冠脉CTA的技术和解剖

CoronaryCTA:CoronaryAnatomy&Terminology-ACardioEogisVsPerspective.CoronaryCTA:CoronaryAnatomy&Terminology-ACardioEogisVsPerspective.AW野JulieMiller,MD.F.A.G.C/?AssistantProfessorofMedicineInternentionalCardiologyJohns.HopkinsUniVersit'y如果要描述一个动脉，需要描述它的起始，走行，分支名称，大小（包括管径和分布范围），优势类型，并对图像质量进行评价（这在冠脉成像应用普遍，但是在其它地方，一般不在报告里面进行评价ArteryDescriptionOrigin-Originating§usp/^inus.of-yalsaivaCourse+Branchnam已Size(caliberanddistribution)-Small,Medium,LargeD'onninan^eAdequacyofimagequalityforinterpretation-Overall,pervessel,pefsegnnentDXY.CN中间支的图像RamusjntermediusCourtesyDXY.CNDrJones.8Partners,AustraliaA'MT:Vrf-J—IMJf*,LA'MT:Vrf-J—IMJf*,L：Z血5E-M［：'■：■右侧冠状动脉起自右侧冠状窦，位置上低于左侧冠状动脉，有0.1%的病例起于左侧冠状动脉窦。走行沿着右侧房室沟，走向房室交界点。85%的病例发出后后降支，有边缘支和右侧后旁支。15〜20%的病例为右侧优势类型NormalRightCoronaryArtery(RCA)・Origin-Righ(l^erthantheLM)-AnomalousfromLSV=1%-Course-DownrightAVgrovetowardcrux:ofheart.■Branches-Riqhtposteriordescending(85%)-^cuteMarginalbranches-Rightpo^terior-laleral-.t?rilicalissues-DominanceC15-?O%J：正常右侧冠状动脉的解剖NormalAnatomy(RCA)正常右侧冠状动脉的曲面重建NormalAnatomy(RCA)正常右侧冠状动脉的曲面重建NormalAnatomy(RCA)其它的分支有窦房结动脉，约60%来自于右侧冠状动脉，约40%来自于左侧冠状动脉房室结动脉，右侧冠状动脉动脉圆锥支，起自右侧冠状动脉的近端，很多病例为单独起源，可以供应侧壁交通支。ArteryDescriptsn/Origin-OriginatingCusp7sinusSourseBrandhnam已Size[Qahb^randdistribution)-Small,Medium,LargeD^nninanteAdequac^：ofimagequalityforinterpretation-Overall,pervessel,per.'segnnentDXY.CN右侧优势型RightDominance左侧优势型LeftDominance描述病变，需要描述病变发生的位置（起始部，近端，中间部，远侧端），分叉，长度（狭窄时,小于10cm为局限，离散型，大于20mm为弥漫性，大范围）、偏心性还是中心性，有无扭曲，有无栓子，软斑块和钙化，有无溃疡穿孔等A^teryDescriptionOrigin-OriginatingCusp/；-&inus'..ofValsalva'dourseBranchnam已Size(valiberanddistributit)-n)-Small,Medium,LargeDominanc-sAdequacyofimagequalityforinterpretation-Overall,pervessel,persegmentDXY.CN前降支的弥漫性病变DiffuseLADDisease局限的溃疡性斑块FocalUlceratedPlaque局限的溃疡性斑块FocalUlceratedPlaque冠脉的异常CoronaryAnomalies冠脉的异常CoronaryAnomaliesBenign(0.5-1%)(80%ofanomalies)—已已parat已LAD/L(LXosHa-LC&originfromRSVorRCA-LCXcoursE5behndaoita-Anomalousorioinfromaorta・HighanteriororyinofRCA.<LM—SmallfistulaPetentiallj^serious：(20%ofanomalies)-J0ng；nof.CA：fromoppositeaorticsinus-(.1-.^%)-Anomalous；-originrrcrinpa(-.oi%：］:-MultpleorLargecoronaiy.tistulaE一singlecoronaryartery冠脉的异常类型CoronaryAnomaliesMuiTnal.LUiaiimL,uinuntLMTruihLAD.1L冠脉的异常类型CoronaryAnomaliesMuiTnal.LUiaiimL,uinuntLMTruihLAD.1L匚::■:dciumiRijATomLEirtBlnuQLMtumRatitCmrunscBlnur;LNdhunMuhtCDni"邸Plrw■:DXilCNfinrtrfiaflerfs.LT,A册JCaE忸£异常的右侧冠状动脉AnomalousRCA异常的左冠动脉干结束了，总结。CONCLUSIONS-Knowledgeofnormalcardiac,coronaryarteryandcoronaryvenousanatomy,aswellasknowledgeofpathologicchangesareimportant!ninterpretationofCTA.■Angiographicinterpretationshouldincludeassessmentofadequacyofimageforevaluationofeacharteiy/segrnent.Eacharteryshouldbeexaminedforitsorigin,course,size,branches,andabnormalities/lesions.Acomprehensiveandclinically-usefulMDCTAstudyshouldincorporate