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The median arcuate ligament syndrome revisited by CT angiography and the use of ECG gating — a single centre case series and literature review

Department of Clinical Radiology, Derriford Hospital, Plymouth PL6 8DH, UK

Correspondence: Nathan Manghat, Green Lane Cardiovascular Service, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand 1030. E-mail: docnatman{at}msn.com

The significance of median arcuate ligament-associated coeliac axis compression can be readily delineated by CT angiography but is a source of some controversy in the literature, particularly given the relatively high incidence of this finding in otherwise asymptomatic individuals. This case series, with an emphasis on CT findings, aims to (i) illustrate the anatomy, (ii) elude to the variable outcome and uncertainty of those patients diagnosed, (iii) question the reliability of existing imaging techniques, with the additional use of multiphase electrocardiogram (ECG)-gated CT acquisition, and therefore (iv) augment the description of the currently recognized pathophysiology. We propose the clinical usefulness of ECG-gated vascular angiography, other than that necessary to image the coronary arteries, in vascular compression syndromes such as this.