Korean J Radiol.  2013 Apr;14(2):294-298. 10.3348/kjr.2013.14.2.294.

Cavernous Hemangioma of the Ilium Mimicking Aggressive Malignant Bone Tumor with Increased Activity on 18F-FDG PET/CT

• Ko SW
• Park JG

• KMID: 1482790
• DOI: http://doi.org/10.3348/kjr.2013.14.2.294

Abstract

Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (18F-FDG) uptake on 18F-FDG PET/CT.

Keyword

Ilium; Bone tumor; Hemangioma; CT; MR; PET; CT

MeSH Terms

Bone Neoplasms/radionuclide imaging
Diagnosis, Differential
Female
Fluorodeoxyglucose F18/*diagnostic use
Hemangioma, Cavernous/*radionuclide imaging
Humans
Ilium/*blood supply
Magnetic Resonance Imaging
Positron-Emission Tomography and Computed Tomography
Radiopharmaceuticals/*diagnostic use
Young Adult
Radiopharmaceuticals
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Cavernous hemangioma of ileum in 22-year-old female mimicking aggressive malignant bone tumor with increased activity on 18F-FDG PET/CT. A. Plain radiograph of pelvis shows huge, geographic osteolytic lesion with thick, irregular sclerotic rim in left ilium. B, C. On precontrast CT image (B), there is irregular, large osteolytic lesion in left ilium with exophytic soft tissue mass and stippled calcifications. On contrast-enhanced CT (C), mass shows heterogeneous enhancement with irregular, rim and septal enhancement. D-F. On MRI, mass has heterogeneous intermediate signal on T1-weighted image (D), heterogeneous high signal on fat suppressed T2-weighted image (E), and thick irregular low signal septa on T1 and T2-weighted images. After enhancement with gadolinium, mass shows heterogeneous enhancement and non-enhanced septa (F). 18F-FDG = 2-fluoro [fluroine-18]-2-deoxy-D-glucose. G. 99mTc hydroxymethane diphosphonate bone scan. Anterior view shows increased peripheral isotope uptake of left iliac bone lesion. H-J. 18F-FDG PET MIP (H), PET axial (I), and PET/CT fusion axial (J) images show heterogeneously increased FDG uptake of left iliac bone lesion (maximum SUV = 5.1). K. Photomicrograph shows dilated blood-filled vessels lined by flattened endothelial cells (H/E, × 200).

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