冠脉CTA：冠脉解剖

1、Coronary CTA:coronary anatomy & terminology-A cardiologists perspective,Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University,冠脉CTA：冠脉解剖,Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University,Artery Description,

2、Origin: Originating cusp / sinus of valsalva Course Branch name Size (caliber and distribution):small medium large Dominance Adequacy of image quality for interpretation overall， per vessel ，per segment,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,Normal Left Main (LM),Or

3、igin -left sinus valsalva -Absent in 1% Separate,adjacent LAD LCX ostia - 0.5% Branches: LAD & LCX =85% LAD,LCX and Ramus 10-15% Critical issues: stenosis due to risk region Presence of ostial disease Other: aneurysms anomalous take off,左冠状动脉主干（LM),起点： 左valsalva窦（左冠窦） 1例外 直接分出LAD LCX占0.5 分支：分出LAD LC

4、X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,Left Anterior Descending(LAD),Origin: -Form Left Main 95-99% -1-3% separate ostium Left sinus Course Anterior intraventricula groove toward apex 2 variations in termination Branches:Diagonals septal perforators Critical issues Presence

5、 of ostial/proximal disease Myocardial bridges Other:aneurysms anomalous take off,左前降支（LAD）,起点：9599起源于LM 1-3%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,Normal Anrtomy（LAD),Left Circumflex (LCX),Origin: Originating form LM in 96-98% 5-2% separate ostium LCX ori

6、gin form right sinus or RCA (0.4%) Course:down distal left AV groove Branches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant) Critical issues dominance (15-20%),起点：96-98%起源于LM 5-2%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

7、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%),Normal Anatomy (LCX),Normal Anatomy (LCX),Ramus intermedius （中间支）,Normal Right coronary artery(RCA),Origin: right sinus of valsalva (lower than LM) Anomalous form LSV =0.1% Course: down distal right AV groove toward crux of heart Branches Right post

8、erior descending (85%) Acute marginal branches Right posterior lateral Critical issues: dominance (15-20%),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%）,Normal anatomy(RCA),Normal anatomy(RCA),Other branches,SA nodal Artery -Approx 60%RCA 40%

9、LCX AV Nodal Artery-RCA Conus Artery-RCA -Proximal many with separate origin -May supply collateral,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,Right dominance,Left dominance,Lesion description,Location -Ostial(first 2-3mm ) -Proximal -Mid -Distal Bifurcation Length (stenosis) -Discrete/focal le

10、sion (20mm) Concentric/eccentric Tortuosity Thrombus soft plaque calcium Ulcerated/concentric,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（20MM) 同心环/偏心的 曲折的 血栓 软粥样斑块 钙化 溃疡,Diffuse LAD Disease,Focal ulcerated plaque,Coronary anomalies,Benign(0.5-1%) (80% of anomalies) Separate LAD/LCX ostia LCX origin fro

11、m RSA or RCA LCX courses behind aorta Anomalous origin from aorta High anterior origin of RCA LM Small fistula,冠状动脉异常,良性(0.5-1%) (80% of 异常) LAD/LCX 口 LCX 起源于 RSA or RCA LCX 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,Coronary anomalies,Potentially serious(20% of anomalies) Origin of CA opposite aortics sinus (0.1-0.2%) Anomalous origin form PA (0.01%) Multiple or Large coronary fistulae Single Coronary a