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A radio-anatomical study of median arcuate ligament syndrome: unveiling the morphology and morphometry of median arcuate ligament, celiac trunk, and superior mesenteric artery

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Abstract

Purpose

In the context of medical literature, a significant lacuna exists in understanding median arcuate ligament syndrome (MALS). While clinical aspects are well documented, literature lacks a robust exploration of the anatomical relationship between the celiac trunk and the median arcuate ligament (MAL).

Methods

Morphometric parameters, including the vertebral level of MAL origin, MAL thickness, celiac trunk (CeT) origin level, diameter, and distances between CeT/Superior Mesenteric Artery (SMA) and the MAL center were observed on 250 CT angiograms. Cadavers (n = 11) were dissected to examine the same parameters and histo-morphological examination of MAL tissue was done.

Results

Radiological findings established average MAL thickness of 7.79 ± 2.58 mm. The celiac trunk typically originated at T12. The average distance between the celiac trunk and the MAL center was 1.32 ± 2.04 mm. The angle of the celiac trunk to the abdominal aorta was primarily obtuse. The average celiac trunk diameter was 5.53 ± 1.33 mm. Histological examinations revealed a diverse MAL composition, indicating variable mechanical properties.

Conclusion

This study provides comprehensive morphometric data on the anatomical relationship between the MAL and the celiac trunk. In contrast to available literature which says the average MAL thickness of > 4 mm is an indicator of increased thickness, we observed much higher average thickness in the studied population. The findings contribute to a better understanding of normal anatomical variations which can serve as reference values for accurate radiological diagnosis of MALS. The histological examination revealed the heterogeneous nature of the MAL tissue composition, suggesting variable mechanical properties and functions in different regions.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

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Authors and Affiliations

  1. Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India

    Arthi Ganapathy

  2. Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India

    Sudipta Mohakud & Alamelu Alagappan

  3. Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India

    Sipra Rout, Praisy Joy & Aarthi Manokaran

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  1. Arthi Ganapathy
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by [Arthi Ganapathy], [Sudipta Mohakud], [Alamelu Alagappan], and [Aarthi Manokaran]. Data analysis was done by [Arthi Ganapathy], [Sipra Rout], and [Praisy Joy]. The first draft of the manuscript was written by [Arthi Ganapathy] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Arthi Ganapathy.

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Ganapathy, A., Mohakud, S., Rout, S. et al. A radio-anatomical study of median arcuate ligament syndrome: unveiling the morphology and morphometry of median arcuate ligament, celiac trunk, and superior mesenteric artery. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04231-w

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