冠脉CTA：冠脉解剖课件

CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversityCoronaryCTA:coronaryanatomy1冠脉CTA：冠脉解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

冠脉CTA：冠脉解剖JuileMillerMD2ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentArteryDescriptionOrigin:Orig3动脉的描述起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面动脉的描述起点：起始点/valsalva窦4NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoffNormalLeftMain(LM)Origin5左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中间支10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）6LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffLeftAnteriorDescending(LAD)O7左前降支（LAD）起点：95－99％起源于LM1-3%直接开口于左冠窦行程：心室前方经室间沟达心尖最后分为两支分支：角支室间隔支关键问题：冠状动脉近端或冠状动脉口疾病心肌桥动脉瘤，（内膜）不规则剥离

左前降支（LAD）起点：95－99％起源于LM8NormalAnrtomy（LAD)NormalAnrtomy（LAD)9LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)LeftCircumflex(LCX)Origin:10起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降分支：钝缘支左后外侧支（营养后外侧壁）左后降支(左侧优势）关键问题：左侧优势（15%-20%)起点：96-98%起源于LM11NormalAnatomy(LCX)NormalAnatomy(LCX)12NormalAnatomy(LCX)NormalAnatomy(LCX)13Ramusintermedius（中间支）Ramusintermedius（中间支）14NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)NormalRightcoronaryartery

(15右冠状动脉(RCA)起点：左valsalva窦（右冠窦）0.1%起源于左心室行程：沿右房室沟下降至房室交点分支：后降支PDA（85%）锐缘支AM右室后侧支PL

关键问题：右侧优势（85%）右冠状动脉(RCA)起点：左valsalva窦（右冠窦）16Normalanatomy(RCA)Normalanatomy(RCA)17Normalanatomy(RCA)Normalanatomy(RCA)18OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralOtherbranchesSAnodalArtery19其他分支窦房结动脉：约60%起源于RCA,40%LCX房室结动脉：RCA圆锥动脉：RCA其他分支窦房结动脉：约60%起源于RCA,40%LCX20RightdominanceRightdominance21LeftdominanceLeftdominance22LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricLesiondescriptionLocation23病变的描述定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（<10MM)连续/弥漫（>20MM)同心环/偏心的曲折的血栓软粥样斑块钙化溃疡病变的描述定位：开口，邻近，中间，末梢24DiffuseLADDiseaseDiffuseLADDisease25FocalulceratedplaqueFocalulceratedplaque26CoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistulaCoronaryanomaliesBenign(0.5-127冠状动脉异常良性(0.5-1%)(80%of异常)LAD/LCX口LCX起源于RSAorRCALCX行程在主动脉后从主动脉异常起源RCA前高位起源小的瘘管冠状动脉异常良性(0.5-1%)(80%of异常)28CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryarteryCoronaryanomaliesPotentially29潜在危险(20%of异常)起源与主动脉窦对面的室壁瘤(0.1-0.2%)异常起源于PA(0.01%)多发或大的冠状动脉瘘单一冠状动脉潜在危险(20%of异常)30CoronaryanomaliesCoronaryanomalies31AbsentLeftMain

(separateLAD/LCXorigins)AbsentLeftMain

(separateLAD32AnomalousRCAAnomalousRCA33AnomalousLMfromRSVAnomalousLMfromRSV34冠脉CTA：冠脉解剖课件35CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversityCoronaryCTA:coronaryanatomy36冠脉CTA：冠脉解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

冠脉CTA：冠脉解剖JuileMillerMD37ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegmentArteryDescriptionOrigin:Orig38动脉的描述起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面动脉的描述起点：起始点/valsalva窦39NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoffNormalLeftMain(LM)Origin40左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中间支10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）41LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoffLeftAnteriorDescending(LAD)O42左前降支（LAD）起点：95－99％起源于LM1-3%直接开口于左冠窦行程：心室前方经室间沟达心尖最后分为两支分支：角支室间隔支关键问题：冠状动脉近端或冠状动脉口疾病心肌桥动脉瘤，（内膜）不规则剥离

左前降支（LAD）起点：95－99％起源于LM43NormalAnrtomy（LAD)NormalAnrtomy（LAD)44LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)LeftCircumflex(LCX)Origin:45起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降分支：钝缘支左后外侧支（营养后外侧壁）左后降支(左侧优势）关键问题：左侧优势（15%-20%)起点：96-98%起源于LM46NormalAnatomy(LCX)NormalAnatomy(LCX)47NormalAnatomy(LCX)NormalAnatomy(LCX)48Ramusintermedius（中间支）Ramusintermedius（中间支）49NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)NormalRightcoronaryartery

(50右冠状动脉(RCA)起点：左valsalva窦（右冠窦）0.1%起源于左心室行程：沿右房室沟下降至房室交点分支：后降支PDA（85%）锐缘支AM右室后侧支PL

关键问题：右侧优势（85%）右冠状动脉(RCA)起点：左valsalva窦（右冠窦）51Normalanatomy(RCA)Normalanatomy(RCA)52Normalanatomy(RCA)Normalanatomy(RCA)53OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-MaysupplycollateralOtherbranchesSAnodalArtery54其他分支窦房结动脉：约60%起源于RCA,40%LCX房室结动脉：RCA圆锥动脉：RCA其他分支窦房结动脉：约60%起源于RCA,40%LCX55RightdominanceRightdominance56LeftdominanceLeftdominance57LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentricLesiondescriptionLocation58病变的描述定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（<10MM)连续/弥漫（>20MM)同心环/偏心的曲折的血栓软粥样斑块钙化溃疡病变的描述定位：开口，邻近，中间，末梢59