Celiac Artery Compression by the Median Arcuate Ligament: A Pitfall of End-expiratory MR Imaging

Lee, Vivian S.; Morgan, Joseph N; Tan, Audrey; Pandharipande, Pari V.; Krinsky, Glenn A.; Barker, Jonathan A; Lo, Calvin; Weinreb, Jeffrey C.

doi:10.1148/radiol.2282020689

Cited by 68 publications

(46 citation statements)

References 15 publications

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“…Nevertheless, we found no significant difference in GDA flow between inspiration and expiration, except for one of our patients, who presented a physiological flow direction at inspiration and an inversion at expiration. Since CA stenosis increases at expiration, 20 with an increase of 10% reported by Lee et al 21 in a Doppler study, we recommend performing the phase-contrast MRI study only in expiration in order to decrease examination time.…”

Section: Discussionmentioning

confidence: 95%

“…19 Furthermore, we propose to focus on the GDA. Indeed, understanding the global haemodynamics in the coeliac arteries is complex because of the anatomy of the coeliac vasculature and the variations of flow with breathing 20,21 and with the degree of CA stenosis from one patient to another. Moreover, absolute values of normal blood flow in the hepatic artery for a given patient are difficult to establish since flow depends on many parameters.…”

Section: Introductionmentioning

confidence: 99%

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Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Haquin

Sigovan

Mabrut

et al. 2017

BJR

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Objective: To evaluate the correlation between the gastroduodenal artery (GDA) haemodynamic changes and the degree of coeliac axis (CA) stenosis using phasecontrast MRI. Methods: The study was institutional review board approved, and written informed consent was obtained from patients included prospectively. A two-dimensional phase-contrast MRI was performed in 23 patients scheduled for a potential complex supramesocolic surgery, in a plane perpendicular to the GDA, during inspiration and expiration. The peak and mean velocities (V p and V m ), mean flow rate (Q m ) and flow direction at inspiration and at expiration have been correlated with the degree of CA stenosis evaluated by CT. Results: 13 of 23 patients presented CA stenosis due to the median arcuate ligament (34-80% of stenosis), 4 of them had associated atheromatous calcifications. V p , V m and Q m of GDA presented a significant and linear relationship with the degree of CA stenosis, at inspiration as well as at expiration (r . 0.74, p , 0.001). Velocities and flow rates presented a different pattern depending on the degree of CA stenosis: ,34% (n 5 10), flow direction remained physiological with low velocities and flow rates; .60% of stenosis (n 5 5), a reverse flow direction with increased velocities and flow rates were observed; variable patterns between 34% and 60%. Conclusion: Phase-contrast MRI permits the evaluation of haemodynamic changes in GDA induced by CA stenosis, including median arcuate ligament compression, and could be of great interest in therapeutic decision making in supramesocolic surgery, such as liver transplantation or duodenopancreatectomy, by detecting haemodynamically significant stenoses. Advances in knowledge: Physiological phase-contrast MRI detects haemodynamically significant stenoses of the CA by evaluating haemodynamic parameters in the GDA. Physiological phase-contrast MRI demonstrates that flow in the GDA can be a direct marker of the real haemodynamic impact of a CA stenosis on the hepatic vascularization and could thus participate in the presurgical work-up of duodenopancreatectomy or hepatic graft, whereas existing pre-operative imaging are only morphological.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Haquin

Sigovan

Mabrut

et al. 2017

BJR

View full text Add to dashboard Cite

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“…Additional findings include poststenotic dilatation of the distal celiac trunk, dilated peripancreatic collateral vessels, pancreaticoduodenal artery aneurisms, atheromatous plaques in the aorta [21][22][23] and mitral valve prolapse [24].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations are vague and diagnosis may rely on findings at duplex and color flow Doppler sonography [2,8], angiographic [2,3,19,20,21,25], CT [3,4,9,21] or MR [2,6,22] imaging but differentiation between clinically relevant celiac artery compression and incidental narrowing may be difficult [16,22].…”

Section: Discussionmentioning

confidence: 99%

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Celiac Artery Compression by the Median Ligament: An Uncommon Cause of Abdominal Pain in the Emergency Department. Report of a Case~!2009-12-31~!2010-05-06~!2010-07-06~! DONE

Ferri¹,

Magrini²,

Capotondi³

et al. 2010

TOEMJ

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Abstract:The Authors report a case of a patient presenting in the Emergency Department (ED) with severe epigastric pain refractory to therapeutic treatment, with onset after forced ice water ingestion caused by joking compression of a soft PET ® bottle during drinking.The Angio MR and angiography performed, after exclusion of suspected esophagus rupture and other esophago-gastric diseases, to rule out an ischemic origin of the pain demonstrate a stenosis of the celiac artery resulting from median arcuate ligament narrowing, the so-called Dunbar's Syndrome.The Dunbar's Syndrome is uncommon and some aspects such as the vascular etiology of symptoms are still controversial.In this report clinical presentation, differential diagnosis and pathophysiology of this disease are discussed.

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Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer

Laïnas

Fuks

Gaujoux

et al. 2017

British Journal of Surgery

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Celiac Artery Compression by the Median Arcuate Ligament: A Pitfall of End-expiratory MR Imaging

Abstract: Accentuation of celiac artery compression at end expiration can give rise to a potential pitfall of breath-hold abdominal imaging. When compression is suspected, imaging should be performed during inspiration.

Cited by 68 publications

References 15 publications

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Phase-contrast MRI evaluation of haemodynamic changes induces by a coeliac axis stenosis in the gastroduodenal artery

Celiac Artery Compression by the Median Ligament: An Uncommon Cause of Abdominal Pain in the Emergency Department. Report of a Case~!2009-12-31~!2010-05-06~!2010-07-06~! DONE

Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer

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