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Differentiation of localization of spinal hemangioblastomas based on imaging and pathological findings

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Abstract

Intramedullary + extramedullary hemangioblastomas with largely extramedullary growth are rare and often incorrectly assigned as intradural-extramedullary tumors preoperatively. Preoperative evaluation of the precise tumor location is important for total resection of tumor and improving the surgical outcome. The aim of this study was to provide the first identification of the key differences among of preoperative MR images of hemangioblastomas in different locations and to correlate these with pathological findings. The subjects were 26 patients with surgery for spinal hemangioblastoma in our department, including 6 with an intramedullary tumor who were complicated with von Hippel Lindau disease. Intramedullary, intramedullary + extramedullary, and intradural-extramedullary tumors were present in 22, 3 and 1 cases, respectively. Sagittal MR images showed that intramedullary and intramedullary + extramedullary tumors gave intramedullary T2 high intensity areas (HIAs) spreading toward the craniocaudal sides of the tumor, whereas such findings were absent for the intradural-extramedullary tumor. All the tumors showed strong contrast on axial images, with focal enhancement of hemangioblastomas limited to the intramedullary region (focal type); smooth boundary lines between the spinal cord and the extramedullary tumor (smooth type); and a snowman sign for intramedullary + extramedullary tumors, which provided a key characteristic for differentiating intramedullary + extramedullary tumors from those limited to the extramedullary region. In pathological findings, the Ki67 activity was less than 1% for intramedullary and intradural-extramedullary tumors, but 18–25% in all cases with an intramedullary + extramedullary tumor. In conclusion, on preoperative MRI, a change in the intramedullary HIAs spreading the craniocaudal sides of the tumor on sagittal T2 weighted image (T2WI) and a snowman sign on contrast axial T1WI may be important for differentiation among spinal hemangioblastomas in different locations. Pathologically, we found that intramedullary + extramedullary hemangioblastoma has high cell proliferative activity, which may suggest that enlargement of this tumor occurs faster than that of intramedullary hemangioblastoma.

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Acknowledgments

The authors thank Ms. Saho Horiuchi for her assistance throughout this study.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, Japan

    Shiro Imagama, Norimitsu Wakao, Kei Ando, Kenichi Hirano, Ryoji Tauchi, Akio Muramoto & Naoki Ishiguro

  2. Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, 50 Hachikennishi, Aotake-cho, Toyohashi, Aichi, 441-8570, Japan

    Zenya Ito

  3. Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Gengo 36-3, Morioka-cho, Obu, Aichi, 474-8511, Japan

    Yoshihito Sakai

  4. Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei, Minato-ku, Nagoya, Aichi, 455-8530, Japan

    Fumihiko Kato & Yasutsugu Yukawa

  5. Department of Orthopaedic Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan

    Koji Sato

  6. Institute for Medical Science of Aging, Aichi Medical University, Nagakute-cho, Aichigun, Aichi, 480-1195, Japan

    Yoshio Hashizume

  7. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Yukihiro Matsuyama

Authors
  1. Shiro Imagama
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  2. Zenya Ito
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  3. Norimitsu Wakao
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  4. Yoshihito Sakai
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  5. Fumihiko Kato
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  6. Yasutsugu Yukawa
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  7. Koji Sato
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  8. Kei Ando
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  9. Kenichi Hirano
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  10. Ryoji Tauchi
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  11. Akio Muramoto
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  12. Yoshio Hashizume
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  13. Yukihiro Matsuyama
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  14. Naoki Ishiguro
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Corresponding author

Correspondence to Shiro Imagama.

Additional information

This paper is designed and submitted acting on guideline of IRB of Nagoya University Graduate School of Medicine and all patients have signed consent forms for this study.

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Imagama, S., Ito, Z., Wakao, N. et al. Differentiation of localization of spinal hemangioblastomas based on imaging and pathological findings. Eur Spine J 20, 1377–1384 (2011). https://doi.org/10.1007/s00586-011-1814-6

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  • DOI: https://doi.org/10.1007/s00586-011-1814-6

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