多排CT心血管影像应用_徐雷鸣.ppt

1、多排CT心血管影像应用,徐雷鸣 浙江大学医学院附属二院放射科,目的,回顾和总结多排CT心血管应用， 增进和提高其临床实践,内容,多排CT心血管应用简史 冠状动脉 左房 大动脉 其他,Godfrey N. Hounsfield, The Nobel Prize in Physiology or Medicine 1979 with Allan M. Cormack Atkinsons Morley Hospital and the first human patient was examined on October 1, 1971.,历史回顾,original sketch from Hous

2、fields notebook. This picture was taken at the UKRC 2005 exhibition, Manchester G-Mex centre.08:56, 20 July 2006 (UTC),1970,1990,1998,CT领域主要的技术演变,2005,扫描部位的延伸,80年代 横断 CT,扫描速度的演变,90年代 螺旋CT,2000年代 多层 CT,扫描层数“竞赛“,2s,1s,0.75s,4,16,64,头部,体部,2006,单源CT,双源CT,Somatom Definition,CT三十年,128,320,CT临床应用领域,64层CT,1

3、28-320层CT,双源CT,Definition AS,64层CT可以实现 很好的各项常规检查， 可开展有条件限制的心脏成像,GE HD,无需控制心率的心脏检查 无可比拟的急症诊断 唯一的 双能量成像,真正全脏器灌注 全时相血管造影 动态四维成像,Siemens volume zoom, 2001,Siemens sensation 16, 2004 0.420.37s/rot, RT=93ms,Siemens sensation 64, ?,Siemens definition AS, ?,Siemens definition flash, ? 0.28s/rot, TR=75ms,Sie

4、mens definition dual source, ? 0.33s/rot, TR=83ms,现状和展望,配套条件,高浓度造影剂，370 I/ml碘造影剂 双筒高压注射器 工作站和软件 高效的工作小组,Coronary artery bypass with both saphenous and LIMA grafts,心脏CTA原理:扫描时心脏运动同时,数据采集与ECG信号记录同步。,成像方法: 1. 前瞻性心电触发序列扫描 2. 回顾性心电门控螺旋扫描,冠脉CTA检查,检查前病人准备和过程,双源CT，心率方面无需特别准备 64排及以下CT 心电图，度和度房室传导阻滞不易检查 心率65b

5、pm，使用阻滞剂，使用前测量血压，做好记录 如无禁忌，使用阻滞剂 口服50100mg倍他乐克（metoprolol）, 约30分钟后扫描 或静注艾司洛尔0.1g，约510分钟后扫描 注射造影剂前，硝酸甘油0.5mg，舌下含服（扩张冠脉） 告知检查过程，训练病人屏气，取得配合 扫描、重建和分析,冠脉CTA检查,RCA,LAD,LCx,LCA,左冠起始异常,LAD 339:659-666,Diagram of the Sites of 69 Foci Triggering Atrial Fibrillation in 45 Patients,房颤策源地肺静脉周围房肌袖,左房和肺静脉影像观察,术中逆

6、行造影 CT造影 磁共振左房和肺静脉造影 超声 其他,16层MDCT心房肺静脉造影,造影剂100120ml（300 gI/ml），速率4ml/s 左房造影剂跟踪扫描， 心室率小于70bpm，采用门控；否则不用 扫描参数160.75mm/转，螺距1，扫描范围肺底至心尖 容积再现后处理,肺静脉及分支显示,消融隔离区域从肺静脉内、到静脉口缘再到肺静脉前庭,心房内观肺静脉开口，右中肺静脉（RM）,消融前影像,肺静脉解剖及变异 肺静脉干长度 心房形态和容积 心房和心耳是否有附壁血栓,肺静脉解剖变异 ssrll右下叶上静脉，bsrll右下叶基底静脉,Marom EM.et al, Radiology 20

7、04;230:824-829,Copyright 2005 American Heart Association,Branching pattern of PV anatomy in AF patients and controls,Kato R et al. Circulation. 2003;107:2004-2010,Copyright 2007 by the American Roentgen Ray Society,Cronin, P. et al. Am. J. Roentgenol. 2004;183:767-778,-58-year-old man with atrial fi

8、brillation, variant of three right inferior pulmonary veins,Copyright 2007 by the American Roentgen Ray Society,Demos, T. C. et al. Am. J. Roentgenol. 2004;182:1139-1150,-35-year-old woman with coronary sinus type of atrial septal defect with left superior vena cava (SVC) draining into left atrium,C

9、opyright 2007 by the American Roentgen Ray Society,Cronin, P. et al. Am. J. Roentgenol. 2004;183:767-778,-56-year-old man with atrial fibrillation and separate drainage of right middle pulmonary vein into left atrium,Copyright 2007 by the American Roentgen Ray Society,Cronin, P. et al. Am. J. Roentg

10、enol. 2004;183:767-778,-51-year-old man with atrial fibrillation and rare pulmonary venous anomalies,左心房容积测量,心房内窥镜 静脉口测量 箭头示左共干与心耳分界肌嵴,左心房血栓,左心房肿瘤,术后并发症影像,肺静脉栓塞 肺静脉狭窄 心包填塞 左心房血肿 左房食管漏,Copyright 2006 by the American Roentgen Ray Society,Ravenel, J. G. et al. Am. J. Roentgenol. 2002;178:664-666,-Left

11、superior pulmonary vein occlusion and venous infarction after radiofrequency ablation in 31-year-old man with refractory atrial fibrillation,Copyright 2007 by the American Roentgen Ray Society,Kelly, S. et al. Am. J. Roentgenol. 2006;186:1317-1319,-67-year-old woman with intramural hematoma in left

12、atrium after attempted radiofrequency ablation of pulmonary vein ostia,Copyright 2005 American Heart Association,Packer, D. L. et al. Circulation 2005;111:546-554,SCT demonstration of PV stenosis affecting left inferior PV as shown in oblique view of heart,Copyright 2007 by the American Roentgen Ray Society,Cronin, P. et al. Am. J. Roentgenol. 2004;183:767-778,-50-year-old man with atrial fibrillation,40岁男性，轻度胸部不适，6月前房颤射频消融术后,