多排螺旋CT在心外科的临床应用.ppt

多排螺旋CT在心外科的临床应用,吕滨（代表CT室全体人员）中国医学科学院阜外心血管病医院2008年12月11日,MDCT和DSCT在中国的情况,16排MDCT共550台,64排MDCT共350台,DSCT装机36台68%(636家医院)开展冠状动脉CTA检查53%(496家医院)每月开展冠脉CTA520例阜外医院每天冠状动脉CTA平均45例,Light-speedVCT,GE,阜外医院的CT设备,DualSourceCT,Siemens,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,CoronaryArteryDisease,35.1%(97/279)男性和18.8%(62/330)女性冠状动脉钙化阳性,p0.001Agaston钙化积分103.1374.9(男性组)、48.0219.2(女性组),p0.05男性组和女性组均随年龄增加而升高,p0.001150例小样本研究：北京地区比上海和广州发病率高且严重,p0.05危险因素、颈动脉超声同时被评估,社区亚临床人群冠状动脉粥样硬化初步研究结果（阜外医院资料）,冠状动脉斑块成像,68%ACS是由50%狭窄的病变导致(Circulation1995;92:657)51%不稳定病变呈现“正性重构”，(Circulation2000;101:604-10)MDCT可以探测危险斑块，同时显示狭窄,动脉粥样硬化模型研究国家自然科学基金项目,新西兰白兔模型的造影图像,MDCT探测尚无管腔狭窄的危险斑块,纤维斑块,男性，41岁,不稳定心绞痛薄层纤维帽，较大脂核,64-MDCT与IVUS的对照研究（阜外医院资料：n66）,16-MDCT：48例(119节段),r=0.58,p0.00164-MDCT：18例(25节段),r=0.87,p0.001中华放射学杂志2007;41:1027-1031.,冠心病诊断,MDCT与传统冠状动脉造影对照（阜外医院资料：n=1056；97.3%冠状动脉节段可以分析）,SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis.EuropeanJournalofRadiology2006;60:279-286,急性冠脉综合征AcuteCoronarySyndrome,男性,42岁,吸烟,高LDL,急性不稳定心绞痛发作后16小时,完全阻塞性病变，指导PCI,他汀类药物治疗能否抑制斑块进展？药物？PCI？哪个更好？,斑块随访,34例MDCT与SPECT对照研究结果(阜外医院资料):敏感性=93.3%(14/15),特异性=84.2%(16/19)，准确率=88.2%(30/34).,早期探测急性心内膜下心肌梗塞,平扫,动脉期增强扫描,5分钟延迟扫描,前降支结扎后3小时CT扫描,“首过法”MRA,同位素SPECT,TTC染色,冠状动脉搭桥术后随访,2006.3月2008.10月，1436例(男1192/女244，60.811.8岁).通畅率:LIMA=92%(877/953)，p0.001SVG=87.1%(1455/1670).通畅率:LAD=91.9%(557/606),LCx=87.2%(599/687)，RCA=84.4%(621/736)p0.52,MDCT诊断冠状动脉搭桥血管再狭窄,GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.,男性,75岁,高危险因素无OMI,CABG适应症,心功能研究DSCT,UCG和MRI对照研究,DSCT,MRI,CourtesyofSDImageInstitute,China,辐射剂量管理实现前瞻性心电门控扫描辐射剂量从13.54.1(1.2-28.1)mSv降低为4.01.5(1.2-7.5)mSv（阜外医院资料：n316）,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,AorticDiseases,MDCT诊断主动脉疾患,2278例(M/F=1740/538)49.512.3岁24小时急诊平均每天13例术前和术后均行CT检查替代血管造影,MIP/CPR三维重建图像,男性，42岁腹主动脉瘤支架隔离术前后,Female,35years.MarfanssyndromeStanfordBaorticdisection.Davidaortareplacement,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,CongenitalHeartDiseases,CongenitalHeartDiseasesonMDCT,774patients(M/F=425/349,14.818.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.,CT诊断先心病的优势和适应症,观察肺动脉发育和体肺侧支血管情况观察主动脉弓发育和畸形肺静脉畸形引流的诊断28例手术证实：CT诊断敏感性91.3（超声85.7%）CT诊断特异性100（超声94.3%）,主肺间隔缺损动脉导管未闭,右肺动脉起自升主动脉动脉导管未闭,男性，16个月.主动脉缩窄主动脉弓发育不良动脉导管未闭室间隔缺损,主动脉弓离断,女性，1个月，主动脉弓离断（B型）,女性，37岁，主动脉弓离断（C型）,肺静脉畸形引流,右上肺静脉入左房右下肺静脉入下腔左上肺静脉入冠状静脉窦左下肺静脉入左房,1979年诺贝尔生理和医学奖获得者“因为发明了计算机体层摄影术（CT）,AllanM.Cormack(1924-1998),GodfreyN.Hounsfield(1919-2004),下一个有前途的应用将会是冠状动脉成像HounsfieldGN.计算机医学成像.诺贝尔获奖感言,1979年.12.8日,ClinicalApplicationsofMulti-detectorrowSpiralCT（MDCT）onCardiovascualrSurgery,BinLu,M.D.DepartmentofRadiology,FuWaiCardiovascularInstitute,PekingUnionMedicalCollege11Dec.2008,MDCTandDSCTinChina,16-MDCT(550),64-MDCT(350),DSCT(36)68%(636hospitals)performCCTA53%(496hospitals)perform5-20casesofCCTApermonth45casesofCCTAperformedinFuWaiperday,Light-speedVCT,GE,CTScannersinFuWaiHospital,DualSourceCT,Siemens,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,CoronaryArteryDisease,35.1%(97/279)maleand18.8%(62/330)femaleareCACpositive,pSouthern(ShangHaiandGuangZhou),p0.05Riskfactors,carotidUSwereevaluated,1.1PrevalenceofSub-clinicalCoronaryAtherosclerosisonChinesePopulation,1.2CoronaryArteryPlaqueImaging,68%ACScausedbylesionsof50%stenosis(Circulation1995;92:657)51%unstablelesionsarepositiveremodeling;(Circulation2000;101:604-10)MDCTvisualizesbothvulnerableplaquesandluminalnarrowing,AtheroscleroticModelonRabbitsGrantedbytheNaturalScienceFundationofChina,TranscatherterAngiographyonNewZealandWhiteRabbitModels,Detectionofplaquewithoutstenosis,Fibrousplaque,Male,41years,UnstableanginaThin-fibrouscapandbigfattycore,64-MDCTvsIVUS(FuWaiData),48caseson16-MDCT,r=0.58,p0.00118caseson64-MDCT,r=0.87,p0.001ChineseJRadiology2007;41:1027-1031.,1.3DiagnosisofCAD,ComparisonofMDCTwithConventionalCoronaryAngiography（n=1056；97.3%ofsegmentswereevaluable）,SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis.EuropeanJournalofRadiology2006;60:279-286,1.4AcuteCoronarySyndrome,Male,42years,currentsmoking,HighLDL,onsetofunstableanginain16hours,CoronaryTotalOcclusion,Canstatinsinhibitvulnerable/softplaqueprogression?Whichisbetter?Medication?PCI?,1.5PlaqueF-U,ComparisonstudybetweenMDCTandSPECT(34CasesofFUWAIhospital):SEN=93.3%(14/15),SPE=84.2%(16/19)andACCU=88.2%(30/34).,1.6DetectionofAcuteMyocardialInfarction,PlainScans,First-passCTA,Late-enhancementof5mins,3HourslaterofLADLigation,First-passMRA,SPECT,TTC染色,1.7Follow-upofCABG(DatafromFuWaiHospital),Mar.2006toOct.2008,1436patients(M/F=1192/244,60.811.8years).Patency:LIMA=92%(877/953)SVG=87.1%(1455/1670)p0.001Patency:LAD=91.9%(557/606),LCx=87.2%(599/687)RCA=84.4%(621/736)p0.52,EvaluationofCABGRestenosisbyMDCT,GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.,Male,75years,highrisksNon-MI,indicationforCABG,1.8HeartFunctionEvaluationsComparisonstudyamongDSCT,UCGandMRI,DSCT,MRI,CourtesyofSDImageInstitute,China,1.9ExposionDoseManagementProspectiveECGTriggeringisavailableDoseisdecreased:13.54.1(1.2-28.1)mSvto4.01.5(1.2-7.5)mSv,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,AorticDiseases,AorticDiseasesonMDCT,2278patients(M/F=1740/538)49.512.3years24-houremergencyAverage13casesperdaybeforeandafteroperationTosubstituteofconventionalAngiography,MIP/CPRReconstructedImages,Male,42years.AbdominalAorticAneurysm.Beforeandafterintraluminalstentingisolation.,Female,35years.MarfanssyndromeStanfordBaorticdisection.Davidaortareplacement,SUBTITLES,CoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseases,CongenitalHeartDiseases,CongenitalHeartDiseasesonMDCT,774patients(M/F=425/349,14.818.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.,AdvantagesandIndicationsofCTforCHD,Pulmonaryarterydevelopmentsandaorto-pulmonarycollaterals.Aorticarchdevelopmentsandmalforma