循环系统影像诊断学文档1

,心脏大血管影像诊断学 正常表现与基本病变 放射学院 于广会 ,Taishan medical university,Taishan medical university,Review,Taishan medical university,Taishan medical university,Review,Coronary artery: left main,开口于升主动脉左冠状窦左主干 行走于左心耳与肺动脉主干 起始部之间，长度610mm前室间沟分为前降支和左回旋 支，也可发出中间支前降支与回旋支形成夹角， 40150，半数为直角,前降支,前降支（Left Anterior Descending，LAD）左主干的直接延续，从左主干发出，沿室间沟走行，绕过心尖，终止于心脏的膈面分支分别向三个方向发出 左室前支 右室前支 前室间支,Left Circumflex,左旋支（left Circumflex Branch，LCX）几呈直角起自左主干，沿左房室沟走行，先向左，然后从前绕向后，止于心脏膈面分支左缘支（Obtuse Marginal Branch，OM）左室前支（Left anterium ventricular branches）左室后支（ Left posterior ventricular branches）左房支（Left auticular branches）,Right Coronary Artery,开口于升主动脉右冠窦内，行走于右房室沟内，在肺动脉起始部与右心耳之间向下行走，通过心脏右缘至心脏膈面。在后室间沟与房室沟的交叉点附近分为后室间支和右旋支窦房结支后室间支右旋支右房支,影像学检查方法,X线检查造影检查和DSA CTMRIUS,Taishan medical university,线摄影位置,后前位：远达片，靶片距2m右前斜位：后前位左旋4560，服钡。观察左心房，肺动脉段，右心室漏斗部左前斜位：自后前位右旋60，观察各个房室和主动脉弓的全貌左侧位：,Taishan medical university,线诊断的价值,肺血管纹理的异常、增多、减少肺源性心脏病肺内病变的情况胸部其他异常 心包、胸膜、纵隔、骨骼、血管及瓣膜钙化,Taishan medical university,Taishan medical university,心胸比率测量,Taishan medical university,胸部X线正常表现：右前斜位,胸部X线正常表现：左前斜位,胸部X线正常表现：左侧位,正常心脏外形 体型、横膈位置、心胸比率、夹角,Taishan medical university,影响因素 性别 年龄 体位 呼吸 其它：妊娠、心动周期,Taishan medical university,再回首,Taishan medical university,Taishan medical university,Left ventricle angiography,1房室间隔2漏斗间隔3二尖瓣后联合4前乳头肌5后乳头肌,3,4,1,2,5,Taishan medical university,Taishan medical university,CT检查,正常解剖血管成像冠状动脉 冠脉钙化积分 CT冠脉后处理,Ascending Aorta升主动脉Descending Aorta降主动脉Pulmonary Artery肺动脉Superior Vena Cava上腔静脉Left Coronary Artery(LCA)左冠状动脉Left Main Artery(LMA) 左主干Left Anterior Descending(LAD) 左前降支Left Marginal Branch(LMB)左边缘支Left Circumflex(LCX) 左回旋支,Right Coronary Artery(RCA) 右冠状动脉Posterior Descending Artery(PDA) 后降支Conus Branch 动脉圆锥支Left Atrium 左心房Right Atrium 右心房Left Ventricle 左心室Right Ventricle 右心室Cardiac Vein 心脏静脉Mitral Valv 二尖瓣Coronary Sinus 冠状窦,Cardiac Anatomy,主动脉弓上层面,主动脉弓层面,主肺动脉窗,Ascending Aorta,Pulmonary Artery,Descending Aorta,Ascending Aorta,Pulmonary Artery,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,Ascending Aorta,Pulmonary Artery,Descending Aorta,Superior Vena Cava,Ascending Aorta,Pulmonary Artery,Descending Aorta,Superior Vena Cava,CT平扫图象 CT增强图象,Cardiac Anatomy,小于29mm,Superior Vena Cava,Superior Vena Cava,LMA,LMA,Ascending Aorta,Ascending Aorta,Descending Aorta,Descending Aorta,LAD,Left MarginalBranch,LAD,Left MarginalBranch,CT平扫图象 CT增强图象,Cardiac Anatomy,Superior Vena Cava,Ascending Aorta,Descending Aorta,LAD,Left MarginalBranch,LMA,LCX,Superior Vena Cava,Ascending Aorta,Descending Aorta,LAD,Left MarginalBranch,LMA,LCX,Pulmonary Artery,Pulmonary Artery,CT平扫图象 CT增强图象,Cardiac Anatomy,Superior Vena Cava,Superior Vena Cava,Descending Aorta,Descending Aorta,Pulmonary Artery,Pulmonary Artery,LAD,LCx,LCx,LMB,LMB,LAD,LeftAtrium,LeftAtrium,CT平扫图象 CT增强图象,Cardiac Anatomy,Superior Vena Cava,Superior Vena Cava,Descending Aorta,Descending Aorta,Pulmonary Artery,Pulmonary Artery,LAD,LCx,LCx,LMB,LMB,LAD,LeftAtrium,LeftAtrium,CT平扫图象 CT增强图象,Cardiac Anatomy,Descending Aorta,LCx,LMB,LAD,LeftAtrium,Descending Aorta,LCx,LMB,LAD,LeftAtrium,RightAtrium,LeftVentricle,LeftVentricle,Ascending Aorta,Ascending Aorta,RightAtrium,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,RCA,Left Ventricle,Left Ventricle,Right Ventricle,Right Ventricle,Left Atrium,Left Atrium,RightAtrium,RightAtrium,LCx,LMB,LCx,LMB,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,RightAtrium,LCx,LMB,RCA,Left Ventricle,Right Ventricle,Left Atrium,RightAtrium,LCx,LMB,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,RCA,Left Ventricle,Left Ventricle,Right Ventricle,Right Ventricle,Left Atrium,Left Atrium,Right Atrium,Right Atrium,LCx,LMB,LCx,Cardiac Vein,LMB,Cardiac Vein,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LCx,LMB,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LCx,LMB,Aortic Valve,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LCx,LMB,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LCx,LMB,Aortic Valve,Cardiac Vein,Cardiac Vein,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LCx,LMB,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LMB,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,Conus Branch,Conus Branch,Mitral Valve,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LMB,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LMB,Cardiac Vein,Cardiac Vein,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,LMB,RCA,Right Ventricle,Left Atrium,Right Atrium,Left Ventricle,Mitral Valve,Descending Aorta,Descending Aorta,Cardiac Vein,Cardiac Vein,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,RCA,Left Ventricle,Right Ventricle,Left Atrium,Right Atrium,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,Descending Aorta,Descending Aorta,RCA,Left Ventricle,Right Ventricle,Right Atrium,RCA,Left Ventricle,Right Ventricle,Right Atrium,Coronary Sinus,Coronary Sinus,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Right Atrium,RCA,Left Ventricle,Right Ventricle,Right Atrium,Descending Aorta,Descending Aorta,Coronary Sinus,Coronary Sinus,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,Right Atrium,RCA,Left Ventricle,Right Ventricle,Right Atrium,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,RCA,Left Ventricle,Right Ventricle,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,RCA,Left Ventricle,Right Ventricle,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,RCA,Left Ventricle,Right Ventricle,Descending Aorta,Descending Aorta,Liver,Stomach,Liver,Stomach,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,RCA,Left Ventricle,Right Ventricle,Descending Aorta,Descending Aorta,CT平扫图象 CT增强图象,Cardiac Anatomy,RCA,Left Ventricle,Right Ventricle,RCA,Left Ventricle,Right Ventricle,Descending Aorta,Descending Aorta,Liver,Stomach,Liver,Stomach,CT平扫图象 CT增强图象,Cardiac Anatomy,PDA,Left Ventricle,Right Ventricle,PDA,Right Ventricle,Liver,Stomach,Liver,Stomach,CT平扫图象 CT增强图象,Cardiac Anatomy,冠状动脉钙化的定量积分： 钙化面积（mm2）CT值的峰值系数 100HU-200HU为1，201HU-300HU为2，301HU-400HU为3意义： 冠状动脉钙化的数量反映了冠状动脉粥样硬化的程度及冠状动脉狭窄的程度 随着积分增高，冠心病发病的可能性随之增加 意味着至少一处冠状动脉分支横断面狭窄超过75%,Taishan medical university,Taishan medical university,Taishan medical university,thin-Slab MIP,LCX,Right Coronary Artery,Taishan medical university,Taishan medical university,Taishan medical university,Taishan medical university,MR成像,短轴,LV,RV,MR成像,垂直长轴(两腔心),LV,RV,常用成像平面,水平长轴(四腔心),LV,RV,常用成像平面,心脏 MR,True FISP,CE-心肌活性,CE-MRA,Taishan medical university,Taishan medical university,右冠状动脉,左冠状动脉,Taishan medical university,Taishan medical university,基本病变X线表现,心脏各房室增大的表现心脏疾病的肺血管改变心脏疾病的主动脉改变心力衰竭的改变,心脏增大的形态,二尖瓣型主动脉型普大型木靴型,Taishan medical university,Taishan medical university,心脏各房室增大,左心室增大左心房增大右心室增大右心房增大心脏普遍增大,左心室增大X线表现,心影呈主动脉型流出道增大左心缘下部圆隆，并向左扩展心尖向左下方移位相反搏动点上移,流入道增大左心室向后向下隆凸扩展，斜位60度心后缘仍与脊柱重叠房室切迹向上移位 心室间沟向前下方移位左侧位心后食管前间隙狭小以致消失心脏右旋,高血压病、主动脉瓣病变、二尖瓣关闭不全、动脉导管未闭,左心室增大示意图（正位）,左心室增大示意图（左前斜位）,Taishan medical university,左心房增大X线表现,左心房压迫推移食道造成压迹和移位心底部双心房阴影和右心缘双重边缘气管分叉展开，隆突角增大，左主支气管受压抬高心后上缘局部隆突后前位片，左心缘出现左心耳的弧状突起,见于二尖瓣病变、左心衰竭、动脉导管未闭、室间隔缺损,左心房增大示意图 正位 左前斜位 右前斜位,左心耳,肺动脉段,双弧影,心底部,右心室增大X线表现,心影呈二尖瓣型流出道增大右心室上下径增加后前位上心腰丰满或膨隆，长度增加，左心缘相反搏动点向下移位右前斜位心前缘膨隆，心前间隙变小,流入道增大心室深径和宽径增加 心室的膈面段延长 心尖向左移位并抬高左前斜位上室间沟向后上方移位，心前缘下段向前凸出,见于二尖瓣狭窄、肺源性心脏病、肺动脉狭窄、肺动脉高压、先心心内间隔缺损、法四,右心室增大示意 正位 左侧位,右心室增大示意图 左前斜位 右前斜位,右心房增大X线表现,右心缘向右扩展并圆隆，最突出位置常比较高，右上纵隔的上腔静脉增宽左前斜位上右心房段延长，凸隆并与心室段成角，右心房段超过整个右心缘长度的一半以上右前斜位心后缘向后方突出，并常超过食管。横膈上方的心后间隙变窄或闭锁,见于右心衰竭、房间隔缺损、三尖瓣病变、心房黏液瘤,右心房增大示意图,心脏普遍增大的X线表现,肺血管的改变,肺血减少肺血增多肺瘀血肺动脉高压肺动脉高压(高流量性肺动脉高压）阻塞性肺动脉高压（肺内小血管痉挛、狭窄）肺静脉高压,肺血减少,原因三尖瓣狭窄三尖瓣闭锁肺动脉狭窄,肺门血管影变小肺野血管纹理变细肺野异常清晰肺动脉大分支变细小侧支循环影出现：肺野内细小、扭曲而紊乱的网状血管影,肺缺血,肺动脉影变细/消失右侧由于侧枝循环的建立而致肺纹理紊乱,肺充血,肺充血原因左向右分流先天性心脏病引起循环血量增加的疾病 贫血 甲状腺机能亢进 脚气病,X线表现肺动脉及其各支分支均扩张增粗肺动脉段膨隆两肺门影扩大透视可见肺动脉段及肺门血管搏动增强,肺充血,右肺门影增大，增浓右下肺动脉增粗，增浓,Taishan medical university,肺动脉高压,阻塞性正常肺动脉主干压力15-30mmHg,肺动脉段膨出肺大血管增粗右心室增大肺野血管纹理变细 肺门截断现象,肺淤血,肺静脉回流通道狭窄或阻塞二尖瓣孔狭窄或阻塞左心室衰竭缩窄性心包炎影响左心,肺静脉扩张：增高轻时，肺静脉普遍扩张；增高达到一定程度后，肺血管选择性收缩，下叶静脉变细，上叶静脉进一步扩张肺门阴影增大，模糊肺野透光度普遍减低间隔线的出现,Taishan medical university,肺瘀血 肺水肿,Taishan medical university,肺静脉压25mmHg,间质性肺水肿,肺泡性肺水肿,间质性肺水肿,肺纹理增强，边缘模糊肺门增大模糊，结构不清间隔线：Kerley A、B、C肺野透亮度普遍减低胸膜肥厚少量胸腔积液,Interstitial pulmonary edema,Pulmonary hemosiderosis,M35Long-standing mitral stenosis,肺泡性肺水肿,左心衰竭的可靠征象腺泡状密度阴影，相互融合成为不规则片状模糊阴影蝴蝶状,肺静脉淤血肺门模糊肺水肿（间质性+肺泡性）,Taishan medical university,Pulmonaryedema,Bat wing edema,心力衰竭,左心衰竭二尖瓣病变高血压冠心病主动脉病变,右心衰竭继发于左心衰竭肺源性心脏病心房间隔缺损伴有肺动脉狭窄的先天性心脏病弥漫性心肌病变,左心衰竭,病理基础：肺静脉压力升高和肺部淤血肺静脉压力升高导致毛细血管内压力升高，超过血液渗透压时，液体从血管内进入肺间质并进入肺泡内引起肺水肿,X