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On contrast administration, Ritipenem homogenous enhancement is seen.[6,14,17] Magnetic resonance imaging MRI features largely depend on the proportion of fat and vascularity of the lesions. Scattered foci of hyper- and hypo-intense T1 signal with predominant intermediate T1 signal are seen on MRI imaging. Low signal intensity on T1-weighted images indicates decreased marrow fat or greater vascular component, may be correlated with more aggressive behavior. Thickened trabeculae demonstrate low signal intensity on MRIs obtained in all sequences.[20] On T2-weighted images, hemangiomas generally appear as multiple high-signal intensity lobules that resemble a bunch of grapes. This appearance is due to cavernous or cystic vascular spaces containing stagnant blood. Fluid-fluid levels can also be noted within these spaces.[16] Punctate or reticular low-signal intensity areas may be present, representing fibrous tissue, fast flow within vessels, or foci of calcification. Areas of thrombosis appear as circular low-signal intensity areas at MRI similar to click here phleboliths. Hyperintense signal on T2-weighted images correlates with intralesional fat content. Hemangiomas demonstrate avid enhancement after gadolinium administration.[20] Small capillary hemangiomas can demonstrate homogeneous signal intensity and high perfusion whereas cavernous hemangiomas demonstrate low perfusion.[21] Digital subtraction angiography Angiography confirms the hypervascularity of the lesions showing enlargement of the external carotid artery branches.[15] Rarely, there may be an internal CB-839 nmr carotid supply.[12] Angiography is usually performed in conjunction with embolization of systematic hemangiomas prior to surgery. As majority of the lesions are seen in parietal and frontal bones, middle meningeal and superficial temporal arteries tend to be the most common arterial feeders. The feeding vessels often have a coarse appearance. No direct arterial or venous communication exists, so no draining vein is identified in early arterial phase. However, due to increased flow, dilated and tortuous veins may be seen.[2,18] Skeletal scintigraphy On 99mTc methylene diphosphonate scintigrams, calvarial hemangiomas may show a level of radionucleotide uptake that is lower than, equal to, or slightly higher than that in surrounding bone. Hence, in addition, use of adjunctive99m Tc-labeled red blood cell (RBC) scans is made. Likewise the dynamic scintigraphic imaging in the diagnosis of hepatic hemangiomas which is characterized by increased accumulation of a RBC tracer on delayed blood pool images, similar criterion has been used in the diagnosis of calvarial hemangiomas; however, detection is limited in lesions