冠脉cta冠脉解剖
Coronary CTA:coronary anatomy & terminology-A cardiologists perspective Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University 冠脉CTA：冠脉解剖 Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University Artery Description nOrigin: Originating cusp / sinus of valsalva nCourse nBranch name nSize (caliber and distribution):small medium large nDominance nAdequacy of image quality for interpretation overall， per vessel ，per segment 动脉的描述 n起点：起始点/valsalva窦 n行程 n分支名称 n大小（口径及分布）：小、中、大 n支配区域 n合适的图像质量：总体，每条血管，每个 层面 Normal Left Main (LM) nOrigin -left sinus valsalva -Absent in 1% Separate,adjacent LAD LCX ostia - 0.5% nBranches: LAD & LCX =85% LAD,LCX and Ramus 10-15% nCritical issues: stenosis due to risk region Presence of ostial disease Other: aneurysms anomalous take off 左冠状动脉主干（LM) n起点： 左valsalva窦（左冠 窦） 1例外 直接分出LAD LCX占0.5 n分支：分出LAD LCX占58% LAD,LCX 和 中间支 10-15% n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 Left Anterior Descending(LAD) nOrigin: -Form Left Main 95-99% -1-3% separate ostium Left sinus nCourse nAnterior intraventricula ngroove toward apex n2 variations in termination nBranches:Diagonals septal perforators nCritical issues Presence of ostial/proximal disease Myocardial bridges Other:aneurysms anomalous take off 左前降支（LAD） n起点：9599起源于LM 1-3%直接开口于左冠窦 n行程：心室前方 经室间沟达心尖 最后分为两支 n分支：角支 室间隔支 n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 Normal Anrtomy（LAD) Left Circumflex (LCX) nOrigin: Originating form LM in 96-98% 5-2% separate ostium LCX origin form right sinus or RCA (0.4%) nCourse:down distal left AV groove nBranches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant) nCritical issues dominance (15-20%) n起点：96-98%起源于LM n5-2%单独开口 nLCX起源于右冠窦或RCA约0.4% n行程：沿着左房室沟下降 n分支：钝缘支 左后外侧支（营养后外侧壁） n 左后降支 (左侧优势） n关键问题：左侧优势（15%-20%) Normal Anatomy (LCX) Normal Anatomy (LCX) Ramus intermedius （中间支） Normal Right coronary artery (RCA) nOrigin: right sinus of valsalva (lower than LM) nAnomalous form LSV =0.1% nCourse: down distal right AV groove toward crux of heart nBranches nRight posterior descending (85%) nAcute marginal branches nRight posterior lateral nCritical issues: dominance (15-20%) 右冠状动脉(RCA) n起点：左valsalva窦（右冠窦） n0.1%起源于左心室 n行程：沿右房室沟下降至房室 交点 n分支：后降支 PDA（85%） n 锐缘支 AM n 右室后侧支 PL n关键问题：右侧优势（85%） Normal anatomy(RCA) Normal anatomy(RCA) Other branches nSA nodal Artery -Approx 60%RCA 40%LCX nAV Nodal Artery-RCA nConus Artery-RCA -Proximal many with separate origin -May supply collateral 其他分支 n窦房结动脉：约60%起源于RCA,40%LCX n房室结动脉：RCA n圆锥动脉：RCA Right dominance Left dominance Lesion description nLocation -Ostial(first 2-3mm ) -Proximal -Mid -Distal nBifurcation nLength (stenosis) -Discrete/focal lesion (20mm) nConcentric/eccentric nTortuosity nThrombus soft plaque calcium nUlcerated/concentric 病变的描述 n定位：开口，邻近，中间，末梢 n分叉 n长度（狭窄）：间断/局灶性病变（ 20MM) n同心环/偏心的 n曲折的 n血栓 软粥样斑块 钙化 n溃疡 Diffuse LAD Disease Focal ulcerated plaque Coronary anomalies nBenign(0.5-1%) (80% of anomalies) nSeparate LAD/LCX ostia nLCX origin from RSA or RCA nLCX courses behind aorta nAnomalous origin from aorta nHigh anterior origin of RCA nLM nSmall fistula 冠状动脉异常 n良性(0.5-1%) (80% of 异常) nLAD/LCX 口 nLCX 起源于 RSA or RCA nLCX 行程在主动脉后 n从主动脉异常起源 n RCA前高位起源 n小的瘘管 Coronary anomalies nPotentially serious(20% of anomalies) nOrigin of CA opposite aortics sinus (0.1-0.2%) nAnomalous origin form PA (0.01%) nMultiple or Large coronary fistulae nSingle Coronary artery n潜在危险(20% of 异常) n起源与主动脉窦对面的室壁瘤(0.1-0.2%) n异常起源于PA (0.01%) n多发或大的冠状动脉瘘 n单一冠状动脉 Coronary anomalies Absent Left Main (separate LAD/LCX origins) Anomalous RCA Anomalous LM from RSV
