*3.3.1 Intraosseous hemangioma*

Intraosseous hemangioma (IH) is a benign, slow-growing vascular neoplasm. Though it mainly involves the vertebrae and craniofacial bones, it can rarely involve long bones (mainly intramedullary in metadiaphyseal region; rarely cortical or subperiosteal) [79]. IH are usually identified in females between the age of 30– 50 years. The most common pathologic type is cavernous hemangioma. On radiographs, intraosseous hemangiomas may show a "sunburst" or "honeycomb" appearance. On CT, IH may demonstrate the classic "polka dot" sign (due to associated coarse appearance of the trabecular bone), honeycomb appearance of the lytic lesion (because of internal linear trabeculations), or a spiculated "Irish lace" pattern. MRI helps in better delineation of location and extent of the hemangioma. On MRI, IH demonstrates intermediate to high T1 signal, high T2 signal, and diffuse or peripheral enhancement with signal intensity similar to the adjacent vessels [80] (**Figure 24A** and **B**). Most of the IH lesions are asymptomatic and need no treatment. Symptomatic vertebral hemangiomas without neurologic deficits can be managed by radiotherapy [81].
