In the spine, the typical site of involvement is the vertebral body, although the lesion may spread into the pedicle or the lamina and spinous process. Most spinal hemangiomas are asymptomatic and most are discovered incidentally. Symptoms occur when a lesion located within the affected spine spreads into the epidural space and compresses the nerve roots or spinal cord. This lesion is most often combined with a lesion in the mid-thoracic spine. Spinal cord compression is less common and results from a fracture of the involved vertebral body with associated soft tissue mass or hematoma formation. The incidence of hemangioma appears to increase with age, most commonly after middle age, and is twice as common in women as in men. Clinical symptoms are related to the location and growth rate of the tumor. They are usually asymptomatic and are discovered incidentally. If the tumor is located in the spine, a few of them may produce spinal cord or nerve root compression symptoms, and pathological fracture and paraplegia are common complications. Imaging manifestations 1. X-ray features: angiomas are characterized by osteolytic lesions in multiple locations or as coarse vertical streaks. Vertebral lesions are coarse foveal or fenestrated or corduroy-like, and this is a specific sign of vertebral hemangioma. 2, CT features: manifestation of multi-dotted high-density shadow, called the round dotted flower cloth-like appearance. 3, MRI features: T1 and T2-weighted images often have high signal areas, consisting of corresponding vascular portions and extravascular adipose tissue, and the thickened trabeculae show low signal intensity regardless of the pulse sequence used. The differential diagnosis requires differentiation from Paget’s disease, Langerhans histiocytomatosis, melanoma, and metastatic lesions. Treatment Vertebral hemangiomas that are asymptomatic generally do not require treatment and require only clinical dynamic observation. If clinical symptoms are present, treatment is required. Radiation therapy is generally considered to be moderately sensitive to radiation therapy for bone hemangioma. Its indications: (1) those who do not adapt to surgical treatment; (2) those whose surgical resection is not complete, and eliminate the residual tumor tissue by radiotherapy. However, radiation therapy can damage the endothelial cells of spinal cord blood vessels, which is prone to thrombosis and can lead to radiation myelitis, so it should be considered carefully when choosing the treatment. 2.Selective arterial embolization Selective arteriography to identify the treated blood vessels and the blood vessels of the spinal cord, and inject embolic agent through a catheter inserted into the artery to embolize the blood vessels supplying the tumor and make the tumor smaller, so as to relieve the pressure on the spinal cord or reduce the bleeding when removing the tumor. The technique of this operation is demanding, and the key is to choose which artery to embolize, otherwise, it will possibly lead to vascular spinal cord injury. 3.Surgical treatment When the spinal cord is compressed due to bone hemangioma, the tumor should be surgically removed and the spinal canal decompressed, which is an effective treatment.