Color Doppler imaging of cervicocephalic fibromuscular dysplasia

Among the 15,000 patients who underwent color Doppler imaging (CDI) of the cervicocephalic arteries during the study period, all cases fulfilling ultrasound criteria of FMD were included into the case series. Criteria of FMD were: 1. Segmental string-of-beads pattern, 2. Localization in the distal extracranial part of internal carotid artery (ICA) or vertebral artery (VA), and 3. (optional): Direct and/or indirect criteria of stenosis.CDI detected FMD in 39 vessels (37 ICA and 2 VA segments) of 21 patients. 16 patients had bilateral manifestation on ICA, one of those also on VA, bilaterally. CDI disclosed 4 symptomatic high-grade ICA stenoses, 3 of them underwent endovascular treatment. 5 patients with moderate symptomatic ICA stenoses got medical treatment. In 6 patients FMD was the most likely cause of headache and in one patient FMD was diagnosed as a cause of vertigo.CDI may be used for detection of cervicocephalic FMD. Due to the unfavourable localisation of FMD for CDI, the sensitivity of CDI is lower in comparison to angiography. However, high-grade FMD stenoses that require invasive treatment can be recognized on the basis of indirect hemodynamic criteria.Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory arteriopathy of unknown etiology with segmental manifestation on medium-sized arteries in various regions of the body [1]. Manifestation on the renal arteries with the possible consequence of renovascular hypertension is remarkably frequent [2]. The cervico-cephalic arteries, especially the internal carotid artery (ICA) are attacked with an incidence of about 0.6 – 1%, often bilaterally [3]; manifestation also occurs on the vertebral artery (VA) [4]. The disease can occur at any age but is usually diagnosed in middle-aged, predominately female individuals [4].Angiography reveals in most cases the typical string-of-beads pattern (fig. 1) with alternating regions of lumen narrowing and vessel dilatation over a length of 3 – 5 cm [3]; the pr