最新多排螺旋CT在心外科的临床应用ppt课件.ppt
16-MDCT：48例例 (119节段节段), r=0.58, p0.00164-MDCT：18例例 (25节段节段), r= 0.87, p0.001 中华放射学杂志中华放射学杂志2007;41:1027-1031.钙化斑块钙化斑块非钙化斑块非钙化斑块混合斑块混合斑块敏感性敏感性 (%) 92% 68% 73%特异性特异性 (%) 96% 83% 89% 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 男性男性, 42岁岁,吸烟吸烟, 高高LDL, 急性不稳定心绞痛发作后急性不稳定心绞痛发作后16小时小时u他汀类药物治疗能否抑他汀类药物治疗能否抑制斑块进展？制斑块进展？u药物？药物？PCI？哪个更好？哪个更好？ 34例例MDCT与与SPECT对照研究结果对照研究结果 (阜外医院资料阜外医院资料): 敏感性敏感性=93.3% (14/15), 特异性特异性=84.2% (16/19)，准确率，准确率=88.2% (30/34).n 2006.3月月2008.10月，月，1436例例(男男1192 / 女女244，60.811.8岁岁). n 通畅率通畅率: LIMA=92% (877/953)， p0.001SVG= 87.1% (1455/1670).n 通畅率通畅率: LAD=91.9% (557/606),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诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVGregory 70%92%89%77Sigurdsson 86%99%8199Gregory SA, et al. Am J Cardiol 2006;98:877-884.Sigurdsson G, et al. J Am Coll Cardiol 2006;48:772-778.u男性男性, 75岁岁, 高危险因素高危险因素u无无OMI, CABG适应症适应症lDSCTlMRICourtesy of SD Image Institute, China降低为降低为l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Aortic Diseasesu2278 例例 (M/F=1740/538) 49.512.3岁岁 u24小时急诊小时急诊u平均每天平均每天13例例u术前和术后均行术前和术后均行CT检查检查 u替代血管造影替代血管造影 u 男性，男性，42岁岁u 腹主动脉瘤腹主动脉瘤 u 支架隔离术前后支架隔离术前后n Female, 35 years.n Marfans syndrome n Stanford B aortic disection.n Davidaorta replacementl Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Congenital Heart Diseasesu774 patients (M/F=425/349, 14.818.3 yearsu3 days to 79 years; 223 pt. 1 yearuSupplemental tool for cardiac echo and catheterizations.l观察肺动脉发育和体肺侧支血管情况观察肺动脉发育和体肺侧支血管情况 l观察主动脉弓发育和畸形观察主动脉弓发育和畸形 l肺静脉畸形引流的诊断肺静脉畸形引流的诊断 l28例手术证实：例手术证实：CT诊断敏感性诊断敏感性91.3（超声（超声85.7%） CT诊断特异性诊断特异性100（超声（超声94.3%）右肺动脉起自升主动脉动脉导管未闭右肺动脉起自升主动脉动脉导管未闭l 男性，男性，16个月个月. l 主动脉缩窄主动脉缩窄l 主动脉弓发育不良主动脉弓发育不良l 动脉导管未闭室间隔缺损动脉导管未闭室间隔缺损女性，女性，1个月，主动脉弓离断（个月，主动脉弓离断（B型）型）女性，女性，37岁，主动脉弓离断（岁，主动脉弓离断（C型）型）肺静脉畸形引流肺静脉畸形引流F 右上肺静脉入左房右上肺静脉入左房F 右下肺静脉入下腔右下肺静脉入下腔 F 左上肺静脉入冠状静脉窦左上肺静脉入冠状静脉窦 F 左下肺静脉入左房左下肺静脉入左房Allan M. Cormack (1924-1998) Allan M. Cormack (1924-1998) Godfrey N. Hounsfield (1919-2004)Godfrey N. Hounsfield (1919-2004) Hounsfield GN. Hounsfield GN. 计算机医学成像计算机医学成像. . 诺贝尔获奖感言诺贝尔获奖感言, 1979, 1979年年.12.8.12.8日日Clinical Applications of Multi-Clinical Applications of Multi-detector row Spiral CT detector row Spiral CT （MDCTMDCT）on Cardiovascualr Surgeryon Cardiovascualr Surgery l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Coronary Artery Diseasel35.1% (97/279) male and 18.8% (62/330) female are CAC positive, p0.001lAgaston score: 103.1374.9 (male) and 48.0219.2 (female), p0.05 lCAC score are rising with increasing of age, p Southern (ShangHai and GuangZhou), p0.05lRisk factors, carotid US were evaluated F 68% ACS caused by lesions of 50% stenosis (Circulation 1995;92:657)F 51% unstable lesions are positive remodeling; (Circulation 2000;101:604-10)F MDCT visualizes both vulnerable plaques and luminal narrowing Transcatherter Angiography on NewZealand White Rabbit Models 48 cases on 16-MDCT, r=0.58, p0.00118 cases on 64-MDCT, r= 0.87, p0.001 Chinese J Radiology 2007;41:1027-1031.CalcifiedNon-calcifiedMixturedSensitivity (%) 92% 68% 73%Specificity (%) 96% 83% 89% 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 Male, 42 years, current smoking, High LDL, onset of unstable angina in 16 hoursuCan statins inhibit vulnerable/soft plaque progression?uWhich is better? Medication? PCI? 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).n Mar. 2006 to Oct. 2008, 1436 patients (M/F=1192 / 244, 60.811.8 years). n Patency: LIMA=92% (877/953) SVG= 87.1% (1455/1670) p0.001n Patency: LAD=91.9% (557/606), LCx=87.2% (599/687) RCA=84.4% (621/736) p0.52Evaluation of CABG Restenosis by MDCTSENSPEPPVNPVGregory 70%92%89%77Sigurdsson 86%99%8199Gregory SA, et al. Am J Cardiol 2006;98:877-884.Sigurdsson G, et al. J Am Coll Cardiol 2006;48:772-778.uMale, 75 years, high risksuNon-MI, indication for CABGlDSCTlMRICourtesy of SD Image Institute, China to l Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Aortic Diseasesu2278 patients (M/F=1740/538) 49.512.3 years u24-hour emergencyuAverage 13 cases per dayubefore and after operation uTo substitute of conventional Angiography u Male, 42 years.u Abdominal Aortic Aneurysm. u Before and after intraluminal stenting isolation.n Female, 35 years.n Marfans syndrome n Stanford B aortic disection.n Davidaorta replacementl Coronary Artery Diseasel Aortic Diseasesl Congenital Heart Diseasesl Congenital Heart Diseasesu774 patients (M/F=425/349, 14.818.3 yearsu3 days to 79 years; 223 pt. 1 yearuSupplemental tool for cardiac echo and catheterizations.lPulmonary artery developments and aorto-pulmonary collaterals. lAortic arch developments and malformations. lAbnormal drainage of pulmonary veins.lSurgery results of 28 cases :Sen.=91.3% (85.7%)Spe.=100% (94.3%)R.PA originated from A.AO+PDAl Male, 16 months. l Aortic Coarctationl Dysplasia of Aortic Archl PDA+VSDFemale, 1 month years old. （Type B）Female, 37 years old. （Type C）Abnormally Pulmonary Vein ConnectionsF R.S.PV to LAF R.I.PV to IVC F L.S.PV to C.S F L.I.PV to LAAllan M. Cormack (1924-1998) Allan M. Cormack (1924-1998) Godfrey N. Hounsfield (1919-2004)Godfrey N. Hounsfield (1919-2004) “A further promising field may be the “A further promising field may be the detection of the coronary arteries”detection of the coronary arteries”Hounsfield GN. Computed Medical Imaging. Nobel Lecture, 8 Dec. 1979
