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Introduction: The currently accepted pathophysiological concept behind median arcuate ligament syndrome (MALS) is vascular compromise by atypically positioned median arcuate ligament. Despite many articles on MALS, only sparse data on the outcome in general and the rather poor outcome after intervention have been reported and this makes at least questionable the current concepts of the underlying disease. Material and methods: A total of 364 patients with suspected celiac trunk pathology underwent a standardized ultrasound assessment procedure: suspected diagnostic features for MALS such as typically elevated peak flow velocities (PV) in the celiac trunk or atypical celiac trunk deflection-angles (DA) were defined in patients and in 20 matched volunteers. Results: All the 6 retrospectively clearly diagnosed MALS-patients as well as 40% (8/20) of volunteers presented a DA of over 50°. MALS-patients presented a mean inspiratory PV of 172cm/s (± 40.9 cm/s), a mean expiratory PV of 425cm/s (±130.1 cm/s) with a PV-amplitude of 249.1% (±68.9%). Volunteers presented a mean inspiratory PV of 126.9cm/s (±42 cm/s), a mean expiratory PV of 209.9cm/s (±80.1 cm/s) with a PV-amplitude of 169.4% (±54.3%). Conclusions: The combination of a maximum expiratory PV of over350 cm/s and a DA higher than 50° seems to be a most reliable indicator for MALS in this small series of patients. Based on these data we propose that functional ultrasound should be the first line in screening for MALS. However, a clear pathophysiological definition of MALS remains still obscure. [ABSTRACT FROM AUTHOR]

Aim: To assess technical and lesion related factors affecting the quality of ultrasound guided core needle biopsy (CNB) of musculoskeletal soft tissue tumors. Materials and Methods: Data of 223 CNBs were evaluated in a retrospective study. Diagnostic yield was calculated for all lesions on the basis of lesion location (extremity/torso), examiner, biopsy needle gauge/length and number of acquired samples. Diagnostic accuracy was calculated for surgical lesions (n= 113) based on final specimen histology. Chi-square test based Phi-coefficient calculations were performed to search for associations between each factor and diagnostic yield. Results: Overall diagnostic yield was 94.6%. There was no significant difference in diagnostic yield between specialist biopsies (96.8%) and resident biopsies (93.1%), between lesions located in the extremities (94.9%) and lesions in the torso (93.8%) and on the basis of needle gauge or number of acquired cores. Diagnostic accuracy was 100% for surgical lesions. The only factor influencing the quality of CNB was lesion composition (repeat biopsies in myxoid and/or inhomogeneous lesions). Conclusion: The most important aspects to achieve constant high quality results with ultrasound guided CNBs in the work-up of musculoskeletal soft tissue tumors are expertise concerning identification and targeting of viable tumor components and strict adherence to a quality controlled biopsy procedure. Once this is achieved, technical factors have almost no effect on the quality of CNB. [ABSTRACT FROM AUTHOR]