patients who are asymptomatic [1] and are seen in 11% of a large postmortem series [2]. Hemangiomas usually are seen in the fourth and fifth decades of life, with men twice as likely to be affected [1]. A diagnosis is often straightforward with typical plain radiographic, computed tomographic (CT), and magnetic resonance imaging (MRI) findings. However, the diagnosis may occasionally be challenging, with hemangiomas displaying a variety of atypical appearances and may be mistaken for an aggressive lesion, which may require further imaging, biopsy, or surgical excision. Knowledge of the more common unusual appearances of hemangiomas can help improve diagnostic confidence and potentially avoid percutaneous biopsies and patient and clinician anxiety. We also discuss the role of interventional radiology in performing a biopsy of atypical lesions as well as treating lesions with selective embolization and vertebroplasty.