Compression of the Celiac Trunk Caused by Median Arcuate Ligament in Children and Adolescent Subjects: Evaluation with Contrast-enhanced MR Angiography and Comparison with Doppler US Evaluation

Purpose: Compression of the celiac trunk by the median arcuate ligament can lead to clinically significant reduction in celiac blood flow and cause clinical symptoms. Doppler ultrasound (US) can be used to screen for stenoses of the celiac trunk and to reduce unnecessary catheter angiography. A noninvasive alternative method is magnetic resonance (MR) angiography. Materials and Methods: A series of 32 children and adolescent patients were evaluated retrospectively; 22 had a positive history of abdominal angina and the other 10 were referred for abdominal imaging including MR angiography for other reasons and were used as a control group. Results: In the patient group, all evaluated patients showed the typical hook-shaped appearance of the celiac trunk and focal narrowing with high-grade stenosis on MR angiography, which were eliminated after laparoseopic treatment. In the control group, no typical signs of median arcuate ligament syndrome were detected. US measurement of the mean preoperative peak velocity in the patient group was 304 cm/s +/- 49. The mean postoperative peak velocity was 163 cm/s +/- 29. In the control group without symptoms, the mean peak velocity was 140 cm/s +/- 25. The difference in pre- and postoperative peak velocities in the patient group was highly significant (P <.0001). Conclusions: MR angiography can confirm the diagnosis of median arcuate ligament syndrome by demonstrating the characteristic focal narrowing of the celiac artery in children presenting with the appropriate clinical symptoms and is an excellent alternative to catheter angiography, especially in a pediatric population.