Korean J Radiol.  2013 Oct;14(5):810-817. 10.3348/kjr.2013.14.5.810.

MRI Features of Spinal Epidural Angiolipomas

• Hu S
• Hu CH
• Hu XY
• Wang XM
• Dai H
• Fang XM
• Cui L

• KMID: 1711439
• DOI: http://doi.org/10.3348/kjr.2013.14.5.810

Abstract

OBJECTIVE
To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery.
MATERIALS AND METHODS
Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings.
RESULTS
Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass.
CONCLUSION
Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

Keyword

Epidural neoplasms; Spinal canal; Blood vessels; Lipoma; Magnetic resonance imaging

MeSH Terms

Adult
Aged
Angiolipoma/*diagnosis/surgery
Diagnosis, Differential
Epidural Neoplasms/*diagnosis/surgery
Female
Follow-Up Studies
Humans
Laminectomy/methods
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Retrospective Studies
Thoracic Vertebrae
Young Adult

Figure

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  Fig. 1 Type 1 epidural angiolipoma. 50-year-old female with bilateral lower extremity adynamia of 18 months. A. Noncontrast T1-weighted sagittal MR image showed homogeneous hyperintense mass compressing spinal cord and scarred with thin-strips or spots of vessels (arrow). Mass was spindle-shaped as longitudinal axis parallel to that of spine and both ends were spinous and pen-like. B. Noncontrast T2-weighted sagittal MR image showed that mass was also hyperintense. C. Postcontrast T1-weighted sagittal MR image showed obvious enhancement of mass. D. Postcontrast T1-weighted axial MR image showed mass displacing thecal sac anteriorly.

• 

  Fig. 2 Epidural angiolipoma with intratumoral hematoma. 24-year-old female with suddenly paraplegia of 6 days. A. Noncontrast T1-weighted sagittal MR image showed epidural isointense mass with little hyperintense surrounding by. B. Noncontrast T2-weighted sagittal MR image showed that central of mass is hypointense but periphery is hyperintense. C. Fat-saturated T2-weighted sagittal MR image showed no decrease of hyperintense region. D. Noncontrast T1-weighted axial MR image showed mass slightly displacing thecal sac anteriorly. E. Microscopically, tumor was composed of abundant vascular channels (★) and mature adipose tissue (arrow), indicative of angiolipoma (haematoxylin and eosin stained, original magnification × 200).

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  Fig. 3 Type 2 epidural angiolipoma. 77-year-old male with bilateral lower extremity numbness of 4 months. A. Noncontrast T1-weighted sagittal MR image showed inhomogeneous mass that had component which demonstrated as being hypointense, while portions of tumor which were hyperintense were seen above and below hypointense area. B. Noncontrast T2-weighted sagittal MR image showed that mass which compressed spinal cord was hyperintense. Slit-like low signal could be seen between tumor and spinal. C. Postcontrast T1-weighted sagittal MR image showed inhomogeneous enhancement of mass without any sign of blood flow-void phenomenon. D. Postcontrast T1-weighted axial MR image showed mass locating in posterior epidural space of spinal.

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