Which imaging modalities are recommended for the diagnosis of Fibromuscular Dysplasia in primary care settings?

In primary care settings, the recommended imaging modalities for diagnosing fibromuscular dysplasia (FMD) primarily include duplex ultrasound and computed tomography angiography (CTA). Duplex ultrasound is often the first-line, non-invasive imaging tool used to assess accessible arteries such as the renal and carotid arteries, providing information on vessel structure and blood flow without radiation exposure NICE NG128. CTA offers detailed visualization of arterial anatomy and characteristic features of FMD, such as the 'string of beads' appearance, and is useful when ultrasound findings are inconclusive or when more comprehensive vascular assessment is needed NICE NG128. Magnetic resonance angiography (MRA) is another non-invasive option that can be considered, especially to avoid radiation, but it may be less available or practical in primary care NICE NG128. Conventional catheter-based angiography remains the gold standard for definitive diagnosis but is generally reserved for specialist settings due to its invasive nature and is not typically performed in primary care NICE NG128.

Therefore, in primary care, initial evaluation with duplex ultrasound followed by referral for CTA or MRA as appropriate aligns with current clinical practice and multidisciplinary recommendations for FMD diagnosis Shah et al. 2021.