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Celiac Artery Compression by the Median Arcuate Ligament: A Pitfall of End-expiratory MR Imaging¹

¹ From the Department of Radiology-MRI, New York University Medical Center, 530 First Ave, New York, NY 10016. Received June 9, 2002; revision requested August 14; revision received August 29; accepted October 24. Address correspondence to V.S.L. (e-mail: vivian.lee@med.nyu.edu).

View larger version (18K): [in a new window]   Figure 1. Diagram of sagittal view of abdominal aorta shows celiac artery compression by the median arcuate ligament (solid and dashed line). At expiration (Exp), the aorta and its major branches, including the celiac artery (C), move cephalad (arrow). This typically causes worsening of compression by the median arcuate ligament. (Image courtesy of Martha Helmers, BS, New York University Medical Center, New York, NY)

View larger version (126K): [in a new window]   Figure 2a. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show moderate celiac artery narrowing in a 52-year-old man suspected of having hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (arterial phase acquisition) and (b) end inspiration (venous phase acquisition) show that focal narrowing at the origin of the celiac artery (arrow, a) is seen only at end expiration (a).

View larger version (102K): [in a new window]   Figure 2b. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show moderate celiac artery narrowing in a 52-year-old man suspected of having hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (arterial phase acquisition) and (b) end inspiration (venous phase acquisition) show that focal narrowing at the origin of the celiac artery (arrow, a) is seen only at end expiration (a).

View larger version (103K): [in a new window]   Figure 3a. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show mild to moderate celiac artery narrowing in a 65-year-old man with hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (venous phase) and (b) end inspiration (arterial phase) show narrowing of the origin of the celiac artery (arrowheads, a) at end expiration, which is improved at end inspiration.

View larger version (100K): [in a new window]   Figure 3b. Sagittal reconstructions of contrast-enhanced 3D MR angiograms (4.5/1.9, 12° flip angle) show mild to moderate celiac artery narrowing in a 65-year-old man with hepatocellular carcinoma. Images obtained during suspended respiration at (a) end expiration (venous phase) and (b) end inspiration (arterial phase) show narrowing of the origin of the celiac artery (arrowheads, a) at end expiration, which is improved at end inspiration.

View larger version (27K): [in a new window]   Figure 4. Change in percentage of celiac artery stenosis between end expiration and end inspiration among subset of 22 patients who had at least 20% change. In three patients (), the degree of stenosis increased at end inspiration, while the remaining 19 patients () had markedly less stenosis at end inspiration.