医学影像诊断学02心脏大血管.ppt

1、医学影像诊断学02心脏大血管,目的要求,Understand the cardiovascular detections of X-ray and USG Master the normal X-ray appearance of the heart and great vessels Master the X-ray appearance of enlargment of every chamber Master the radiological characters(X-ray, USG) of several cardiovascular diseases,课时分配1,Unit 1 Ex

2、amination Techniques X-ray 5min CT 5min MRI 5min USG 5min Unit 2 Observation and Analysis of Imaging Topography of the normal heart and the great vessels in the X-ray examinations 40min X-ray signs of common pathological changes 40min,课时分配2,Unit 3 Imaging diagnosis of diseases RHD 20min ASD 20min F4

3、 20min Pericardiac effusion and constrictive pericarditis 20min Aortic dissection 20min,第三节 疾病诊断 Unit 3 Imaging diagnosis of diseases,风湿性心脏病,Rheumatic Heart Disease,-Rheumatic Heart Disease,Clinical features and pathology Pathology: valvular stenosis / insufficiency Hemodynamics: MS: LAPV PA( Pul. H

4、ypertension ) RV AS: LVLA,PV, post-stenosis dilatation of aorta Valvular insufficiency : dilatation of chambers MI: Early stage Late stage: LA PA(Pul. Hypertension) Clinical features: 20-40Y, female; MS, AS, TS; rare PS Signs and symptoms,Signs of imaging X-ray signs: calcification of valve MS: Mitr

5、al configuration (heart shape) Bulging of pul. artery segment, atrophy of knob and LV LA, RV(enlargement) “double contour”, retrosternal space Pul. congestion interstitial pul. edema “hemosiderosis”（含铁血黄素沉着）,-Rheumatic Heart Disease,Signs of imaging MI: LA, LV, RV, normal size or atrophy of aortic k

6、nob ( severe MI ) pul. circulatory hypertension venous venous and arterial,-Rheumatic Heart Disease,Mitral Stenosis,Mitral Stenosis,Mitral Insufficiency,Mitral Insufficiency,TS / TI：USG signs AS / AI: “Aortic shape” of the heart silhouette,-Rheumatic Heart Disease,Aortic Stenosis,Aortic Insufficienc

7、y,AS. + AI.,CT signs Calcification of valve Size of chambers Thrombus in LA,-Rheumatic Heart Disease,MRI signs thickening of valve Size of chambers Thrombus in LA MRI movie,-Rheumatic Heart Disease,Diagnosis and differential diagnosis Clinical signs severe: reticular shadow of collateral vascularity

8、 thin and sparse pulmonary artery, decreased vascular (arteries) lung markings,-Tetralogy of Fallot,Tetralogy of Fallot,Tetralogy of Fallot,Tetralogy of Fallot,Cardioangiography（CAG） Selective right heart angiography Ventricular septal defect RV, PA LV, Aorta Pulmonary. stenosis Overriding aorta,-Te

9、tralogy of Fallot,CT MSCT、EBCT and DSCT with contrast+MIP and/or MPR Show the direct signs: c 、VSD、 Overriding aorta 、hypertrophy of the right ventricle,-Tetralogy of Fallot,MRI Tra+Cor: Pulmonary or the outlet of right ventricle stenosis 、VSD、 Overriding aorta 、hypertrophy of the right ventricle Tr

10、a+4-ch+short-axi: size of VSD、 hypertrophy of the right ventricle Tra+short-axi: degree of aorta Overriding MR Cine: Pul.valve motionflow direction of VSD CE MRA: Aotor and Pul. artery,-Tetralogy of Fallot,-Tetralogy of Fallot,USG M,2D: Widening of aortor and Overriding、 VSD、 hypertrophy of the righ

11、t ventricle、hypertrophy of the right ventricle Doppler：color flow of PS and VSD,-Tetralogy of Fallot,Diagnosis and differential diagnosis Clinical signs LV,-Aortic dissection,Figure 1. Chest radiograph of a patient with aortic dissection.,-Aortic dissection,Figure 2. Chest radiograph of a patient wi

12、th aortic dissection presenting with hemothorax.,-Aortic dissection,Figure 3. Chest radiograph demonstrating widened mediastinum in a patient with aortic dissection.,-Aortic dissection,Cardioangiography Thoracic aortic angiography Visualization of the true and false lumens intimal flap aortic regurg

13、itation stenosis/ obstruction of coronary arteries,-Aortic dissection,Figure 4. Angiogram demonstrating dissection of the aorta (same patient as in Image 3).,-Aortic dissection,Angiogram demonstrating dissection of the aorta,USG CT Contrast enhancement CT scan With the advent of helical CT with mult

14、iplanar and 3D reconstruction, CT is quickly replacing the angiogram as the criterion in many institutions.,-Aortic dissection,Figure 5. Patient with an ascending Type I aortic dissection showing the intimal flap.,-Aortic dissection,Figure 6. Patient with a Type I aortic dissection involving the asc

15、ending and descending aorta.,-Aortic dissection,Figure 7. Patient showing a Type II aortic dissection with extravasation of blood into the pleural cavity.,-Aortic dissection,CT Diagnosis of Aortic dissection (DeBakay type III ),MRI Without Contrast enhancement ：MR cine Contrast enhancement MRA（CE-MRA）,-Aort