REGULAR CONTENT
Final ID
455
Type
Original Scientific Research-Oral or Pos
Authors
L Dalag1, M Patel1, L Kang1, J Lorenz1
Institutions
1University of Chicago Medicine, Chicago, IL
Purpose
Compression of the celiac artery (CA) by the median arcuate ligament can severely reduce blood flow leading to abdominal pain referred to as median arcuate ligament syndrome (MALS). Traditionally, conventional angiography has been the gold standard for MALS diagnosis. Herein we evaluate the diagnostic role of noninvasive methods through screening Doppler ultrasonography (DUS) and computed tomographic angiography (CTA).
Materials & Methods
A retrospective analysis was performed on all patients with non-acute abdominal pain who underwent work-up for mesenteric ischemia with DUS and CTA from 2009 to 2014. Correlation between maximum inspiratory and expiratory CA velocities per DUS and minimum CA diameter per CTA was evaluated with linear regression. Correlation between maximum velocities per DUS and Radiologist's subjective presence of MALS morphology was evaluated with Student's t-test.
Results
60 patients were evaluated with both DUS and CTA. Mean peak velocity on DUS was 328 cm/s (sdev=106) on expiratory and 203 cm/s (sdev=55) on inspiratory phases. Mean minimum CA diameter on CTA was 3.3mm (sdev=1.6) on expiratory and 5.3mm (sdev=1.6) on inspiratory phases. MALS morphology was subjectively identified on 35 (58%) cases. Linear regression analysis demonstrated that both inspiratory and expiratory phase DUS measurements of CA velocities were inversely correlated to minimum CA diameter measured on CTA (p=0.013 and p=0.004, respectively). Subjective presence of CA compression on CTA is significantly associated with increased expiratory Doppler velocities (p=0.022) but not inspiratory Doppler velocities (p=0.861).
Conclusions
CTA can confirm the diagnosis of MALS by demonstrating focal narrowing of the celiac artery in patients positively screened with DUS. The degree of CA narrowing is significantly correlated with DUS velocities. Moreover, subjective identification of MALS morphology on CTA is significantly correlated with increased DUS velocities on expiration, an expected finding in the pathophysiology of CA compression by the median arcuate ligament during expiration. CTA is a noninvasive alternative to conventional angiography and correlates well with DUS findings in MALS diagnosis.
Final ID
455
Type
Original Scientific Research-Oral or Pos
Authors
L Dalag1, M Patel1, L Kang1, J Lorenz1
Institutions
1University of Chicago Medicine, Chicago, IL
Purpose
Compression of the celiac artery (CA) by the median arcuate ligament can severely reduce blood flow leading to abdominal pain referred to as median arcuate ligament syndrome (MALS). Traditionally, conventional angiography has been the gold standard for MALS diagnosis. Herein we evaluate the diagnostic role of noninvasive methods through screening Doppler ultrasonography (DUS) and computed tomographic angiography (CTA).
Materials & Methods
A retrospective analysis was performed on all patients with non-acute abdominal pain who underwent work-up for mesenteric ischemia with DUS and CTA from 2009 to 2014. Correlation between maximum inspiratory and expiratory CA velocities per DUS and minimum CA diameter per CTA was evaluated with linear regression. Correlation between maximum velocities per DUS and Radiologist's subjective presence of MALS morphology was evaluated with Student's t-test.
Results
60 patients were evaluated with both DUS and CTA. Mean peak velocity on DUS was 328 cm/s (sdev=106) on expiratory and 203 cm/s (sdev=55) on inspiratory phases. Mean minimum CA diameter on CTA was 3.3mm (sdev=1.6) on expiratory and 5.3mm (sdev=1.6) on inspiratory phases. MALS morphology was subjectively identified on 35 (58%) cases. Linear regression analysis demonstrated that both inspiratory and expiratory phase DUS measurements of CA velocities were inversely correlated to minimum CA diameter measured on CTA (p=0.013 and p=0.004, respectively). Subjective presence of CA compression on CTA is significantly associated with increased expiratory Doppler velocities (p=0.022) but not inspiratory Doppler velocities (p=0.861).
Conclusions
CTA can confirm the diagnosis of MALS by demonstrating focal narrowing of the celiac artery in patients positively screened with DUS. The degree of CA narrowing is significantly correlated with DUS velocities. Moreover, subjective identification of MALS morphology on CTA is significantly correlated with increased DUS velocities on expiration, an expected finding in the pathophysiology of CA compression by the median arcuate ligament during expiration. CTA is a noninvasive alternative to conventional angiography and correlates well with DUS findings in MALS diagnosis.