Vertebral Haemangioma on MRI: What the Finding Means and When Further Examination Is Required

A vertebral haemangioma is a benign vascular lesion that develops within the bone tissue of a vertebra. It is most often discovered incidentally during an MRI or CT scan of the spine performed because of back pain, a suspected herniated disc, an injury, or another condition.

In most cases, a vertebral haemangioma is small, causes no symptoms, and does not require specific treatment. However, the doctor should assess its structure, location, size, and effect on surrounding tissues because atypical or rare aggressive forms may occasionally occur.

In brief: a typical vertebral haemangioma seen on MRI is usually a benign incidental finding. It is not a metastasis and generally does not pose a risk when no symptoms are present. Further management depends on its MRI characteristics, clinical symptoms, and the doctor’s recommendations.

What Is a Vertebral Haemangioma?

The spine consists of individual vertebrae containing bone tissue and bone marrow. A haemangioma develops as a result of a local proliferation of vascular structures with varying amounts of fatty tissue.

The lesion is most commonly located within the vertebral body, which is the main weight-bearing part of the vertebra. Less commonly, it may extend into the vertebral arch or posterior elements.

A vertebral haemangioma may also be referred to as:

• a haemangioma of the vertebral body;
• a spinal haemangioma;
• a vertebral vascular lesion;
• a vascular lesion of the vertebra.

These terms may describe the same benign lesion, although the exact meaning of the report depends on its location and imaging characteristics.

Is a Vertebral Haemangioma a Tumour?

A haemangioma is classified as a benign vascular lesion. It is not cancer, it is not a metastasis, and a typical haemangioma does not spread throughout the body.

However, the word “haemangioma” alone is not enough to determine whether follow-up is required. The radiologist assesses whether the lesion has a typical appearance and whether there are signs of bone destruction, extension beyond the vertebra, or involvement of the spinal canal.

If the report mentions an “atypical haemangioma”, this does not mean that the lesion is malignant. The term indicates that its MRI signal differs from the classic appearance, so additional information may be required for clarification.

What Causes a Vertebral Haemangioma?

The exact cause of vertebral haemangiomas is not always known. Their development is associated with particular features of the structure and growth of blood vessels within bone tissue.

A haemangioma is generally not caused by physical activity, poor posture, osteochondrosis, or a herniated disc. These conditions may be detected at the same time but do not necessarily share the same cause.

In many people, the lesion remains present for a long time and is discovered only during a routine or unrelated examination.

Where Are Vertebral Haemangiomas Most Commonly Located?

A haemangioma can occur in any part of the spine, but it is most commonly found in the thoracic and lumbar vertebrae. It is less frequently located in the cervical spine or sacrum.

The MRI report usually specifies the exact level:

• C1–C7 — cervical vertebrae;
• Th1–Th12 — thoracic vertebrae;
• L1–L5 — lumbar vertebrae;
• S1–S5 — sacral vertebrae.

For example, the wording “haemangioma of the Th8 vertebral body” means that the lesion was detected in the eighth thoracic vertebra.

What Does a Vertebral Haemangioma Look Like on MRI?

MRI allows the radiologist to assess the bone marrow within the vertebrae, the spinal cord, nerve roots, intervertebral discs, ligaments, and surrounding soft tissues.

A typical haemangioma often contains a considerable amount of fatty tissue and vascular components. On standard MRI sequences, it usually has a characteristic signal that allows the radiologist to distinguish it confidently from most other abnormalities.

When describing a haemangioma, the radiologist evaluates:

• the exact vertebra and the part of the vertebra in which the lesion is located;
• the length, width, and height of the lesion;
• the proportion of the vertebral body that it occupies;
• the uniformity of its structure;
• the amount of fatty and vascular tissue;
• the condition of the cortical bone;
• whether it extends into the posterior elements of the vertebra;
• the condition of the spinal canal;
• the presence of an epidural or paravertebral component;
• possible compression of the spinal cord or nerve roots;
• signs of a pathological fracture.

Typical, Atypical, and Aggressive Haemangiomas: What Is the Difference?

Type of haemangioma	What it means
Typical	Has characteristic MRI or CT features, usually causes no symptoms, and is often discovered incidentally.
Atypical	Contains less fatty tissue and more vascular tissue, so its appearance may be less characteristic and require further clarification.
Aggressive	May enlarge the vertebra, extend beyond it, narrow the spinal canal, or affect neural structures.

An aggressive haemangioma is not the same as a malignant lesion. The term describes its growth pattern and effect on surrounding structures. Aggressive haemangiomas are considerably less common than ordinary asymptomatic lesions.

Which Haemangioma Features May Require Further Assessment?

Additional imaging or medical consultation may be recommended when MRI shows:

• an atypical MRI signal;
• a large lesion;
• involvement of a substantial part of the vertebral body;
• expansion or deformation of the vertebra;
• disruption of the cortical bone;
• extension into the vertebral arch or other posterior elements;
• a soft-tissue component extending beyond the vertebra;
• narrowing of the spinal canal;
• pressure on the spinal cord or nerve roots;
• a pathological fracture;
• significant changes compared with a previous examination;
• imaging features that do not match the typical appearance of a haemangioma.

These findings do not automatically confirm cancer. They indicate that the lesion should be assessed in greater detail and compared with other clinical and imaging information.

Can a Vertebral Haemangioma Cause Pain?

Most vertebral haemangiomas do not cause pain. If MRI also reveals disc protrusions, herniated discs, facet joint osteoarthritis, spinal stenosis, or other degenerative changes, these abnormalities may be a more likely cause of the symptoms.

A haemangioma may be associated with pain if it is large, alters the structure of the vertebra, weakens the bone, extends beyond the vertebra, or affects neural structures.

It is therefore important not to assume that a haemangioma found on MRI is necessarily responsible for back pain. The imaging findings should be compared with the location of the pain, neurological symptoms, and physical examination results.

What Symptoms Can an Aggressive Haemangioma Cause?

In rare cases, a vertebral haemangioma may cause:

• persistent localised back pain;
• pain radiating into an arm, around the chest, or into a leg;
• numbness, tingling, or a “pins and needles” sensation;
• reduced sensation;
• weakness in the arms or legs;
• difficulty walking or impaired coordination;
• restricted mobility;
• symptoms caused by compression of the spinal cord or nerve roots.

The symptoms depend on the part of the spine in which the lesion is located and which structures are affected.

When Is Urgent Medical Attention Required?

Seek urgent medical attention if back pain is accompanied by:

• sudden or rapidly increasing weakness in the limbs;
• significant loss of sensation;
• numbness in the perineal or saddle area;
• difficulty urinating or loss of bowel control;
• a sudden deterioration in walking ability;
• severe pain following even a minor injury;
• sudden pain in a patient with known weakening of the vertebral body.

These symptoms may be associated not only with a haemangioma but also with other conditions requiring urgent diagnosis.

When Is MRI Recommended for a Suspected Haemangioma?

A spine MRI may be recommended when:

• a haemangioma was incidentally detected on an X-ray or CT scan;
• a previous report mentioned an atypical vertebral lesion;
• the structure of the bone marrow needs to be assessed;
• back pain is persistent or progressive;
• numbness, weakness, or other neurological symptoms have developed;
• the spinal canal and neural structures need to be examined;
• the lesion needs to be compared with a previous examination;
• treatment or another procedure is being planned;
• the haemangioma must be distinguished from another vertebral lesion.

Which Part of the Spine Should Be Examined?

The part of the spine containing the haemangioma or causing the symptoms should be examined.

Location	Recommended examination
Cervical vertebrae C1–C7	Cervical spine MRI
Thoracic vertebrae Th1–Th12	Thoracic spine MRI
Lumbar vertebrae L1–L5	Lumbar spine MRI
Sacrum	MRI of the sacrum or sacroiliac region, depending on the medical referral

If the lesion has already been identified, provide the exact level stated in the report when booking the examination. For example: a haemangioma at Th7, L2, or within the C6 vertebral body.

MRI or CT for a Vertebral Haemangioma

Method	What it helps assess
MRI	The bone marrow, fatty and vascular components of the lesion, spinal cord, nerve roots, spinal canal, and soft tissues.
CT	The bony trabeculae, cortical layer of the vertebra, bone strength, deformation, and characteristic structural features of a haemangioma.
X-ray	The general structure and shape of the vertebrae, although small haemangiomas may not be visible.

MRI and CT do not always replace one another. With a typical haemangioma, the findings of one imaging method may be sufficient. If the appearance is atypical, the doctor may recommend CT to assess the bone structure in more detail or compare the lesion with previous examinations.

Is Contrast Needed for MRI of a Haemangioma?

Intravenous contrast is usually not required to identify a typical vertebral haemangioma. Standard MRI sequences are often sufficient to determine the nature of the lesion.

Contrast-enhanced MRI may be recommended when:

• the lesion has an atypical appearance;
• differential diagnosis with another abnormality is required;
• an epidural or paravertebral component is present;
• an active inflammatory or neoplastic process is suspected;
• treatment is being planned;
• previous examination findings were inconclusive;
• the doctor needs to assess blood supply and contrast enhancement characteristics.

The need for contrast enhancement is determined by the doctor based on the imaging findings, symptoms, and the patient’s medical history.

Does a Vertebral Haemangioma Need Follow-Up?

A small typical haemangioma that causes no symptoms and has no signs of aggressive growth often does not require regular follow-up MRI scans.

Monitoring may be recommended when:

• the lesion has atypical characteristics;
• its nature has not been conclusively established;
• the haemangioma occupies a significant part of the vertebra;
• pain or neurological symptoms are present;
• there are signs of weakened bone tissue;
• changes need to be assessed over time;
• treatment has been performed.

The doctor determines the appropriate follow-up interval. Undergoing frequent MRI scans without a specialist’s recommendation is usually unnecessary.

How Is a Vertebral Haemangioma Treated?

An asymptomatic typical haemangioma usually does not require treatment. If the lesion causes pain, weakens the vertebra, or affects neural structures, the treatment approach is selected individually.

Depending on the clinical situation, treatment may include:

• observation;
• symptomatic pain management;
• restriction of certain activities as advised by a doctor;
• percutaneous vertebroplasty;
• embolisation of the blood vessels supplying the lesion;
• radiotherapy in selected cases;
• decompressive or stabilising surgery;
• a combination of several treatment methods.

The choice depends on the spinal level, symptoms, stability of the vertebra, extent of the lesion, and condition of the spinal cord. The size of the haemangioma alone does not determine whether surgery is necessary.

What Should You Avoid After a Haemangioma Is Detected?

• Do not interpret the word “haemangioma” as confirmation of cancer.
• Do not assume that every episode of back pain is caused by the haemangioma without consulting a doctor.
• Do not undergo frequent follow-up MRI scans without medical advice.
• Do not begin medication without identifying the cause of the symptoms.
• Do not withhold information about a large lesion or weakened vertebra from a massage therapist, rehabilitation specialist, or manual therapist.
• Do not ignore progressive weakness, numbness, or difficulty walking.

Which Doctor Should You Consult?

The MRI report can be reviewed by a neurologist, orthopaedic trauma specialist, neurosurgeon, or the doctor who referred you for the examination.

A neurosurgical consultation is particularly important when the haemangioma:

• has aggressive features;
• extends into the spinal canal;
• compresses the spinal cord or nerve roots;
• is accompanied by neurological symptoms;
• has caused a pathological fracture;
• requires selection of an appropriate treatment method.

How to Prepare for a Spine MRI

Special preparation is usually not required for a standard spine MRI without contrast. Before the examination, patients should:

• bring a medical referral, if available;
• bring previous MRI, CT, and X-ray images and reports;
• remove jewellery, watches, and other metal objects;
• inform the staff about a pacemaker, implants, prostheses, clips, and other devices;
• report any previous spinal surgery;
• inform the staff in advance about pregnancy or claustrophobia;
• confirm the preparation requirements if contrast enhancement is planned.

It is important to remain still during the scan. This is necessary to obtain clear images of the vertebrae, spinal cord, and neural structures.

What Should You Do After Receiving the Results?

The presence of a haemangioma in the MRI report does not mean that the lesion needs to be treated or removed immediately. The following should first be assessed:

• whether the haemangioma has a typical appearance;
• which vertebra is affected;
• how much of the vertebra it occupies;
• whether there are signs of aggressive growth;
• whether the symptoms correspond to the level of the lesion;
• whether there are other possible causes of pain;
• whether comparison with previous examinations is required.

The final management plan is determined by the doctor after reviewing the MRI findings, symptoms, neurological status, and other medical information.

Spine MRI in Kyiv near Shuliavska

At HBMedical Medical Centre, patients can undergo MRI of the cervical, thoracic, and lumbar spine in Kyiv. The examination can assess vertebral haemangiomas, bone marrow, intervertebral discs, spinal cord, nerve roots, and the spinal canal.

The examination is performed using a 1.5 Tesla Siemens Magnetom Sempra MRI scanner. The medical centre is located at 3 Oleksandra Dovzhenka Street, Kyiv, near Shuliavska metro station.

When booking the examination, it is advisable to tell the administrator:

• which part of the spine needs to be examined;
• whether a haemangioma has been detected previously;
• which spinal level is stated in the previous report;
• whether contrast enhancement is required;
• whether previous MRI or CT examinations are available for comparison;
• whether you have implants or other possible MRI restrictions.

Current information about available examinations can be found on the MRI in Kyiv page.

Book a spine MRI at HBMedical to clarify the nature of vertebral changes and receive a detailed radiology report.

Frequently Asked Questions

Is a vertebral haemangioma dangerous?

A small typical haemangioma is usually not dangerous and does not require treatment. Lesions with atypical or aggressive features, neurological symptoms, or a risk of weakening the vertebra require additional attention.

Can a haemangioma become cancerous?

A typical haemangioma is a benign lesion and is not considered a precancerous condition. If its appearance is atypical, the doctor may recommend additional imaging to confirm the diagnosis.

Does a haemangioma need treatment if there is no pain?

In most cases, an asymptomatic typical haemangioma does not require treatment. The decision regarding follow-up is based on its size, structure, and location.

Can a haemangioma cause back pain?

It can, but this is uncommon. Back pain is often associated with other spinal abnormalities, so the doctor should compare the MRI findings with the symptoms and physical examination results.

What does an atypical haemangioma mean?

An atypical haemangioma has a less characteristic appearance on MRI, often because it contains less fatty tissue and more vascular tissue. It is not necessarily dangerous, but CT, contrast-enhanced MRI, or follow-up may be required.

What does an aggressive haemangioma mean?

This term means that the lesion affects the structure of the vertebra, extends beyond it, or compresses neural structures. The word “aggressive” does not mean that the haemangioma is cancerous.

Is contrast required to diagnose a haemangioma?

Contrast is usually not required for a typical haemangioma. It may be recommended when the appearance is atypical, the lesion extends beyond the vertebra, or another abnormality needs to be excluded.

Can you exercise with a vertebral haemangioma?

Special restrictions may not be required for a small asymptomatic haemangioma. If the lesion is large, weakens the vertebra, or causes pain, the appropriate level of physical activity should be discussed with a doctor.

How often is follow-up MRI required?

There is no single follow-up schedule suitable for every patient. A typical asymptomatic haemangioma often does not require regular monitoring, while the interval for atypical lesions is determined by the doctor.

This material is provided for informational purposes and does not replace a medical consultation.