Vertebral Hemangioma vs. bone mets

marymoir · October 2009

Turning once again to this wonderful community for advice/support.

I have been experiencing numbness in my left cheek, arm, and hand for about 3 mos. Onco sent me for a brain MRI, which was clean., so he sent me to a neurologist, who ordered an MRI of my cervical spine. Neuro called me to give me the results (always wonder if it's a good or bad sign when the doctor calls as vs. the nurse!!) She said that the scan showed what appeared to be hemangiomas in my T2 and T3 vertebra, & explained that those usually are benign vascular tumors unrelated to my breast cancer. However, the radiologist indicated that mets could present a similar appearance on MRI, so she wanted me to have a CT scan. When the nurse called to schedule it, I asked her to send me a copy of the report. It says:

"Hyperintense T1 and T2 signal with contrast enhancement is present within the vertebral bodies of T2 and T3. The signal does not surpress on the fat-surpressed sequences. This may represent atypical hemangiomas however metastatic disease could have a similar appearance. Consider further evaluation with CT scan of the cervical spine."

So of course I decide to play radiologist & go trolling the 'net yesterday trying to find something that will tell me that the radiologist's description is more typical of hemangioma than mets, and find an article that says hemangiomas are dark on fat supressed sequences, but mets stay lit up with fat supression. However, it also says that hemangiomas are bright on both T1 and T2, while mets are dark on T1. So my attempt to play radiologist just made me more confused.

I scheduled the CT at the same time they're doing a lumbar puncture (to rule out leptomeningeal mets), but unfortunately that means I have to wait 5 days. So of course I'm freaking out playing the waiting game. Anyone else out there had this type of situation where they are trying to distinguish b/w spine mets and hemangiomas??? Please share, whatever the results were, good or bad.

Thanks!

Mary

SoutherMother · October 2009

Can you possible get a PET/CT scan instead of a plain CT scan. This all seems similar to my case. Except that I had a PET scan that showed a high SUV value (6.3) that went up in the next PET scan to 7.2. Then it went hypermetabolic (9.0?) on the next scan along with some back ache symptoms. My Neurologist was sure it was cancer but Oncologist was not 100% without a biopsy. Did two biopsies (total of six pokes into my T-8) without catching the cancer on the samples. But the lab report has all the descriptions of what cancer looks like in those biopsies, it just wouldn't stain for cancer(s). The cancer board all agreed that a low dose of radiation should help control its intensity and growth. Sure enough, had radiation, which left the next PET scan showing no hypermetabolic activity in T-8. I keep trying to believe it is a hemangioma but the Oncology Radiologist, Radiologist, Oncologist and Neurologist say no, it is not the case. My medical records call it metastatic cancer and that I am stage four, but I hold out that it is a hemangioma. Are your lesions in the posterior or anterior of the vertabrae? I would have to look it up in my notes but cancer tends to be in one but not the other. Please let us know how it turns out.

marymoir · October 2009

Southermother --

Thanks for the reply! Sorry to hear what a nightmare you've been through, but glad to hear that your (met/hemangioma??) is stable. Don' t know which part of the vertebrae since all I have is the written radiologist's report, which doesn't say. But your post made me realize that I don't know if my onc knows about the MRI results, so I should check to see if he wants me to have any other imaging done at the same time ast the CT. (already have a lumbar puncture scheduled that day to rule out leptomeningeal mets, might as well make a day of it LOL!!)

I'll let you know what I find out

marymoir · November 2009

Update --

Had a CT last week of the area which had the lesions. My oncologist wasn't able to weigh in before the scan to indicate whether he tought a PET should be combined, so just had the CT. Radiologist's report on the CT scan came back w/ the same "CYA" language to the effect that they were probably just hemangiomas, but couldn't entirely rule out mets.

Just got a call from onc's office -- they asked if I was having any pain in my back (no, just numbness in arm/hand/cheek). Onc thinks we should just watch the spots unless they become symptomatic (ie., I start getting pain in that area of my back). He said that if it is mets, it will eventually cause pain due to bone destruction.

Sounds rather utilitarian, but kind of glad to be given permission to "get on with my life." Before last week's lumbar puncture fiasco last week, I would've been demanding a PET scan. As it is now, I like the idea of just assuming they are hemangiomas. I'm so busy w/ work/kids that I'm going to worry about that stuff (at least, until the next little ache or pain comes along LOL). Happy to take a break from tests for a while!!

SoutherMother · November 2009

Glad to hear that you are moving on with the other worries of life. Hope the spots stay quiet and eventually prove to be hemangiomas.

lahela · September 2014

This is a really old thread, but I wondered if there was any progress for you or if anyone else was dealing with this? I had a spine MRI last week due to localized pain and radiating pain down my arm, along with reduced strength and reflexes in that arm. Radiologist saw what he thought was a hemangioma, did a CT of the vertebra (T5) and still says hemangioma, but I'm kinda terrified!

Kksauze · January 2016

Hello ladies, it's been a while since anyone posted here. I have been in remission for about 1 1/2 years and am suffering quite a lot with neck and back pain since August last year. In June I had a PET for lingering cough and that didn't show malignancy, only the radiation pneumonitis of right lung, when the headaches and neck pain started in early August I had an MRI, which came back with mild cervical degeneration and a hemangioma at the neck. I had Physical therapy for two months and meds and it only seemed to get worse. Back pain between shoulder blades is awful and it wakes me up at night. Another MRI done a couple days ago and no change from previous at the neck but several other hemangiomas at the spine, no malignancy, but months of pain make me worry. This can't be normal. Anyone of you experience the same? Is it possible mets can be mistaken for hemangiomas even in an MRI? Ribs on right side are weak, they fracture easy and right hip nagging pain, but onco Doctor seems to believe nothing is wrong. I had a very difficult treatment; I found out about the cancer and pregnancy on same day, and I was warned it would be risky to carry the pregnancy because of all the hormones that I'd be making that could feed the cancer. Now this haunts me. I am so discouraged.

Thank you for your time!

K

Jumpship · January 2016

bump

Allydp · February 2016

I just stumbled across this post and thought I'd share my experience.

I had a lesion on my sternum light up on my MRI at initial diagnosis. My medical team was divided whether or not it was mets, so I had a bone scan and PET. Both were clear and it was deemed a benign tumor. However, a few weeks later I read my report on my patient portal and was stunned to learn that same MRI also revealed 2 atypical hemangiomas on my spine. The verbiage clearly stated they were suspicious of mets. When I asked my MO and BS, they both said that because neither showed up on the bone scan or PET they weren't concerned and no follow up was needed.

I just couldn't let it go. I finally ended up getting a 2nd opinion at another hospital and requested a follow up scan to ensure no change. They looked at my MRI and agreed to the scan. All 3 areas showed no change and the they were definitely cleared as benign at that point.

I also have lots of pain in my back in the exact area of these darn hemangiomas. I also have pain underneath my shoulder blades, posterior ribs and bouts of nerve pain down both legs. The follow up scan helped me to move on from the worry of them being mets, but the pain definitely plays tricks with me and makes me second guess! So you ladies are not alone in this!

K - could you see an orthopedic surgeon regarding the back pain and easily fractured ribs? They might be able to do a work up and hopefully give you some peace of mind.

finallyoverit · May 2017

This is a very old thread.. but it was exactly the sort of positive, encouraging posts I needed to see tonight. Thank you ladies. I couldn't be more grateful for each and everyone of you for sharing your experiences. I'm in the middle of testing for hemangioma vs bone mets and I'm scared silly. These posts give me hope and strength to take it one step at a time and move forward with testing to see exactly what we are dealing with.

MelissaDallas · May 2017

I have a spinal hemangioma that was an "incendentaloma" found when I had ovarian cancer on a CT scan. I don't remember them ever questioning that it was anything else though

JMouse · June 2019

I too stumbled on this dormant thread and thought I'd add my story, too.

During my Taxol chemo, I developed worrying aches and pains, including a sore spot on my spine mid-back and an adjacent pulled muscle feeling. My medical team assured me weird pains were normal... but the pains persisted enough that after chemo and radiation I asked for a scan.

This week I was told the MRI shows two "non-classic" hemangiomas on my T6 and L2 vertebrae. My radiation oncologist has told me not to worry but wants a bone scan.

Of course, I'm now afraid these are in fact bone mets. Has anyone had an atypical vertebral hemangioma with pain that did not prove to be breast cancer gone amok?

Any words would be welcome. Thank you.

[EDIT] Since the thread is sleepy, I'll just add to my orginal post. My bone scan was clear, so the current verdict is atypical hemangiomas. It was a huge relief to my family to get that call. RO suggested monitoring them with another MRI in 6 months, but I might seek a biopsy if the pain worsens.

Vertebral Hemangioma vs. bone mets

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