Median arcuate ligament syndrome: Multidetector computed tomography findings

Objective: We aimed to describe the clinical and multidetector computed tomography (MDCT) angiography findings of celiac, mesenteric, and renal artery entrapment by the median arcuate ligament. Materials and Methods: Patients (n = 453) who underwent MDCT abdominal aorta angiography in a period of 3 years were retrospectively reviewed for vascular compression by median arcuate ligament known as median arcuate ligament syndrome. The MDCT examinations were performed with 16-slice (n = 292) and 64-slice scanners (n = 161). The median arcuate ligament itself and adjacent vascular branches of abdominal aorta were assessed for compression by 2 different radiologists who are experienced on MDCT angiography more than 3 years. Both axial, multiplanar reformatted images and 3-dimensional angiograpbies were used for interpretation. Results: Twelve patients were found to have clinically significant vessel entrapments by median arcuate ligament; 6 of them with celiac artery, 4 of them with renal artery, and 2 of them with both celiac and mesenteric artery involvement. Patients with celiac and mesenteric vessel entrapments presented with epigastric pain. All patients with renal artery entrapment had resistant hypertension. The MDCT showed the proximal narrowing caused by compression of median arcuate ligament. The proximal portions of renal arteries pulled down and in toward the aorta, with mild to moderate narrowing. Conclusions: The MDCT examination with multiplanar images and 3-dimensional angiography is a noninvasive imaging technique that can be used with high accuracy in the diagnosis of median arcuate ligament syndrome.