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Median arcuate ligament syndrome: evaluation with CT angiography

Karen M Horton1, Mark A Talamini, Elliot K Fishman

  • 1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 3253, Baltimore, MD 21287, USA. kmhorton@jhmi.edu

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|September 15, 2005
PubMed

Insights

Median arcuate ligament syndrome, a cause of abdominal pain due to celiac axis compression, is now diagnosed using CT angiography. This imaging technique reveals a characteristic hooked narrowing of the celiac artery.

Area of Science:

  • Vascular Surgery
  • Diagnostic Imaging
  • Gastroenterology

Background:

  • The median arcuate ligament can compress the celiac axis, leading to median arcuate ligament syndrome (MALS).
  • MALS can cause significant abdominal pain and may necessitate surgical intervention.
  • Traditional diagnosis relied on conventional angiography, which is invasive.

Purpose of the Study:

  • To highlight the diagnostic utility of three-dimensional computed tomographic (CT) angiography in identifying median arcuate ligament syndrome.
  • To describe the characteristic imaging findings of MALS on CT angiography.
  • To emphasize the role of CT angiography in guiding surgical treatment decisions.

Main Methods:

  • Review of patients diagnosed with median arcuate ligament syndrome.
  • Analysis of three-dimensional CT angiograms to identify characteristic celiac axis narrowing.
  • Comparison of CT angiography findings with conventional angiography and clinical presentation.

Main Results:

  • CT angiography accurately demonstrated focal narrowing of the proximal celiac axis in MALS patients.
  • The narrowing exhibited a characteristic hooked appearance, differentiating it from atherosclerotic disease.
  • CT angiography facilitated the diagnosis in patients with appropriate clinical symptoms.

Conclusions:

  • Three-dimensional CT angiography is a valuable, non-invasive tool for diagnosing median arcuate ligament syndrome.
  • The characteristic hooked narrowing on CT angiography aids in distinguishing MALS from other causes of celiac artery stenosis.
  • Accurate diagnosis with CT angiography is crucial for planning effective surgical decompression or vascular reconstruction.

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