1、Coronary CTA:coronary anatomy & terminology-A cardiologists perspective,Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University,冠脈CTA：冠脈解剖,Juile Miller MD Assistant professor of Medicine Interventional Cardiology Johns Hopkins University,Artery Description,

2、Origin: Originating cusp / sinus of valsalva Course Branch name Size (caliber and distribution):small medium large Dominance Adequacy of image quality for interpretation overall， per vessel ，per segment,動(dòng)脈的描述,起點(diǎn)：起始點(diǎn)/valsalva竇 行程 分支名稱(chēng) 大?。趶郊胺植迹盒?、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,Normal Left Main (LM),Or

3、igin -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 ostial disease Other: aneurysms anomalous take off,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LAD LCX占0.5 分支：分出LAD LC

4、X占58% LAD,LCX 和 中間支 10-15% 關(guān)鍵問(wèn)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,Left Anterior Descending(LAD),Origin: -Form Left Main 95-99% -1-3% separate ostium Left sinus Course Anterior intraventricula groove toward apex 2 variations in termination Branches:Diagonals septal perforators Critical issues Presence

5、 of ostial/proximal disease Myocardial bridges Other:aneurysms anomalous take off,左前降支（LAD）,起點(diǎn)：9599起源于LM 1-3%直接開(kāi)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(wèn)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,Normal Anrtomy（LAD),Left Circumflex (LCX),Origin: Originating form LM in 96-98% 5-2% separate ostium LCX ori

6、gin form right sinus or RCA (0.4%) Course:down distal left AV groove Branches obtuse marginal branches Left posterior-lateral: define by acute margin and supply PL wall Left posterior descending (if dominant) Critical issues dominance (15-20%),起點(diǎn)：96-98%起源于LM 5-2%單獨(dú)開(kāi)口 LCX起源于右冠竇或RCA約0.4% 行程：沿著左房室溝下降 分

7、支：鈍緣支 左后外側(cè)支（營(yíng)養(yǎng)后外側(cè)壁） 左后降支 (左側(cè)優(yōu)勢(shì)） 關(guān)鍵問(wèn)題：左側(cè)優(yōu)勢(shì)（15%-20%),Normal Anatomy (LCX),Normal Anatomy (LCX),Ramus intermedius （中間支）,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 heart Branches Right post

8、erior descending (85%) Acute marginal branches Right posterior lateral Critical issues: dominance (15-20%),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(wèn)題：右側(cè)優(yōu)勢(shì)（85%）,Normal anatomy(RCA),Normal anatomy(RCA),Other branches,SA nodal Artery -Approx 60%RCA 40%

9、LCX AV Nodal Artery-RCA Conus Artery-RCA -Proximal many with separate origin -May supply collateral,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,Right dominance,Left dominance,Lesion description,Location -Ostial(first 2-3mm ) -Proximal -Mid -Distal Bifurcation Length (stenosis) -Discrete/focal le

10、sion (20mm) Concentric/eccentric Tortuosity Thrombus soft plaque calcium Ulcerated/concentric,病變的描述,定位：開(kāi)口，鄰近，中間，末梢 分叉 長(zhǎng)度（狹窄）：間斷/局灶性病變（20MM) 同心環(huán)/偏心的 曲折的 血栓 軟粥樣斑塊 鈣化 潰瘍,Diffuse LAD Disease,Focal ulcerated plaque,Coronary anomalies,Benign(0.5-1%) (80% of anomalies) Separate LAD/LCX ostia LCX origin fro

11、m RSA or RCA LCX courses behind aorta Anomalous origin from aorta High anterior origin of RCA LM Small fistula,冠狀動(dòng)脈異常,良性(0.5-1%) (80% of 異常) LAD/LCX 口 LCX 起源于 RSA or RCA LCX 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,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 a