Objective To investigate imaging characteristics of spinal epidural cavernous hemangiomas (ECHs) and improve understanding of this rare disease. Methods This retrospective study included 7 cases of ECH, confirmed with surgical pathology and imaging. All patients underwent computed tomography and conventional magnetic resonance imaging. One patient underwent diffusion-weighted imaging. Results ECH originated from vertebrae with coarsened trabeculae in 5 patients. Among these, 1 tumor was mainly in the intervertebral foramen and paravertebral space, 2 extended to the intraspinal and paravertebral spaces and appeared dumbbell-shaped, and 2 were located in the intraspinal space. Purely epidural hemangiomas were present in 2 patients; 1 of these patients had adjacent bony erosion. Epidural hemangiomas were isointense in 6 patients and hyperintense in 1 patient on T1-weighted images; lesions were hyperintense on T2-weighted images in all 7 patients. Peripheral fat was present in 4 ECHs; 2 were of vertebral origin, and 2 were of epidural space origin. In the patient who underwent diffusion-weighted imaging, the lesion showed restricted diffusion. The affected vertebra had coarsened trabeculae, which may be a critical finding for differentiating ECHs of vertebral origin from foraminal nerve sheath tumors. Peripheral fat around hemangiomas of vertebral origin and primary epidural space hemangiomas indicates chronicity. Conclusions ECHs are classified either as epidural hemangiomas of vertebral origin or as primary epidural hemangiomas. Awareness of imaging characteristics of ECHs may facilitate diagnosis and treatment of these lesions.
