Typical hemangioma

The T2-weighted sagittal image shows a lesion of increased signal intensity replacing the entire L2 vertebral body. Coarse vertically oriented trabeculae are present (arrows).

The T1-weighted sagittal image reveals that the L2 vertebral body lesion (arrow) is of increased signal intensity, similar to that seen on the T2-weighted image.

The T1-weighted axial image demonstrates the coarse trabeculae on end surrounded by fat signal, resulting in a 'salt and pepper" appearance (arrow).

On plain radiographs, hemangiomas often have a vertically striated appearance due to thickening of bony trabeculae. This appearance has been described as "corduroy cloth" or "jail bar" and the overall density of the vertebral body is decreased due to the presence of fatty marrow.

With CT, vertebral body hemangiomas have low attenuation interspersed with thickened bony trabeculae, causing a characteristic "salt and pepper" or "polka dot" appearance on axial images.

With MR imaging, the intralesional fat of the hemangioma causes increased signal intensity on T1 weighted MR images.4 On T2-weighted images, the signal intensity of the hemangiomas also increases because of high water content,4 and the T2-hyperintensity is typically greater than that of fat, thereby differentiating hemangiomas from focal fat deposition.
These signal characteristics also differ from those of metastatic lesions, which have decreased signal intensity on T1 weighted images and increased signal intensity on T2 weighted images.