1、多排螺旋CT在心外科的臨床應(yīng)用,呂濱 中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院 2008年12月11日,MDCT和DSCT在中國的情況, 16排MDCT共550臺, 64排MDCT共350臺, DSCT裝機36臺 68% (636家醫(yī)院)開展冠狀動脈CTA檢查 53% (496家醫(yī)院)每月開展冠脈CTA 520例 阜外醫(yī)院每天冠狀動脈CTA平均45例,Light-speed VCT, GE,阜外醫(yī)院的CT設(shè)備,Dual Source CT, Siemens,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Disease

2、s,Coronary Artery Disease,35.1% (97/279) 男性和18.8% (62/330)女性冠狀動脈鈣化陽性, p0.001 Agaston鈣化積分103.1374.9 (男性組)、 48.0219.2 (女性組), p0.05 男性組和女性組均隨年齡增加而升高, p0.001 150例小樣本研究：北京地區(qū)比上海和廣州發(fā)病率高且嚴重, p0.05 危險因素、頸動脈超聲同時被評估,社區(qū)亞臨床人群冠狀動脈粥樣硬化初步研究結(jié)果（阜外醫(yī)院資料）,冠狀動脈斑塊成像,68% ACS 是由50%狹窄的病變導(dǎo)致 (Circulation 1995;92:657) 51% 不穩(wěn)定病變

3、呈現(xiàn)“正性重構(gòu)”， (Circulation 2000;101:604-10) MDCT 可以探測危險斑塊，同時顯示狹窄,動脈粥樣硬化模型研究 國家自然科學(xué)基金項目,新西蘭白兔模型的造影圖像,MDCT探測尚無管腔狹窄的危險斑塊,纖維斑塊,男性，41歲,不穩(wěn)定心絞痛 薄層纖維帽，較大脂核,64-MDCT與IVUS的對照研究（阜外醫(yī)院資料：n66）,16-MDCT：48例 (119節(jié)段), r=0.58, p0.001 64-MDCT：18例 (25節(jié)段), r= 0.87, p0.001 中華放射學(xué)雜志2007;41:1027-1031.,冠心病診斷,MDCT與傳統(tǒng)冠狀動脈造影對照 （阜外醫(yī)院資

4、料：n=1056；97.3% 冠狀動脈節(jié)段可以分析）,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,急性冠脈綜合征Acute Coronary Syndrome,男性, 42歲,吸煙, 高LDL, 急性不穩(wěn)定心絞痛發(fā)作后16小時,完全阻塞性病變，指導(dǎo)PCI,他汀類藥物治療能否抑制斑塊進展？ 藥物？PCI？哪

5、個更好？,斑塊隨訪,34例MDCT與SPECT對照研究結(jié)果 (阜外醫(yī)院資料): 敏感性=93.3% (14/15), 特異性=84.2% (16/19)，準(zhǔn)確率=88.2% (30/34).,早期探測急性心內(nèi)膜下心肌梗塞,平掃,動脈期增強掃描,5分鐘延遲掃描,前降支結(jié)扎后3小時CT掃描,“首過法” MRA,同位素SPECT,TTC染色,冠狀動脈搭橋術(shù)后隨訪,2006.3月2008.10月，1436例(男1192 / 女244，60.811.8歲). 通暢率: LIMA=92% (877/953)， p0.001 SVG= 87.1% (1455/1670). 通暢率: LAD=91.9% (5

6、57/606), LCx=87.2% (599/687)， RCA=84.4% (621/736) p0.52,MDCT診斷冠狀動脈搭橋血管再狹窄,Gregory SA, et al. Am J Cardiol 2006;98:877-884. Sigurdsson G, et al. J Am Coll Cardiol 2006;48:772-778.,男性, 75歲, 高危險因素 無OMI, CABG適應(yīng)癥,心功能研究 DSCT, UCG 和 MRI對照研究,DSCT,MRI,Courtesy of SD Image Institute, China,輻射劑量管理 實現(xiàn)前瞻性心電門控掃描

7、輻射劑量從 13.54.1(1.2-28.1)mSv降低為4.01.5 (1.2-7.5)mSv （阜外醫(yī)院資料：n316）,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Aortic Diseases,MDCT診斷主動脈疾患,2278 例 (M/F=1740/538) 49.512.3歲 24小時急診 平均每天13例 術(shù)前和術(shù)后均行CT檢查 替代血管造影,MIP / CPR 三維重建圖像,男性，42歲 腹主動脈瘤 支架隔離術(shù)前后,Female, 35 years. Marfans syn

8、drome Stanford B aortic disection. Davidaorta replacement,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Congenital Heart Diseases,Congenital Heart Diseases on MDCT,774 patients (M/F=425/349, 14.818.3 years 3 days to 79 years; 223 pt. 1 year Supplemental tool for cardiac

9、 echo and catheterizations.,CT診斷先心病的優(yōu)勢和適應(yīng)癥,觀察肺動脈發(fā)育和體肺側(cè)支血管情況 觀察主動脈弓發(fā)育和畸形 肺靜脈畸形引流的診斷 28例手術(shù)證實： CT診斷敏感性91.3（超聲85.7%） CT診斷特異性100（超聲94.3%）,主肺間隔缺損動脈導(dǎo)管未閉,右肺動脈起自升主動脈動脈導(dǎo)管未閉,男性，16個月. 主動脈縮窄 主動脈弓發(fā)育不良 動脈導(dǎo)管未閉室間隔缺損,主動脈弓離斷,女性，1個月，主動脈弓離斷（B型）,女性，37歲，主動脈弓離斷（C型）,肺靜脈畸形引流,右上肺靜脈入左房 右下肺靜脈入下腔 左上肺靜脈入冠狀靜脈竇 左下肺靜脈入左房,1979年諾貝爾生理和

10、醫(yī)學(xué)獎獲得者 “因為發(fā)明了計算機體層攝影術(shù)（CT）,Allan M. Cormack (1924-1998),Godfrey N. Hounsfield (1919-2004),下一個有前途的應(yīng)用將會是冠狀動脈成像 Hounsfield GN. 計算機醫(yī)學(xué)成像. 諾貝爾獲獎感言, 1979年.12.8日,Clinical Applications of Multi-detector row Spiral CT （MDCT）on Cardiovascualr Surgery,Bin Lu, M.D. Department of Radiology, Fu Wai Cardiovascular I

11、nstitute, Peking Union Medical College 11 Dec. 2008,MDCT and DSCT in China, 16-MDCT (550), 64-MDCT (350), DSCT (36) 68% (636 hospitals) perform CCTA 53% (496 hospitals) perform 5-20 cases of CCTA per month 45 cases of CCTA performed in FuWai per day,Light-speed VCT, GE,CT Scanners in Fu Wai Hospital

12、,Dual Source CT, Siemens,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Coronary Artery Disease,35.1% (97/279) male and 18.8% (62/330) female are CAC positive, p Southern (ShangHai and GuangZhou), p0.05 Risk factors, carotid US were evaluated,1.1 Prevalence of Sub-clinic

13、al Coronary Atherosclerosis on Chinese Population,1.2 Coronary Artery Plaque Imaging,68% ACS caused by lesions of 50% stenosis (Circulation 1995;92:657) 51% unstable lesions are positive remodeling; (Circulation 2000;101:604-10) MDCT visualizes both vulnerable plaques and luminal narrowing,Atheroscl

14、erotic Model on Rabbits Granted by the Natural Science Fundation of China,Transcatherter Angiography on NewZealand White Rabbit Models,Detection of plaque without stenosis,Fibrous plaque,Male, 41 years, Unstable angina Thin-fibrous cap and big fatty core,64-MDCT vs IVUS (Fu Wai Data),48 cases on 16-

15、MDCT, r=0.58, p0.001 18 cases on 64-MDCT, r= 0.87, p0.001 Chinese J Radiology 2007;41:1027-1031.,1.3 Diagnosis of CAD,Comparison of MDCT with Conventional Coronary Angiography（n=1056；97.3% of segments were evaluable）,Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in c

16、oronary artery disease: A meta-analysis. European Journal of Radiology2006;60:279-286,1.4 Acute Coronary Syndrome,Male, 42 years, current smoking, High LDL, onset of unstable angina in 16 hours,Coronary Total Occlusion,Can statins inhibit vulnerable/soft plaque progression? Which is better? Medicati

17、on? PCI?,1.5 Plaque F-U,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).,1.6 Detection of Acute Myocardial Infarction,Plain Scans,First-pass CTA,Late-enhancement of 5 mins,3 Hours later of LAD Ligation,First-pass MRA,S

18、PECT,TTC染色,1.7 Follow-up of CABG (Data from Fu Wai Hospital),Mar. 2006 to Oct. 2008, 1436 patients (M/F=1192 / 244, 60.811.8 years). Patency: LIMA=92% (877/953) SVG= 87.1% (1455/1670) p0.001 Patency: LAD=91.9% (557/606), LCx=87.2% (599/687) RCA=84.4% (621/736) p0.52,Evaluation of CABG Restenosis by

19、MDCT,Gregory SA, et al. Am J Cardiol 2006;98:877-884. Sigurdsson G, et al. J Am Coll Cardiol 2006;48:772-778.,Male, 75 years, high risks Non-MI, indication for CABG,1.8 Heart Function Evaluations Comparison study among DSCT, UCG and MRI,DSCT,MRI,Courtesy of SD Image Institute, China,1.9 Exposion Dos

20、e Management Prospective ECG Triggering is available Dose is decreased: 13.54.1(1.2-28.1)mSv to 4.01.5 (1.2-7.5)mSv,SUBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Aortic Diseases,Aortic Diseases on MDCT,2278 patients (M/F=1740/538) 49.512.3 years 24-hour emergency Averag

21、e 13 cases per day before and after operation To substitute of conventional Angiography,MIP / CPR Reconstructed Images,Male, 42 years. Abdominal Aortic Aneurysm. Before and after intraluminal stenting isolation.,Female, 35 years. Marfans syndrome Stanford B aortic disection. Davidaorta replacement,S

22、UBTITLES,Coronary Artery Disease Aortic Diseases Congenital Heart Diseases,Congenital Heart Diseases,Congenital Heart Diseases on MDCT,774 patients (M/F=425/349, 14.818.3 years 3 days to 79 years; 223 pt. 1 year Supplemental tool for cardiac echo and catheterizations.,Advantages and Indications of CT for CHD,Pulmonary artery developments and aorto-pulmonary collaterals. Aortic arch developments and malformations. Abnormal dra