A Pictorial Essay on Fibromuscular Dysplasia Imaging: Beyond the String of Beads

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arteriopathy characterized by abnormal cellular proliferation and distorted architecture of the arterial wall. FMD mainly affects the mid-distal segment of renal and extracranial arteries. The clinical phenotype of FMD has recently expanded to include arterial dissection, aneurysm, and tortuosity. FMD is four times more frequent in women than men. The etiology of FMD is unknown, although some theories have been proposed, such as those exploring the role of environmental and genetic factors. Catheter-based angiography, optical coherence tomography, and intravascular ultrasound are some of the most reliable imaging techniques when assessing the morphology of FMD.