多排螺旋CT在心外科的临床应用

1、多排螺旋CT在心外科的临床应用,吕滨 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CTA 520例 阜外医院每天冠状动脉CTA平均45例,Light-speed VCT, GE,阜外医院的CT设备,Dual Source CT, Siemens,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Disease

2、s,Coronary Artery Disease,35.1% (97/279) 男性和18.8% (62/330)女性冠状动脉钙化阳性, p0.001 Agaston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, p0.001 150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 (Circulation 1995;92:657) 51% 不稳定病变

3、呈现“正性重构”， (Circulation 2000;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, p0.001 64-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

4、料：n=1056；97.3% 冠状动脉节段可以分析）,Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in coronary artery disease: A meta-analysis. European Journal of Radiology2006;60:279-286,急性冠脉综合征Acute Coronary Syndrome,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

5、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)， p0.001 SVG= 87.1% (1455/1670). 通畅率: LAD=91.9% (5

6、57/606), 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,Gregory SA, et al. Am J Cardiol 2006;98:877-884. Sigurdsson G, et al. J Am Coll Cardiol 2006;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,Courtesy of SD Image Institute, China,辐射剂量管理 实现前瞻性心电门控扫描

7、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,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Aortic Diseases,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, 35 years. Marfans syn

8、drome Stanford B aortic disection. Davidaorta replacement,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Congenital Heart Diseases,Congenital Heart Diseases on MDCT,774 patients (M/F=425/349, 14.818.3 years 3 days to 79 years; 223 pt. 1 year Supplemental tool for cardiac

9、 echo and catheterizations.,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

10、医学奖获得者 “因为发明了计算机体层摄影术（CT）,Allan M. Cormack (1924-1998),Godfrey N. Hounsfield (1919-2004),下一个有前途的应用将会是冠状动脉成像 Hounsfield GN. 计算机医学成像. 诺贝尔获奖感言, 1979年.12.8日,Clinical Applications of Multi-detector row Spiral CT （MDCT）on Cardiovascualr Surgery,Bin Lu, M.D. Department of Radiology, Fu Wai Cardiovascular I

11、nstitute, Peking Union Medical College 11 Dec. 2008,MDCT and DSCT in China, 16-MDCT (550), 64-MDCT (350), DSCT (36) 68% (636 hospitals) perform CCTA 53% (496 hospitals) perform 5-20 cases of CCTA per month 45 cases of CCTA performed in FuWai per day,Light-speed VCT, GE,CT Scanners in Fu Wai Hospital

12、,Dual Source CT, Siemens,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Coronary Artery Disease,35.1% (97/279) male and 18.8% (62/330) female are CAC positive, p Southern (ShangHai and GuangZhou), p0.05 Risk factors, carotid US were evaluated,1.1 Prevalence of Sub-clinic

13、al Coronary Atherosclerosis on Chinese Population,1.2 Coronary Artery Plaque Imaging,68% ACS caused by lesions of 50% stenosis (Circulation 1995;92:657) 51% unstable lesions are positive remodeling; (Circulation 2000;101:604-10) MDCT visualizes both vulnerable plaques and luminal narrowing,Atheroscl

14、erotic Model on Rabbits Granted by the Natural Science Fundation of China,Transcatherter Angiography on NewZealand White Rabbit Models,Detection of plaque without stenosis,Fibrous plaque,Male, 41 years, Unstable angina Thin-fibrous cap and big fatty core,64-MDCT vs IVUS (Fu Wai Data),48 cases on 16-

15、MDCT, r=0.58, p0.001 18 cases on 64-MDCT, r= 0.87, p0.001 Chinese J Radiology 2007;41:1027-1031.,1.3 Diagnosis of CAD,Comparison of MDCT with Conventional Coronary Angiography（n=1056；97.3% of segments were evaluable）,Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in c

16、oronary artery disease: A meta-analysis. European Journal of Radiology2006;60:279-286,1.4 Acute Coronary Syndrome,Male, 42 years, current smoking, High LDL, onset of unstable angina in 16 hours,Coronary Total Occlusion,Can statins inhibit vulnerable/soft plaque progression? Which is better? Medicati

17、on? PCI?,1.5 Plaque F-U,Comparison study between MDCT and SPECT (34 Cases of FUWAI hospital): SEN=93.3% (14/15), SPE=84.2% (16/19) and ACCU=88.2% (30/34).,1.6 Detection of Acute Myocardial Infarction,Plain Scans,First-pass CTA,Late-enhancement of 5 mins,3 Hours later of LAD Ligation,First-pass MRA,S

18、PECT,TTC染色,1.7 Follow-up of CABG (Data from Fu Wai Hospital),Mar. 2006 to Oct. 2008, 1436 patients (M/F=1192 / 244, 60.811.8 years). Patency: LIMA=92% (877/953) SVG= 87.1% (1455/1670) p0.001 Patency: LAD=91.9% (557/606), LCx=87.2% (599/687) RCA=84.4% (621/736) p0.52,Evaluation of CABG Restenosis by

19、MDCT,Gregory SA, et al. Am J Cardiol 2006;98:877-884. Sigurdsson G, et al. J Am Coll Cardiol 2006;48:772-778.,Male, 75 years, high risks Non-MI, indication for CABG,1.8 Heart Function Evaluations Comparison study among DSCT, UCG and MRI,DSCT,MRI,Courtesy of SD Image Institute, China,1.9 Exposion Dos

20、e Management Prospective ECG Triggering is available Dose is decreased: 13.54.1(1.2-28.1)mSv to 4.01.5 (1.2-7.5)mSv,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Aortic Diseases,Aortic Diseases on MDCT,2278 patients (M/F=1740/538) 49.512.3 years 24-hour emergency Averag

21、e 13 cases per day before and after operation To substitute of conventional Angiography,MIP / CPR Reconstructed Images,Male, 42 years. Abdominal Aortic Aneurysm. Before and after intraluminal stenting isolation.,Female, 35 years. Marfans syndrome Stanford B aortic disection. Davidaorta replacement,S

22、UBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Congenital Heart Diseases,Congenital Heart Diseases on MDCT,774 patients (M/F=425/349, 14.818.3 years 3 days to 79 years; 223 pt. 1 year Supplemental tool for cardiac echo and catheterizations.,Advantages and Indications of CT for CHD,Pulmonary artery developments and aorto-pulmonary collaterals. Aortic arch developments and malformations. Abnormal dra