Polka dot sign (vertebral hemangioma)

Last revised by Daniel J Bell on 4 Dec 2021

The polka dot sign, also known as the salt and pepper sign, is the result of the replacement of the normal cancellous bone by thickened vertical trabeculae surrounded by fat marrow or vascular lacunae in vertebral intraosseous hemangiomas 2. It is the axial equivalent of the corduroy sign or the jail bar sign seen on sagittal and coronal images. On CT the dots are white on a black fatty background, whereas on MRI they are black dots on a white background (on non-fat-suppressed T1 or T2-weighted images).

Occasionally the appearance has also been given the moniker salt and pepper sign for obvious reasons.

History and etymology

Polka dots refer to a clothing pattern consisting of equally sized and spaced filled circles. It is generally confined to casual wear, though a polka dot jersey is famously worn by the best climber in the Tour de France cycling race. 

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Cases and figures

  • Figure 1: polka dot pattern
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 6
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