From Journal of Orthopedic Surgery.

The main difference between typical and atypical hemangiomas of the spine is the ratio of fat to vascular components. Atypical hemangiomas have a higher vascular component and are more likely to be aggressive.
Explanation
Typical hemangiomas usually have a high signal intensity on T1-weighted MRI images. They appear as "corduroy" or "polka-dot" signs on imaging.
Atypical hemangiomas
Have a low signal intensity on T1-weighted MRI images. They can appear isointense or hypointense on T1-weighted images, and hyperintense on T2-weighted images.
Aggressive hemangiomas
Grow beyond the bone's surface and into soft tissues. They can cause cortical destruction, bone expansion, and invasion of the spinal canal.
Atypical hemangiomas can be difficult to diagnose because they can mimic metastatic lesions or primary bony malignancies. They can also be symptomatic.
Imaging techniques Diffusion weighted imaging (DWI), Apparent diffusion coefficient (ADC) maps, T1-weighted dynamic contrast-enhancing, and Quantitative chemical shift MR imaging.
Metastatic vertebral lesion mimicking an atypical hemangioma with ...
An atypical hemangioma is a hemangioma that does not present with a classical imaging appearance and may resemble a more aggressive lesion.
ScienceDirect.com
Vertebral hemangiomas: a review on diagnosis and management
May 24, 2024 — In contrast to typical VHs, atypical VHs tend to have a higher vascular component-to-fat ratio

Journal of Orthopaedic Surgery and Research
Spinal Hemangioma: What It Is, Causes, Symptoms & Treatment
Dec 15, 2023 — How fast do spinal hemangiomas grow? Most spinal hemangiomas grow slowly or stop growing (but don't shrink)

Cleveland Clinic
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This is for informational purposes only. For medical advice or diagnosis, consult a professional. Generative AI is experimental.

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November 2024 - My new spine MRi shows that I have more atypical hemangiomas on my spine again.

My oncologist initially (2024) said I had a 10% chance of having a breast metastasis on my spine. Atypical hemangiomas and metastasis look very much alike on MRI's. Now she says she is not sure because she along with other doctors compared this 2024 MRI to one that was done a couple of years ago. I will have another MRI in 5 more months to see if there is a change to help to determine if the tumors are growing and whether they are causing any problems.

I have pain in my back and some other issues but it is difficult to know what is causing what. I also have an L3 fracture. I will just wait for my next MRI and hope that I don't experience any neurological problems in the meantime.