冠脈cta冠脈解剖

冠脈cta冠脈解剖第1頁/共35頁冠脈CTA：冠脈解剖第2頁/共35頁ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment第3頁/共35頁動(dòng)脈的描述起點(diǎn)：起始點(diǎn)/valsalva竇行程分支名稱大小（口徑及分布）：小、中、大支配區(qū)域合適的圖像質(zhì)量：總體，每條血管，每個(gè)層面第4頁/共35頁NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:

－stenosisduetoriskregion

－Presenceofostialdisease

－Other:aneurysmsanomaloustakeoff第5頁/共35頁左冠狀動(dòng)脈主干（LM)起點(diǎn)：左valsalva竇（左冠竇）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中間支10-15%關(guān)鍵問題：狹窄致局部供血不足冠狀動(dòng)脈口疾病動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離第6頁/共35頁LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff第7頁/共35頁左前降支（LAD）起點(diǎn)：95－99％起源于LM1-3%直接開口于左冠竇行程：心室前方經(jīng)室間溝達(dá)心尖最后分為兩支分支：角支室間隔支關(guān)鍵問題：冠狀動(dòng)脈近端或冠狀動(dòng)脈口疾病心肌橋動(dòng)脈瘤，（內(nèi)膜）不規(guī)則剝離

第8頁/共35頁NormalAnrtomy（LAD)第9頁/共35頁LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)第10頁/共35頁起點(diǎn)：96-98%起源于LM5-2%單獨(dú)開口LCX起源于右冠竇或RCA約0.4%行程：沿著左房室溝下降分支：鈍緣支左后外側(cè)支（營養(yǎng)后外側(cè)壁）左后降支(左側(cè)優(yōu)勢(shì)）關(guān)鍵問題：左側(cè)優(yōu)勢(shì)（15%-20%)第11頁/共35頁NormalAnatomy(LCX)第12頁/共35頁NormalAnatomy(LCX)第13頁/共35頁Ramusintermedius（中間支）第14頁/共35頁NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)第15頁/共35頁右冠狀動(dòng)脈(RCA)起點(diǎn)：左valsalva竇（右冠竇）0.1%起源于左心室行程：沿右房室溝下降至房室交點(diǎn)分支：后降支PDA（85%）銳緣支AM

右室后側(cè)支PL

關(guān)鍵問題：右側(cè)優(yōu)勢(shì)（85%）第16頁/共35頁Normalanatomy(RCA)第17頁/共35頁Normalanatomy(RCA)第18頁/共35頁OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral第19頁/共35頁其他分支竇房結(jié)動(dòng)脈：約60%起源于RCA,40%LCX房室結(jié)動(dòng)脈：RCA圓錐動(dòng)脈：RCA第20頁/共35頁Rightdominance第21頁/共35頁Leftdominance第22頁/共35頁LesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentric第23頁/共35頁病變的描述定位：開口，鄰近，中間，末梢分叉長度（狹窄）：間斷/局灶性病變（<10MM)

連續(xù)/彌漫（>20MM)同心環(huán)/偏心的曲折的血栓軟粥樣斑塊鈣化潰瘍第24頁/共35頁DiffuseLADDisease第25頁/共35頁Focalulceratedplaque第26頁/共35頁CoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistula第27頁/共35頁冠狀動(dòng)脈異常良性(0.5-1%)(80%of異常)LAD/LCX口LCX起源于RSAorRCALCX行程在主動(dòng)脈后從主動(dòng)脈異常起源

RCA前高位起源小的瘺管第28頁/共35頁CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryartery第29頁/共35頁潛在危險(xiǎn)(20%of異常)起源與主動(dòng)脈竇對(duì)面的室壁瘤(0.1-0.2%)異常起源于PA(0.01%)多發(fā)