Imaging Pearls ❯ Vascular ❯ FMD (Fibromuscular Dysplasia)
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Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239- Fibromuscular dysplasia (FMD) is an idiopathic, segmentary, noninflammatory, nonatherosclerotic arteriopathy that can affect all layers of both small- and medium-caliber arteries, with renal, carotid, and vertebral artery involvement in 65% of cases. FMD predominantly affects young women under 30 years of age, with a female-to-male prevalence ratio of 9:1 . While the underlying worldwide prevalence is unknown, to our knowledge, a study of 40 566 670 medical records from January 2015 to January 2020, aggregated from 26 integrated health care systems in the United States, identified 4860 patients with a diagnosis of FMD, revealing an approximate prevalence of 12.0 cases per 100 000 individuals.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - While some authors have suggested that renal artery involvement occurs in more than 75% of patients, a case series of over 1000 patients revealed involvement of the renal arteries in 58% of cases, the carotid or vertebral arteries in 32%, and other vessels (iliac arteries or intracranial arteries) in 10%. There is an average delay of 49 years between the onset of the first symptom to the diagnosis of FMD, leading to impaired quality of life and poor outcomes, including poorly controlled hypertension and its sequelae, including transient ischemic attack, stroke, dissection, or aneurysm rupture.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - The medial type is most common, predominantly affecting women 3050 years of age. It is characterized by alternating ridges of collagen (fibrosis) and rarefaction of smooth muscle cells, leading to loss of the elastic membrane but preserved internal elastic lamina. The classic string-of-beads appearance at angiography reflects regions of alternating stenosis and dilatation (Figs 2, 4). At histologic analysis, the medial type is further subdivided into medial fibroplasia (60%70%), perimedial fibroplasia (15%25%), and medial hyperplasia (5%15%). Perimedial fibroplasia represents less than 1% of disease in adults but is the predominant medial subtype in children.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - The most common imaging manifestations of renal FMD include a tubular, smooth, bandlike focal stenosis (focal FMD) or the classic string-of-beads appearance (multifocal FMD). Aneurysm, tortuosity, dissection, and infarct are commonly seen. Renal involvementclassically manifests as accelerated, malignant, or grade 3 hypertension (blood pressure > 180/110 mm Hg) or drug-resistant hypertension (blood pressure target not achieved despite optimal dosing with a three-drug therapy regimen including a diuretic) in young patients without cardiovascular risk factors. Additional scenarios that warrant screening for FMD include patients with (a) a unilateral small kidney without underlying urologic cause, (b) an abdominal bruit in the absence of atherosclerotic disease or atherosclerotic risk factors, (c) suspected renal artery dissection or renal infarction, or (d) FMD in at least one other vascular territory.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Carotid webs are a unique imaging finding suggestive of FMD, and tortuosity of the carotid or vertebral arteries is considered an FMD variant in the presence of other findings suggestive of FMD . Carotid or vertebral artery FMD may lead to transient ischemic attack or stroke . The estimated prevalence of carotid and vertebral artery FMD ranges from 0.3% to 3.2%, although this may be an overestimation : an angiographic series revealed only four instances of cervical (vertebral) or intracranial FMD among a total of 20 244 patients (0.02%).
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Lower extremity FMD most commonly manifests as multifocal FMD. While typically bilateral and involving the external iliac arteries, it can also occur in the common iliac, internal iliac, common femoral, deep femoral, superficial femoral, and popliteal arteries . FMD involving the iliac arteries was present in 14.7% of patients in the French Assessment of Renal and Cervical Artery Dysplasia (ARCADIA) and 7.6% of patients in the Polish ARCADIA-POL registries. Symptoms include claudication, foot or toe ischemia, and atypical leg symptoms; dissections and aneurysms may occur. However, most patients with lower extremity involvement are asymptomatic and may be diagnosed either incidentallyat imaging or by workup of femoral bruit detected at physical examination.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - FMD is associated with spontaneous coronary artery dissection (SCAD), a rare but increasingly recognized cause of acute coronary syndrome and myocardial infarction affecting a young but otherwise healthy population. SCAD has a strong female predilection, accounting for 10%25% of acute myocardial infarction in women under the age of 50 years, with 50% occurring in the postpartum period. In this relatively rare cause of sudden cardiac death, coronary insufficiency arises from external compression of the true lumen by development of a false lumen within the outer third of the tunica media of the coronary artery wall . This is not associated with atherosclerosis, iatrogenic injury, or trauma.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Visceral artery FMD can involve the celiac axis and hepatic, splenic, and superior and inferior mesenteric arteries. The Polish Assessment of Renal and Cervical Artery Dysplasia (ARCADIA-POL) registry reported mesenteric involvement in 13.2% of patients and splenic artery involvement in 10.4%. Typical imaging findings include aneurysms of th involved vessels or other complications of FMD, particularly spontaneous dissection, as patients with visceral FMD are more likely to have aneurysms or dissections compared with those without visceral FMD. Splanchnic FMD can be asymptomatic or manifest as postprandial flank or abdominal pain, mesenteric ischemia, aneurysms, dissections, or abdominal bruit. Asymptomatic splanchnic artery FMD is often incidentally detected with an imaging examination performed for other purposes.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Various vasculitidesincluding microscopic polyangiitis, rheumatoid vasculitis, systemic lupus erythematosus, and eosinophilic granulomatosis with polyangiitis (EGPA)can cause vascular abnormalities that may initially mimic those of FMD; however, these disease entities typically manifest with additional distinguishing systemic manifestations. A few notable vasculitides that are more likely to mimic FMD include polyarteritis nodosa (PAN), neurofibromatosis type 1 (NF1), Takayasu arteritis, and giant cell arteritis (GCA). Other potential mimics to be discussed include Ehlers-Danlos syndrome (EDS) type IV, median arcuate ligament syndrome, an imaging artifact known as standing waves, and a segmentalarterial mediolysis (SAM).
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - The key differentiators between Takayasu arteritis and FMD are normal levels of inflammatory markers or acutephase reactants (eg, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) in FMD, unless there is infarction of the kidney or bowel (1). As FMD may occur in multiple vascular territories and cause accelerated hypertension, renal impairment, transient ischemic attack, stroke, and vasculopathy (stenosis, aneurysm, or dissection), it may be confused with Takayasu arteritis (1). At imaging, however, the presence of vessel wall thickening or aortic involvement supports a diagnosis of Takayasu arteritis as opposed to FMD; unlike in Takayasu arteritis, vessel abnormalities in FMD show no fluorodeoxyglucose (FDG) uptake at PET examinations.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Like Takayasu arteritis, GCA is a potential mimic of craniocervical FMD. GCA is a chronic systemic vasculitis of large or medium-sized arteries, typically granulomatous in nature, and often involving the thoracic aorta, supra-aortic branches, and temporal artery. GCA leads to ischemic optic neuropathy with potentially irreversible vision loss on the affected side with potential contralateral involvement, which can lead to systemic, neurologic, and ophthalmologic complications. The temporal artery is most often involved, although the aorta and subclavian, iliac, ophthalmic, occipital, and vertebral arteries can also be affected (34). GCA is associated with polymyalgia rheumatica (PMR): 16%21% of patients with PMR eventually develop GCA, and 40%60% of patients with GCA also have PMR.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - Segmental arterial mediolysis (SAM) is characterized by noninflammatory, nonatherosclerotic, dissecting, medium-sized vessel dissections and arterial aneurysms involving medium- sized to large arteries and is often difficult to differentiate from multifocal FMD. A key differentiator is the age at which patients are affected: FMD typically affects those 2050 years of age, whereas individuals older than 50 years are typically affected by SAM . FMD is often slowly progressive and often incidental, while SAM typically has rapid onset affecting a single or multiple vascular beds.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239 - FMD is a rare, idiopathic, systemic arteriopathy with potentially devastating complications. As such, appropriate evaluation for complications of FMD (aneurysm, dissection, myocardial infarction) is essential in at-risk patient populations. Given its higher than expected prevalence, it is important to consider FMD as a differential diagnosis when a vascular abnormality is encountered; investigation for other vascular bed involvement should be performed in all patients. As radiologists play a vital role in diagnosis, workup, and follow-up of patients with FMD, knowledge of this entity is crucial and can have a substantial impact on the clinical course in a patient with FMD by allowing more prompt diagnosis and potentiall life-saving intervention.
Multisystem Imaging Manifestations of Fibromuscular Dysplasia
Anne Sailer Nadia Solomon Anne Marie Cahill et al.
RadioGraphics 2026; 46(3):e240239
Multisystem Imaging Manifestations of Fibromuscular Dysplasia 
- “TAA is broadly classified into three categories based on cause: (1) degenerative, (2) genetically mediated, and (3) inflammatory (ie, aortitis). Degenerative aneurysms are the most common; are associated with advanced age; occur in the absence of a defined genetic aortopathy or familial clustering; and are associated with cardiovascular risk-factors, such as atherosclerosis and hyper- tension. Genetically mediated TAAs are those that occur in the setting of a known clinical syn- drome (eg, Marfan, Ehlers-Danlos) or in the setting of a genetic mutation in molecular pathways known to be associated with TAA (eg, transform- ing growth factor-b signaling pathway).”
Imaging Thoracic Aortic Aneurysm
Kimberly G. Kallianos, Nicholas S. Burris
Radiol Clin N Am 58 (2020) 721–731 - “The etiology of fibromuscular dysplasia (FMD) remains largely unknown. It is well recognized that the incidence is higher in women and the most common clinical presentation is hypertension. It is estimated that the incidence in the general population is 2% to 3%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, and iliac distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, 1 with mild dilation (4.4 cm). Reformatted images were crucial, affecting final assessment in 56% of cases evaluated by reader 1 and 36% evaluated by reader 2.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - "Fibromuscular dysplasia (FMD) is a vascular disease that may result in stenosis, dissection, or aneurysm of nearly all arterial distributions, with the renal and extracranial carotid and vertebral arteries most commonly affected (1). Medium-sized arteries are typically affected, and the disease often involves multiple vascular territories within an individual patient. The etiology of this disease is unclear. It is believed to be neither an inflammatory nor an atherosclerotic process, but genetic and environmental risk factors may play a role in the condition.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “FMD is a diffuse arteriopathy that involves medium-sized arteries in multiple vascular territories throughout the body, most commonly the renal and cerebrovascular arteries. A high prevalence of arterial aneurysm and dissection has been previously demonstrated among patients with FMD. Use of a specialized screening CTA protocol of the chest, abdomen, and pelvis in a single-center group of patients with FMD diagnosis provided important incremental information about aortic branch vessels; however, aortic abnormalities were uncommon in this group (3%). Reformatted images had a significant effect on final interpretations.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “There are three types of FMD: intimal, medial, and adventitial. The majority of the FMD is the medial form typically described as the classic “string of beads sign” that has been observed in 65% to 90% of FMD lesions. The string of beads finding is easily detected using CTA. Several studies have compared DSA and CTA for detection of renal artery stenosis (RAS) and have showed slightly lower sensitivities and specificities for CTA ranging from 88% to 100% and 97% to 99%, respectively.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480.
- “The etiology of fibromuscular dysplasia (FMD) remains largely unknown. It is well recognized that the incidence is higher in women and the most common clinical presentation is hypertension. It is estimated that the incidence in the general population is 2% to 3%. The incidence of FMD in potential living renal donors is reported to be 4% to 6%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
Gavin A. McKenzie et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - "Sixty-eight patients (2.6%; 59 female) with an average age of 52 ± 10 years were diagnosed with FMD according to the independent readers who evaluated the CTA. Unilateral FMD was observed in 46 patients (68%) and bilateral in 22 patients (32%). Three patients had aneurysms of the renal artery. The comorbidities included hypertension (n=21, 31%), dyslipidemia, (n=13, 19%), history of migraines (n=3, 4%), and history of smoking (n=14, 21%). No patients had diabetes mellitus, coronary artery disease, or family history of FMD. Twenty-one patients (31%) had a history of hypertension with 13 patients (62%) treated with antihypertensive medications.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
Gavin A. McKenzie et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “There are three types of FMD: intimal, medial, and adventitial. The majority of the FMD is the medial form typically described as the classic “string of beads sign” that has been observed in 65% to 90% of FMD lesions. The string of beads finding is easily detected using CTA. Several studies have compared DSA and CTA for detection of renal artery stenosis (RAS) and have showed slightly lower sensitivities and specificities for CTA ranging from 88% to 100% and 97% to 99%, respectively. In the present study, the incidence of FMD was 2.6% by CTA compared to 2% to 6.6% in DSA studies. The difference in incidence is likely a reflection of the imaging modality used for detection.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
Gavin A. McKenzie et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “The incidence of FMD in patients who underwent CTA for evaluation of living renal donor protocol is 2.6%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
Gavin A. McKenzie et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480.
- “The etiology of fibromuscular dysplasia (FMD) remains largely unknown. It is well recognized that the incidence is higher in women and the most common clinical presentation is hypertension. It is estimated that the incidence in the general population is 2% to 3%. The incidence of FMD in potential living renal donors is reported to be 4% to 6%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
Gavin A. McKenzie et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480.
- Purpose—To present the incidence, demographics, and clinical presentation of patients diagnosed with renal fibromuscular dysplasia (FMD) who underwent computed tomographic angiographic (CTA) for evaluation of living renal donor protocol.
Conclusion—The incidence of FMD in patients who underwent CTA for evaluation of living renal donor protocol is 2.6%.
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “The etiology of fibromuscular dysplasia (FMD) remains largely unknown. It is well recognized that the incidence is higher in women and the most common clinical presentation is hypertension. It is estimated that the incidence in the general population is 2% to 3%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “There are three types of FMD: intimal, medial, and adventitial. The majority of the FMD is the medial form typically described as the classic “string of beads sign” that has been observed in 65% to 90% of FMD lesions. The string of beads finding is easily detected using CTA. Several studies have compared DSA and CTA for detection of renal artery stenosis (RAS) and have showed slightly lower sensitivities and specificities for CTA ranging from 88% to 100% and 97% to 99%, respectively.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “Screening chest, abdomen, and pelvis CTA in patients with FMD showed substantial and incremental diagnostic yield. Reformatted images should routinely be included in imaging analysis. Abnormalities in the aorta were not common, so screening of the thoracic aorta may not be indicated.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, and iliac distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, 1 with mild dilation (4.4 cm). Reformatted images were crucial, affecting final assessment in 56% of cases evaluated by reader 1 and 36% evaluated by reader 2.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - "Fibromuscular dysplasia (FMD) is a vascular disease that may result in stenosis, dissection, or aneurysm of nearly all arterial distributions, with the renal and extracranial carotid and vertebral arteries most commonly affected (1). Medium-sized arteries are typically affected, and the disease often involves multiple vascular territories within an individual patient. The etiology of this disease is unclear. It is believed to be neither an inflammatory nor an atherosclerotic process, but genetic and environmental risk factors may play a role in the condition.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “The clinical presentation is driven by the vascular beds affected. Renal involvement usually presents with hypertension, and carotid artery involvement is often heralded by pulsatile tinnitus, headache (generally the migraine type), and transient ischemic attack or stroke (often due to carotid or vertebral artery dissection). FMD may also be discovered incidentally in an asymptomatic patient who is imaged for another clinical indication.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “The clinical presentation is driven by the vascular beds affected. Renal involvement usually presents with hypertension, and carotid artery involvement is often heralded by pulsatile tinnitus, headache (generally the migraine type), and transient ischemic attack or stroke (often due to carotid or vertebral artery dissection). FMD may also be discovered incidentally in an asymptomatic patient who is imaged for another clinical indication.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, iliac, and coronary distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aneurysms of the aortic branch vessels ranged in size from 5 to 14 mm. Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, with mild dilation (4.4 cm) in 1 of these cases.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “FMD is a diffuse arteriopathy that involves medium-sized arteries in multiple vascular territories throughout the body, most commonly the renal and cerebrovascular arteries. A high prevalence of arterial aneurysm and dissection has been previously demonstrated among patients with FMD. Use of a specialized screening CTA protocol of the chest, abdomen, and pelvis in a single-center group of patients with FMD diagnosis provided important incremental information about aortic branch vessels; however, aortic abnormalities were uncommon in this group (3%). Reformatted images had a significant effect on final interpretations.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561
- Purpose—To present the incidence, demographics, and clinical presentation of patients diagnosed with renal fibromuscular dysplasia (FMD) who underwent computed tomographic angiographic (CTA) for evaluation of living renal donor protocol.
Conclusion—The incidence of FMD in patients who underwent CTA for evaluation of living renal donor protocol is 2.6%.
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “The etiology of fibromuscular dysplasia (FMD) remains largely unknown. It is well recognized that the incidence is higher in women and the most common clinical presentation is hypertension. It is estimated that the incidence in the general population is 2% to 3%.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “There are three types of FMD: intimal, medial, and adventitial. The majority of the FMD is the medial form typically described as the classic “string of beads sign” that has been observed in 65% to 90% of FMD lesions. The string of beads finding is easily detected using CTA. Several studies have compared DSA and CTA for detection of renal artery stenosis (RAS) and have showed slightly lower sensitivities and specificities for CTA ranging from 88% to 100% and 97% to 99%, respectively.”
Renal Artery Fibromuscular Dysplasia in 2640 Renal Donor Subjects: A CT Angiographic Analysis
McKenzie GA et al.
J Vasc Interv Radiol. 2013 October ; 24(10): 1477–1480. - “Screening chest, abdomen, and pelvis CTA in patients with FMD showed substantial and incremental diagnostic yield. Reformatted images should routinely be included in imaging analysis. Abnormalities in the aorta were not common, so screening of the thoracic aorta may not be indicated.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, and iliac distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, 1 with mild dilation (4.4 cm). Reformatted images were crucial, affecting final assessment in 56% of cases evaluated by reader 1 and 36% evaluated by reader 2.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - "Fibromuscular dysplasia (FMD) is a vascular disease that may result in stenosis, dissection, or aneurysm of nearly all arterial distributions, with the renal and extracranial carotid and vertebral arteries most commonly affected (1). Medium-sized arteries are typically affected, and the disease often involves multiple vascular territories within an individual patient. The etiology of this disease is unclear. It is believed to be neither an inflammatory nor an atherosclerotic process, but genetic and environmental risk factors may play a role in the condition.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “The clinical presentation is driven by the vascular beds affected. Renal involvement usually presents with hypertension, and carotid artery involvement is often heralded by pulsatile tinnitus, headache (generally the migraine type), and transient ischemic attack or stroke (often due to carotid or vertebral artery dissection). FMD may also be discovered incidentally in an asymptomatic patient who is imaged for another clinical indication.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “The clinical presentation is driven by the vascular beds affected. Renal involvement usually presents with hypertension, and carotid artery involvement is often heralded by pulsatile tinnitus, headache (generally the migraine type), and transient ischemic attack or stroke (often due to carotid or vertebral artery dissection). FMD may also be discovered incidentally in an asymptomatic patient who is imaged for another clinical indication.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, iliac, and coronary distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aneurysms of the aortic branch vessels ranged in size from 5 to 14 mm. Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, with mild dilation (4.4 cm) in 1 of these cases.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561 - “FMD is a diffuse arteriopathy that involves medium-sized arteries in multiple vascular territories throughout the body, most commonly the renal and cerebrovascular arteries. A high prevalence of arterial aneurysm and dissection has been previously demonstrated among patients with FMD. Use of a specialized screening CTA protocol of the chest, abdomen, and pelvis in a single-center group of patients with FMD diagnosis provided important incremental information about aortic branch vessels; however, aortic abnormalities were uncommon in this group (3%). Reformatted images had a significant effect on final interpretations.”
Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia.
Bolen M et al
JACC Cardiovasc Imaging. 2017 May;10(5):554-561