Thoracic aortic dissection: pitfalls and artifacts in MR imaging

Results of 53 thoracic magnetic resonance (MR) imaging examinations were reviewed to determine the prevalence and severity of artifacts and pitfalls that may occur in the evaluation of acute aortic dissection. Grade 1 artifacts and pitfalls were mimics of aortic dissection on individual images but could be demonstrated not to represent a dissection when other images from the same sequence were evaluated. Grade 2 artifacts and pitfalls required the use of images from other planes or sequences to distinguish them from a dissection. Grade 3 artifacts and pitfalls could not be distinguished from a dissection without the use of other imaging modalities. Of the 53 cases examined, 34 (64%) had artifacts or pitfalls of grade 1 or higher, 10 (19%) had artifacts or pitfalls of grade 2 or higher, and one case (2%) had grade 3 artifacts or pitfalls. Sixteen cases had more than one artifact or pitfall. Pitfalls and artifacts that mimic aortic dissection occur in a significant percentage of thoracic MR imaging examinations. An awareness of their existence, knowledge of normal anatomy, the use of axial images in all cases with the addition of images in other planes as needed, rotation of phase and frequency gradients as needed, and clinical correlation may avert misinterpretation in nearly all cases.