E2044. The Pseudo-Celiac Artery Dissection: A Diagnostic Pitfall on MR Imaging
During interpretation of routine MR imaging, we have noted the presence of a linear filling defect within the proximal celiac artery on post-contrast T1-weighted images of several patients. Findings appeared consistent with that of an isolated celiac artery dissection. Subsequent imaging, including CT angiography, sonography or follow-up MR studies, demonstrated no evidence of an arterial dissection. These findings likely relate to an artifact of localized signal loss that can be misinterpreted as a vascular abnormality and, despite scrupulous examination, the radiologist may be unable to reliably differentiate between artifact and true dissection.
Educational Goals / Teaching Points
The objective of this educational exhibit is to discuss the appearance of the pseudo-celiac artery dissection pitfall and compare with cases of true celiac artery dissection on MR imaging. Upon completion of this educational exhibit, the learner will be able to recognize the challenges in distinguishing artifact from true dissection, examine strategies to help navigate comprehensive examination and documentation, and hypothesize potential etiologies for these imaging manifestations.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A number of cases will be presented, illustrating MR examples of localized filling defects within the celiac artery that proved to be negative upon further investigation with CT angiography, sonography or follow-up MR imaging. These cases will be contrasted with cases of bona fide celiac artery dissections, corroborated on CT studies. Proposed mechanisms for this pitfall will be discussed.
True isolated celiac artery dissection is difficult to reliably distinguish from artifact on abdominal MRI. Awareness of this potential pitfall along with clinical correlation with the patient’s presentation and symptomatology can aid the radiologist and ordering provider in their evaluations of the patient, thus ameliorating potential implications for the patient’s care.