Vertebral Hemangioma on Spine MRI: What Does It Mean?

A vertebral hemangioma is a benign, non-cancerous growth made of blood vessels inside one of the bones of the spine (a vertebra). It is the most common benign tumour of the spinal column, and most are found by chance on an MRI or CT done for another reason, such as back pain. The large majority cause no symptoms and need no treatment.

This guide is for adults reading an existing spine MRI report that mentions a hemangioma. It explains common report wording and the questions worth asking. It cannot tell you what your own scan shows; only the clinicians who know your history and images can do that.

The word hemangioma is also used for similar benign blood-vessel growths elsewhere, such as in the liver. A spinal hemangioma is in bone, so its follow-up questions are different.

A hemangioma noted on a report does not by itself make back pain an emergency. Some symptoms, though, need urgent assessment whatever the scan said. The NHS advises calling emergency services or going to an emergency department if back pain comes with any of the following:

• Pain, tingling, weakness or numbness in both legs.
• Loss of feeling around the genitals or anus.
• New difficulty passing urine, or losing control of bladder or bowels.
• New changes in genital sensation or sexual function.
• Pain that started after a serious accident, such as a car crash.

Very common. Cleveland Clinic estimates that about 10% of people have one. A 2024 review in the Journal of Orthopaedic Surgery and Research cites older autopsy studies that found them in about 11% of adults and notes that modern imaging may detect even more small lesions.

They are found most often in the thoracic (mid-back) spine, then the lumbar (lower back) spine, and less often in the neck. They are more common in middle age and later, and slightly more common in women. Having more than one is possible.

Radiologists often describe a hemangioma as typical or atypical. A typical hemangioma contains fat, so on MRI it usually looks bright on the two standard image types, called T1 and T2. The thickened bone struts inside it can create a striped look on side views (sometimes called a corduroy pattern) and a spotted look on cross-sections (a polka-dot pattern). Cleveland Clinic describes this line or polka-dot pattern as the usual MRI appearance.

An atypical hemangioma has more blood vessels and less fat, so it may look darker on T1 images. Because it lacks the classic fatty pattern, it can look similar to other bone lesions. That is why the report may suggest extra imaging, such as a CT scan, a different MRI sequence or, less often, a biopsy, to confirm what it is.

An aggressive hemangioma is a different, uncommon description. It means the lesion is growing beyond the bone, for example into the spinal canal or nearby soft tissue, or is weakening the vertebra. Aggressive lesions are the ones most likely to press on nerves or the spinal cord and need treatment.

If your report uses any of these words, ask which one applies and what it means for you. Do not try to reclassify the finding from the images yourself.

Usually not. Cleveland Clinic states that fewer than 5% of spinal hemangiomas cause symptoms. Back pain is very common in general, so a hemangioma seen on a scan is often unrelated to the pain that led to the MRI.

When a hemangioma does cause problems, the 2024 review describes local back pain, and less often nerve symptoms such as numbness, tingling or weakness in the arms or legs. These can happen if the lesion presses on a nerve or on the spinal cord, or if the weakened bone fractures. Rarely, bleeding from a hemangioma can cause sudden symptoms that need immediate care.

Whether your pain comes from the hemangioma or from something else, such as a disc or muscle strain, is a clinical judgement. It depends on your symptoms, an examination and how the images look together.

Most do not. Cleveland Clinic notes that most providers do not recommend treatment when there are no symptoms. The 2024 review states that a typical hemangioma that causes no symptoms generally needs no treatment or follow-up imaging unless symptoms develop.

Atypical lesions are handled with more care. Some specialists prefer watching them with repeat scans; others recommend further tests to confirm the diagnosis. Ask what your team recommends and why.

For hemangiomas that cause symptoms, options named by Cleveland Clinic and the review include:

• Vertebroplasty or kyphoplasty, where bone cement is injected to support the vertebra.
• Injection treatments into the lesion, such as alcohol (ethanol) sclerotherapy.
• Embolization, which blocks the blood vessels feeding the lesion, often before surgery.
• Radiation therapy.
• Surgery to relieve pressure on the spinal cord or nerves, or to remove affected bone.

RadiologyInfo explains that a radiologist reviews the images and sends a signed report to the clinician who requested the scan, who then discusses it with you. Bring the written report, not just a portal summary, and note when your symptoms started. These questions may help:

• Does my report describe the hemangioma as typical, atypical or aggressive?
• Is it likely to be related to my symptoms, or is it an incidental finding?
• Do I need any further imaging to confirm it, and if so, which test and why?
• Is any follow-up scan planned, or only review if symptoms change?
• Which new symptoms should make me seek care sooner?
• If treatment is ever needed, which specialist would I see?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with a hemangioma noted on a spine MRI described their report wording, symptoms and follow-up plans can help you notice what to ask about your own result.

Other people's cases cannot tell you what your scan shows or whether you need treatment. We suggest using them only to prepare clearer questions for the clinician who knows your history.