《冠脉CTA冠脉解剖培训课件.ppt》由会员分享,可在线阅读,更多相关《冠脉CTA冠脉解剖培训课件.ppt(34页珍藏版)》请在三一办公上搜索。
1、冠脉CTA冠脉解剖,冠脉CTA冠脉解剖,Artery Description,Origin: Originating cusp / sinus of valsalvaCourseBranch nameSize (caliber and distribution):small medium largeDominanceAdequacy of image quality for interpretation overall, per vessel ,per segment,冠脉CTA冠脉解剖,2,Artery DescriptionOrigin: Orig,动脉的描述,起点:起始点/valsalv
2、a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,冠脉CTA冠脉解剖,3,动脉的描述起点:起始点/valsalva窦冠脉CTA冠脉解剖,Normal Left Main (LM),Origin-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 osti
3、al disease Other: aneurysms anomalous take off,冠脉CTA冠脉解剖,4,Normal Left Main (LM)Origin冠脉C,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 LCX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,冠脉CTA冠脉解剖,5,左冠状动脉主干(LM)起点: 左valsalva窦(左冠窦),Left Anterior Descending(LAD),Origin:-Form Lef
4、t Main 95-99%-1-3% separate ostium Left sinusCourseAnterior intraventricula groove toward apex2 variations in terminationBranches:Diagonals septal perforatorsCritical issuesPresence of ostial/proximal diseaseMyocardial bridgesOther:aneurysms anomalous take off,冠脉CTA冠脉解剖,6,Left Anterior Descending(LA
5、D)O,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,冠脉CTA冠脉解剖,7,左前降支(LAD)起点:9599起源于LM冠脉CTA冠脉,Normal Anrtomy(LAD),冠脉CTA冠脉解剖,8,Normal Anrtomy(LAD)冠脉CTA冠脉解剖8,Left Circumflex (LCX),Origin: Originating form LM in 96-98% 5-2% separate ostium LCX o
6、rigin form right sinus or RCA (0.4%)Course:down distal left AV grooveBranches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant)Critical issues dominance (15-20%),冠脉CTA冠脉解剖,9,Left Circumflex (LCX) Origin:冠,起点:96-98%起源于LM
7、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%),冠脉CTA冠脉解剖,10,起点:96-98%起源于LM冠脉CTA冠脉解剖10,Normal Anatomy (LCX),冠脉CTA冠脉解剖,11,Normal Anatomy (LCX)冠脉CTA冠脉解剖1,Normal Anatomy (LCX),冠脉CTA冠脉解剖,12,Normal Anatomy (LCX)冠脉CTA冠脉解剖1,Ramus intermedius (中间支),冠脉CTA冠脉解剖,13,Ramus
8、intermedius (中间支)冠脉CTA冠脉,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 heartBranchesRight posterior descending (85%)Acute marginal branchesRight posterior lateralCritical issues: dominance (
9、15-20%),冠脉CTA冠脉解剖,14,Normal Right coronary artery(,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%),冠脉CTA冠脉解剖,15,右冠状动脉(RCA)起点:左valsalva窦(右冠窦)冠脉,Normal anatomy(RCA),冠脉CTA冠脉解剖,16,Normal anatomy(RCA)冠脉CTA冠脉解剖16,Normal anatomy(RCA),冠脉CTA冠脉解剖,17,Normal
10、anatomy(RCA)冠脉CTA冠脉解剖17,Other branches,SA nodal Artery-Approx 60%RCA 40%LCXAV Nodal Artery-RCAConus Artery-RCA-Proximal many with separate origin-May supply collateral,冠脉CTA冠脉解剖,18,Other branchesSA nodal Artery冠,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,冠脉CTA冠脉解剖,19,其他分支窦房结动脉:约60%起源于RCA,40%LCX冠脉
11、C,冠脉CTA冠脉解剖培训课件,Left dominance,冠脉CTA冠脉解剖,21,Left dominance冠脉CTA冠脉解剖21,Lesion description,Location-Ostial(first 2-3mm )-Proximal-Mid-DistalBifurcationLength (stenosis)-Discrete/focal lesion (20mm)Concentric/eccentricTortuosity Thrombus soft plaque calciumUlcerated/concentric,冠脉CTA冠脉解剖,22,Lesion descr
12、iptionLocation冠脉CT,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,冠脉CTA冠脉解剖,23,病变的描述定位:开口,邻近,中间,末梢冠脉CTA冠脉解剖23,Diffuse LAD Disease,冠脉CTA冠脉解剖,24,Diffuse LAD Disease冠脉CTA冠脉解剖24,Focal ulcerated plaque,冠脉CTA冠脉解剖,25,Focal ulcerated plaque冠脉CTA冠脉解,Coronary anomalies,Benign(0.5-1%) (80%
13、of anomalies)Separate LAD/LCX ostiaLCX origin from RSA or RCA LCX courses behind aortaAnomalous origin from aortaHigh anterior origin of RCALMSmall fistula,冠脉CTA冠脉解剖,26,Coronary anomaliesBenign(0.5-1,冠状动脉异常,良性(0.5-1%) (80% of 异常)LAD/LCX 口LCX 起源于 RSA or RCALCX 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,冠脉CTA冠脉解剖,2
14、7,冠状动脉异常良性(0.5-1%) (80% of 异常)冠脉,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 artery,冠脉CTA冠脉解剖,28,Coronary anomaliesPotentially,潜在危险(20% of 异常)起源与主动脉窦对面的室壁瘤(0.
15、1-0.2%)异常起源于PA (0.01%)多发或大的冠状动脉瘘单一冠状动脉,冠脉CTA冠脉解剖,29,潜在危险(20% of 异常)冠脉CTA冠脉解剖29,Coronary anomalies,冠脉CTA冠脉解剖,30,Coronary anomalies冠脉CTA冠脉解剖30,Absent Left Main(separate LAD/LCX origins),冠脉CTA冠脉解剖,31,Absent Left Main(separate LAD,Anomalous RCA,冠脉CTA冠脉解剖,32,Anomalous RCA冠脉CTA冠脉解剖32,Anomalous LM from RSV,冠脉CTA冠脉解剖,33,Anomalous LM from RSV冠脉CTA冠脉解剖,冠脉CTA冠脉解剖,34,冠脉CTA冠脉解剖34,