Imaging Pearls ❯ Vascular ❯ FMD (Fibromuscular Dysplasia)
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- “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