Fibromuscular dysplasia: what the radiologist should know: a pictorial review
Tóm tắt
Fibromuscular dysplasia (FMD) is an idiopathic, segmentary, non-inflammatory and non-atherosclerotic disease that can affect all layers of both small- and medium-calibre arteries. The prevalence of FMD is estimated between 4 and 6 % in the renal arteries and between 0.3 and 3 % in the cervico-encephalic arteries. FMD most frequently affects the renal, carotid and vertebral arteries, but it can theoretically affect any artery. Radiologists play an important role in the diagnosis of FMD, and good knowledge of FMD’s signs will certainly help reduce the delay between the first symptoms and diagnosis. The common string-of-beads aspect is well known, but less common presentations also have to be considered. These less common imaging findings include vascular loops, fusiform vascular ectasia, arterial dissection, aneurysm and subarachnoid haemorrhage. These radiologic presentations should be known by radiologists in order to diagnose possible FMD, particularly when present in young females or when associated with personal or familial hypertension, to reduce the delay between the onset of the first symptom and the final diagnosis. The patients have to be referred to specialised FMD centres for dedicated management. • Fibromuscular dysplasia is not a rare disease.
• Radiologists should recognise less common presentations to orient specific management.
• Vascular loops, fusiform vascular ectasia and a “string-of-beads” aspect are typical presentations.
• Arterial dissection, aneurysm and subarachnoid haemorrhage are less typical radiologic presentations.
Tài liệu tham khảo
Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X (2007) Fibromuscular dysplasia. Orphanet J Rare Dis 2:28
Pasquini M, Trystram D, Oppenheim C, Ploin P, Touzé E (2011) Dysplasie fibromusculaire cervicale et intracrânienne. Press Med 40:713–719
Touze E, Oppenheim C, Trystram D et al (2010) Fibromuscular dysplasia of cervical and intracranial arteries. Int J Stroke 5(4):296–305
Hugenholtz H, Pokrupa R, Montpetit VJ, Nelson R, Richard MT (1982) Spontaneous dissecting aneurysm of the extracranial vertebral artery. Neurosurgery 10(1):96–100
Zimmerman R, Leeds NE, Naidich TP (1977) Carotid-cavernous fistula associated with intracranial fibromuscular dysplasia. Radiology 122(3):725–726
Olin JW, Froehlich J, Gu X et al (2012) The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 125(25):3182–3190
Houser OW, Baker HL Jr (1968) Fibromuscular dysplasia and other uncommon diseases of the cervical carotid artery: angiographic aspects. Am J Roentgenol Radium Ther Nucl Med 104(1):201–212
Manelfe C, Clarisse J, Fredy D, André J, Crouzet G (1974) Dysplasies fibromusculaires des artères cervico-céphaliques. J Neuroradiol 1:149–231
Mettinger KL (1982) Fibromuscular dysplasia and the brain. II. Current concept of the disease. Stroke 13(1):53–58
Blondin D, Lanzman R, Schellhammer F et al (2010) Fibromuscular dysplasia in living renal donors: still a challenge to computed tomographic angiography. Eur J Radiol 75(1):67–71
Neymark E, LaBerge JM, Hirose R et al (2000) Arteriographic detection of renovascular disease in potential renal donors: incidence and effect on donor surgery. Radiology 214(3):755–760
Cragg AH, Smith TP, Thompson BH et al (1989) Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology 172(1):145–147
Schievink WI, Bjornsson J (1996) Fibromuscular dysplasia of the internal carotid artery: a clinicopathological study. Clin Neuropathol 15(1):2–6
Mettinger KL, Ericson K (1982) Fibromuscular dysplasia and the brain. I. Observations on angiographic, clinical and genetic characteristics. Stroke 13(1):46–52
Begelman SM, Olin JW (2000) Fibromuscular dysplasia. Curr Opin Rheumatol 12(1):41–47
Stanley JC, Fry WJ, Seeger JF, Hoffman GL, Gabrielsen TO (1974) Extracranial internal carotid and vertebral artery fibrodysplasia. Arch Surg 109(2):215–222
La Batide A, Perdu J, Ploin P (2007) Dysplasie fibromusculaire artérielle. Press Med 36:1016–1023
Connett MC, Lansche JM (1965) Fibromuscular hyperplasia of the internal carotid artery: report of a case. Ann Surg 162:59–62
Harrison EG Jr, McCormack LJ (1971) Pathologic classification of renal arterial disease in renovascular hypertension. Mayo Clin Proc 46(3):161–167
Stanley J (1996) Renal artery fibrodysplasia. In: Renal Vascular Disease, Novick A, Scoble J, Hamilton G (eds). WB Saunders, London, 21–23
Kincaid OW, Davis GD, Hallermann FJ, Hunt JC (1968) Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med 104(2):271–282
Savard S, Steichen O, Azarine A, Azizi M, Jeunemaitre X, Plouin PF (2012) Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics. Circulation 126(25):3062–3069
Vasbinder GB, Nelemans PJ, Kessels AG et al (2004) Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann Intern Med 141(9):674–682, discussion 682
Willoteaux S, Faivre-Pierret M, Moranne O et al (2006) Fibromuscular dysplasia of the main renal arteries: comparison of contrast-enhanced MR angiography with digital subtraction angiography. Radiology 241(3):922–929
Sabharwal R, Vladica P, Coleman P (2007) Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia. Eur J Radiol 61(3):520–527
Furie DM, Tien RD (1994) Fibromuscular dysplasia of arteries of the head and neck: imaging findings. AJR Am J Roentgenol 162(5):1205–1209
Pannier-Moreau I, Grimbert P, Fiquet-Kempf B et al (1997) Possible familial origin of multifocal renal artery fibromuscular dysplasia. J Hypertens 15(12 Pt 2):1797–1801
Haute Autorité de Santé (2010) Protocole national de diagnostic et de soins : dysplasie fibromusculaire syptomatologique chez l’adulte. HAS, Paris.Available via http://www.hassante.fr/portail/upload/docs/application/pdf/2011-06/synthese_medecin_traitant_sur_la_dysplasie_fibromusculaire_chez_ladulte.pdf. Accessed November 2010
Osborn AG, Anderson RE (1977) Angiographic spectrum of cervical and intracranial fibromuscular dysplasia. Stroke 8(5):617–626
Varennes L, Tahon F, Grand S, et al. (2012) Aspect typique et variantes de la dysplasie fibro-musculaire des artères à destinée encéphalique. French Journeys of Radiology, Paris. Available via http://pe.sfrnet.org/ModuleConsultationPoster/consultationPoster.aspx?intIdPoster=5465. Accessed October 2012
Lacombe M (2001) Isolated spontaneous dissection of the renal artery. J Vasc Surg 33(2):385–391
Ringel SP, Harrison SH, Norenberg MD, Austin JH (1977) Fibromuscular dysplasia: multiple “spontaneous” dissecting aneurysms of the major cervical arteries. Ann Neurol 1(3):301–304
Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344(12):898–906
Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8(7):668–678
Bellot J, Gherardi R, Poirier J, Lacour P, Debrun G, Barbizet J (1985) Fibromuscular dysplasia of cervico-cephalic arteries with multiple dissections and a carotid-cavernous fistula. A pathological study. Stroke 16(2):255–261
Goncharenko V, Gerlock AJ Jr, Shaff MI, Hollifield JW (1981) Progression of renal artery fibromuscular dysplasia in 42 patients as seen on angiography. Radiology 139(1):45–51
Stanley JC, Gewertz BL, Bove EL, Sottiurai V, Fry WJ (1975) Arterial fibrodysplasia. Histopathologic character and current etiologic concepts. Arch Surg 110(5):561–566
Mettinger KL, Soderstrom CE (1978) Pathogenetic profile of TIA before 55. A three-year investigation. J Neurol Sci 36(3):341–348
Cloft HJ, Kallmes DF, Kallmes MH, Goldstein JH, Jensen ME, Dion JE (1998) Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment. J Neurosurg 88(3):436–440
Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29(1):251–256
van de Nes JA, Bajanowski T, Trubner K (2007) Fibromuscular dysplasia of the basilar artery: an unusual case with medico-legal implications. Forensic Sci Int 173(2–3):188–192
Andersen CA, Collins GJ Jr, Rich NM, McDonald PT (1980) Spontaneous dissection of the internal carotid artery associated with fibromuscular dysplasia. Am Surg 46(4):263–266
Lehrer H (1967) The physiology of angiographic arterial waves. Radiology 89(1):11–19
Poloskey SL, Kim E, Sanghani R et al (2012) Low yield of genetic testing for known vascular connective tissue disorders in patients with fibromuscular dysplasia. Vasc Med 17(6):371–378
Gaud S, Cridlig J, Claudon M, Diarrassouba A, Kessler M, Frimat L (2010) Segmental arterial mediolysis and renovascular hypertension. Nephrol Ther 6(7):597–601
Chao CP (2009) Segmental arterial mediolysis. Semin Interv Radiol 26(3):224–232