Stable Atypical Hemangioma at T2: Definition and Clinical Significance
A stable atypical hemangioma at T2 (second thoracic vertebra) is a benign vascular tumor that shows low signal intensity on T1-weighted MRI (lipid-poor variant) but remains unchanged in size and characteristics over time, indicating it is not aggressive and does not require intervention. 1
What "Atypical" Means
The term "atypical" refers specifically to the MRI appearance, not the clinical behavior:
- Atypical hemangiomas show low signal intensity on T1-weighted images (instead of the typical high signal), which occurs due to a higher vascular-to-fat ratio and lower fat content 2, 1
- These lesions may lack the classic "Corduroy sign" (striated appearance on sagittal imaging) and "Polka-dot sign" (punctuated appearance on axial imaging) that characterize typical hemangiomas 2
- The more accurate term is "lipid-poor hemangioma" rather than "atypical," as this better distinguishes them from truly aggressive hemangiomas 1
Is This Normal and What Does "Stable" Mean?
Yes, a stable atypical hemangioma is essentially a normal finding that requires no treatment. 1
- Vertebral hemangiomas are the most common benign tumors of the spine, occurring in 1.9-27% of the general population 3, 2
- "Stable" means the lesion shows no growth, no new extraosseous extension, and no change in imaging characteristics over time 1
- In a study of 30 atypical hemangiomas with mean follow-up of 32 months, 22 lesions remained completely stable, and none showed aggressive behavior 1
Key Distinction: Atypical vs. Aggressive
This is the critical differentiation:
- Atypical hemangiomas (lipid-poor) are NOT the same as aggressive hemangiomas 1
- Aggressive hemangiomas represent less than 1% of vertebral hemangiomas and show extraosseous extension into the spinal canal, causing cord compression and neurologic symptoms 3, 2
- Your stable atypical hemangioma lacks these aggressive features, making it a benign incidental finding 1
What to Monitor
For stable atypical hemangiomas, no routine surveillance is required 1:
- If the lesion remains stable on imaging (no growth, no new symptoms), it can be considered definitively benign 1
- Only symptomatic lesions causing pain, radiculopathy, or myelopathy require intervention 2
- Red flags that would indicate aggressive behavior include: progressive back pain, neurologic deficits (weakness, numbness), or imaging showing extraosseous extension into the spinal canal 3, 4, 5
Clinical Bottom Line
A stable atypical hemangioma at T2 is a benign, incidental finding that does not require treatment or routine follow-up imaging. 1 The "atypical" designation refers only to its MRI appearance (low T1 signal), not to aggressive behavior. As long as it remains stable and you have no symptoms (back pain, weakness, numbness), this is a normal variant that poses no health risk. 1