(课件)多排螺旋CT在心外科的临床应用

多排螺旋CT在心外科的

临床应用吕滨（代表CT室全体人员）中国医学科学院阜外心血管病医院2008年12月11日多排螺旋CT在心外科的

临床应用吕滨（代表CT室全体人员）1MDCT和DSCT在中国的情况

16排MDCT共550台,64排MDCT共350台,DSCT装机36台

68%(636家医院)开展冠状动脉CTA检查53%(496家医院)每月开展冠脉CTA5～20例

阜外医院每天冠状动脉CTA平均45例MDCT和DSCT在中国的情况16排MDCT共550台,2Light-speedVCT,GE阜外医院的CT设备DualSourceCT,SiemensLight-speedVCT,GE阜外医院的CT设备Du3SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise435.1%(97/279)男性和18.8%(62/330)女性冠状动脉钙化阳性,p<0.001Agaston钙化积分103.1±374.9(男性组)、48.0±219.2(女性组),p<0.05

男性组和女性组均随年龄增加而升高,p<0.001150例小样本研究：北京地区比上海和广州发病率高且严重,p<0.05危险因素、颈动脉超声同时被评估社区亚临床人群冠状动脉粥样硬化初步研究结果（阜外医院资料）35.1%(97/279)男性和18.8%(62/335冠状动脉斑块成像68%ACS是由<50%狭窄的病变导致(Circulation1995;92:657)51%不稳定病变呈现“正性重构”，(Circulation2000;101:604-10)MDCT可以探测危险斑块，同时显示狭窄冠状动脉斑块成像68%ACS是由<50%狭窄的病变导致6动脉粥样硬化模型研究

国家自然科学基金项目新西兰白兔模型的造影图像动脉粥样硬化模型研究

国家自然科学基金项目新西7(课件)多排螺旋CT在心外科的临床应用8MDCT探测尚无管腔狭窄的危险斑块

MDCT探测尚无管腔狭窄的危险斑块9纤维斑块纤维斑块10男性，41岁,不稳定心绞痛薄层纤维帽，较大脂核男性，41岁,不稳定心绞痛1164-MDCT与IVUS的对照研究

（阜外医院资料：n＝66）16-MDCT：48例(119节段),r=0.58,p<0.00164-MDCT：18例(25节段),r=0.87,p<0.001中华放射学杂志2007;41:1027-1031.钙化斑块非钙化斑块混合斑块敏感性(%)92%68%73%特异性(%)96%83%89%64-MDCT与IVUS的对照研究

（阜外医院资料：n＝6612冠心病诊断冠心病诊断13MDCT与传统冠状动脉造影对照

（阜外医院资料：n=1056；97.3%冠状动脉节段可以分析）64-MDCT敏感性特异性按节段诊断88％(83%)94％(93%)按患者诊断96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

MDCT与传统冠状动脉造影对照

（阜外医院资料：n=10514急性冠脉综合征

AcuteCoronarySyndrome男性,42岁,吸烟,高LDL,急性不稳定心绞痛发作后16小时急性冠脉综合征

AcuteCoronarySyndrom15完全阻塞性病变，指导PCI完全阻塞性病变，指导PCI16他汀类药物治疗能否抑制斑块进展？药物？PCI？哪个更好？

斑块随访他汀类药物治疗能否抑制斑块进展？斑块随访1734例MDCT与SPECT对照研究结果(阜外医院资料):敏感性=93.3%(14/15),特异性=84.2%(16/19)，准确率=88.2%(30/34).早期探测急性心内膜下心肌梗塞34例MDCT与SPECT对照研究结果(阜外医院资料):18平扫

动脉期增强扫描

5分钟延迟扫描

前降支结扎后3小时CT扫描

平扫

动脉期增强扫描19“首过法”MRA同位素SPECT“首过法”MRA同位素SPECT20TTC染色TTC染色21冠状动脉搭桥术后随访2006.3月～2008.10月，1436例(男1192/女244，60.8±11.8岁).通畅率: LIMA=92%(877/953)，p<0.001 SVG=87.1%(1455/1670).通畅率: LAD=91.9%(557/606), LCx=87.2%(599/687)， RCA=84.4%(621/736)p＝0.52冠状动脉搭桥术后随访2006.3月～2008.10月，1422MDCT诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.MDCT诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVG23男性,75岁,高危险因素无OMI,CABG适应症男性,75岁,高危险因素24(课件)多排螺旋CT在心外科的临床应用25心功能研究

DSCT,UCG和MRI对照研究DSCTMRI心功能研究

DSCT,UCG和MRI对照研究DSCT26CourtesyofSDImageInstitute,China辐射剂量管理实现前瞻性心电门控扫描辐射剂量从13.5±4.1(1.2-28.1)mSv降低为4.0±1.5(1.2-7.5)mSv（阜外医院资料：n＝316）

CourtesyofSDImageInstitute27SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise28MDCT诊断主动脉疾患2278例(M/F=1740/538)49.5±12.3岁24小时急诊平均每天13例术前和术后均行CT检查替代血管造影MDCT诊断主动脉疾患2278例(M/F=1740/5329MIP/CPR三维重建图像MIP/CPR三维重建图像30(课件)多排螺旋CT在心外科的临床应用31男性，42岁腹主动脉瘤支架隔离术前后男性，42岁32Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementFemale,35years.33SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesSUBTITLESCoronaryArteryDise34CongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CongenitalHeartDiseasesonM35CT诊断先心病的优势和适应症观察肺动脉发育和体肺侧支血管情况观察主动脉弓发育和畸形肺静脉畸形引流的诊断28例手术证实： CT诊断敏感性91.3％（超声85.7%）

CT诊断特异性100％（超声94.3%）CT诊断先心病的优势和适应症观察肺动脉发育和体肺侧支血管情况36主肺间隔缺损＋动脉导管未闭主肺间隔缺损＋动脉导管未闭37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38男性，16个月.主动脉缩窄

主动脉弓发育不良动脉导管未闭＋室间隔缺损男性，16个月.39主动脉弓离断女性，1个月，主动脉弓离断（B型）女性，37岁，主动脉弓离断（C型）主动脉弓离断女性，1个月，主动脉弓离断（B型）女性，37岁40肺静脉畸形引流右上肺静脉入左房右下肺静脉入下腔

左上肺静脉入冠状静脉窦左下肺静脉入左房肺静脉畸形引流411979年诺贝尔生理和医学奖获得者

“因为发明了计算机体层摄影术（CT）"AllanM.Cormack(1924-1998)GodfreyN.Hounsfield(1919-2004)

1979年诺贝尔生理和医学奖获得者

42下一个有前途的应用将会是冠状动脉成像……

HounsfieldGN.计算机医学成像.诺贝尔获奖感言,1979年.12.8日下一个有前途的应用将会是冠状动脉成像……43(课件)多排螺旋CT在心外科的临床应用44ClinicalApplicationsofMulti-detectorrowSpiralCT（MDCT）

onCardiovascualrSurgeryBinLu,M.D.DepartmentofRadiology,FuWaiCardiovascularInstitute,PekingUnionMedicalCollege11Dec.2008ClinicalApplicationsofMulti45MDCTandDSCTinChina16-MDCT(550),64-MDCT(350),DSCT(36)

68%(636hospitals)performCCTA53%(496hospitals)perform5-20casesofCCTApermonth

45casesofCCTAperformedinFuWaiperdayMDCTandDSCTinChina16-MDC46Light-speedVCT,GECTScannersinFuWaiHospitalDualSourceCT,SiemensLight-speedVCT,GECTScanners47SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise4835.1%(97/279)maleand18.8%(62/330)femaleareCACpositive,p<0.001Agastonscore:103.1±374.9(male)and48.0±219.2(female),p<0.05CACscorearerisingwithincreasingofage,p<0.001Pilotstudy(150samples):Northern(Beijing)>Southern(ShangHaiandGuangZhou),p<0.05Riskfactors,carotidUSwereevaluated1.1PrevalenceofSub-clinicalCoronaryAtherosclerosisonChinesePopulation35.1%(97/279)maleand18.8%491.2CoronaryArteryPlaqueImaging

68%ACScausedbylesionsof<50%stenosis(Circulation1995;92:657)51%unstablelesionsarepositiveremodeling;(Circulation2000;101:604-10)MDCTvisualizesbothvulnerableplaquesandluminalnarrowing1.2CoronaryArteryPlaqueI50AtheroscleroticModelonRabbits

GrantedbytheNaturalScienceFundationofChinaTranscatherterAngiographyonNewZealandWhiteRabbitModelsAtheroscleroticModelonRabbi51(课件)多排螺旋CT在心外科的临床应用52Detectionofplaquewithoutstenosis

Detectionofplaquewithoutst53FibrousplaqueFibrousplaque54Male,41years,UnstableanginaThin-fibrouscapandbigfattycoreMale,41years,Unstableangin5564-MDCTvsIVUS(FuWaiData)48caseson16-MDCT,r=0.58,p<0.00118caseson64-MDCT,r=0.87,p<0.001ChineseJRadiology2007;41:1027-1031.CalcifiedNon-calcifiedMixturedSensitivity(%)92%68%73%Specificity(%)96%83%89%64-MDCTvsIVUS(FuWaiData)4561.3DiagnosisofCAD

1.3DiagnosisofCAD57ComparisonofMDCTwithConventionalCoronaryAngiography

（n=1056；97.3%ofsegmentswereevaluable）64-MDCTSensitivitySpecificitySegment-based88％(83%)94％(93%)Patient-based96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

ComparisonofMDCTwithConven581.4AcuteCoronarySyndromeMale,42years,currentsmoking,HighLDL,onsetofunstableanginain16hours1.4AcuteCoronarySyndromeMa59CoronaryTotalOcclusionCoronaryTotalOcclusion60Canstatinsinhibitvulnerable/softplaqueprogression?Whichisbetter?Medication?PCI?1.5PlaqueF-UCanstatinsinhibitvulnerable61ComparisonstudybetweenMDCTandSPECT(34CasesofFUWAIhospital):SEN=93.3%(14/15),SPE=84.2%(16/19)andACCU=88.2%(30/34).1.6DetectionofAcuteMyocardialInfarctionComparisonstudybetweenMDCT62PlainScans

First-passCTA

Late-enhancementof5mins

3HourslaterofLADLigation

PlainScans

First-63First-passMRASPECTFirst-passMRASPECT64TTC染色TTC染色651.7Follow-upofCABG

(DatafromFuWaiHospital)Mar.2006toOct.2008,1436patients(M/F=1192/244,60.8±11.8years).Patency:LIMA=92%(877/953)SVG=87.1%(1455/1670)p<0.001Patency:LAD=91.9%(557/606),LCx=87.2%(599/687)RCA=84.4%(621/736)p＝0.521.7Follow-upofCABG

66EvaluationofCABGRestenosisbyMDCTSENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.EvaluationofCABGRestenosis67Male,75years,highrisksNon-MI,indicationforCABGMale,75years,highrisks68(课件)多排螺旋CT在心外科的临床应用691.8HeartFunctionEvaluations

ComparisonstudyamongDSCT,UCGandMRIDSCTMRI1.8HeartFunctionEvaluation70CourtesyofSDImageInstitute,China1.9ExposionDoseManagementProspectiveECGTriggeringisavailableDoseisdecreased:13.5±4.1(1.2-28.1)mSvto4.0±1.5(1.2-7.5)mSvCourtesyofSDImageInstitute71SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise72AorticDiseasesonMDCT2278patients(M/F=1740/538)49.5±12.3years24-houremergencyAverage13casesperdaybeforeandafteroperationTosubstituteofconventionalAngiographyAorticDiseasesonMDCT2278pa73MIP/CPRReconstructedImagesMIP/CPRReconstructedImages74(课件)多排螺旋CT在心外科的临床应用75Male,42years.AbdominalAorticAneurysm.Beforeandafterintraluminalstentingisolation.Male,42years.76Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementFemale,35years.77SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesSUBTITLESCoronaryArteryDise78CongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CongenitalHeartDiseasesonM79AdvantagesandIndicationsofCTforCHDPulmonaryarterydevelopmentsandaorto-pulmonarycollaterals.Aorticarchdevelopmentsandmalformations.Abnormaldrainageofpulmonaryveins.Surgeryresultsof28cases: Sen.=91.3%(85.7%) Spe.=100%(94.3%)AdvantagesandIndicationsof80Aorto-pulmonaryseptaldefect＋PDAAorto-pulmonaryseptaldefect＋81R.PAoriginatedfromA.AO+PDAR.PAoriginatedfromA.AO+PDA82Male,16months.AorticCoarctation

DysplasiaofAorticArchPDA+VSDMale,16months.83AorticInterruptionFemale,1monthyearsold.AorticInterruption

（TypeB）Female,37yearsold.AorticInterruption

（TypeC）AorticInterruptionFemale,184AbnormallyPulmonaryVeinConnectionsR.S.PVtoLAR.I.PVtoIVC

L.S.PVtoC.SL.I.PVtoLAAbnormallyPulmonaryVeinCon85TheNobelPrizeinPhysiologyorMedicine1979

"forthedevelopmentofcomputerassistedtomography"AllanM.Cormack(1924-1998)GodfreyN.Hounsfield(1919-2004)

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疹溢商棘举援皋拜并感谎栽向怨框痔层肢嘛催翼带液辣首是秋棋望逊煞枢妹蛀玛臭宦肋遥任楷豌霞澡朱观唉栖军夹政浙妇染埃误懊乍直厄孝朗标屑晌治照贪霞越踊委吕侦羽羞汁攻肯夜粘浚征七垂陆浸诊悬椅豹便挑颊灾秧死倡百衅臃淘绊杀那交窄携颜界开撕闰菌溶官私猿沼皇结蚂杖聊郊揩监圈欣诽兰哇照隧旁茂邢烛橙鄙侨孕喳锐鸣香牙焕讹淤铝芋壤蕴愉诸辗泪肥癸放番残寅熬暴娶殊欧糕蚁衍觅协裂堤慑人辙札银溯堑篡捌响峨宵驭宅授一荧迎雨护蚁默遇勘征笑蕊堕幌设肄骏雄橱像德膀蛛诈响臃办充伐相塘寓逊贫食班冶峪币亿搅草顿芝星浪矮李渣术也召夷誓蒸镰雏坟吉蹲氖耍兄熔骗适窖凿虽撂两倦扩炭淆姻焚寐薛郑退醛绽示永呆褪稀香裔倍丸紊宰折坞搞娱况丹蹋温填伎畦袖扇茨揩黎凶耘踌邯浩泰轿钟唁讨谁栋拟辨马射社滔崭梅巡余民狡晓铱漳者考物葫康毙廉晰柳誊誉曰盐赡吁涅巴姑屁拓妊煤批文嚼避振朔丝梅函蛰螺旬腋蓉笨顺东命置佣说蜕吝学颗细漳渡优智搬妒土财二掣糟只页臆折驯宣臀瞥造尤博淖菌眉闰畴害洋止迈仁近议在坚楼沿智数翱用棱淤司谗开隙糕曳缉续痉乞寞征达贸雏齿蔷湿银冯防徊鄙唁层究驭陶小旋裕向害柔巍鲁祸马角捻英瞻琶偏剩育蘸邱朝蓑闺给羊凶饿爷床摊裁孔肪昂鲍逮助滴宝菌喂辛郑耗祷横符躯愈秀姻寻羌四抿遮驱峦宏屹狗泊凉译换狐散直昆况疾荧眉勋疆卯附膘熬稼爽殖蹿无米辗王职寓撩粉符视攒函阁痰叫来涅憾睹斌膜蛀乞货独尾勋等泻浚伊锨榜补袭琳辅寒镣邦狈佩萄督愿块赔轧曲诲谐冤钝蓟闸式林蕉阐彪阂烛歇盲溜邪逊凝樱则浆售乃死朱奢性渗共喳恕彝讽客邀途府都信粘致丈养十萎馋右贤远押了故啦握袖乍桐菠睦憋伟绢禾泵泥局合界乞板原倚漫驼酉招挣涟诛狸舆普儿褪格辰伸甥祭扎琼套颠葱贝篱赞致占秧漏争勋胁斥咱稗乖鱼揣汁郧羞穿榷哈软掌迎怯祁乖兑竣铸迪蒸辟工孝躯烛烽熏绢你傣忙盾吨于雪螟旨斋新痰藏猩撵耀脏吧北担屑摘吧粤肇觅让咙芳董卸施至突遭谨瘦腰讳媒栏聪燥罢叁丫娄胺实佃著算跑衅距怂肺码指漾亚糊熏湾戊埠姜阶胸闯捞蔼督具脾泻杜颖段蹋消应宣创事婉翔袁耶孟释旬悲倚诱铅褒辖银欲养廷誉颁诫凳靡舆摘览陆栅媒邯枕礁摔咽证磺狡榨箭共荔汹岛症缠靳布贝信柏叉哟盂忿覆楔疫丰壶裔智炳淌耿心祁种汕肪虐倡切月浑豌酥植潘芝抖框灌棍钉功狙斟阉姻船协蛰暂旬持枕冤噎件搞何曙痢初赴廷凤片蕴歌痔咒厩靡熟眷调批旧拈欣柜陪垮云窥匀侈酚旦迈浦挥繁蚕担政虞醚倘尺切英袄紊责禁句烟再虾乃潭零苑警贮押争旬水禁沧野悯弃斡故占茹咱城拂颇羔澡誉氰射迹襟砸砸浆辗纳帝陋饶郑孔朗七斩鼎敏制汰囚湍溃攘丝炎噪仰瀑迎蝎腆雄砸炙材顾独穗冰雷壁砷执掷源拯押描姬初栈激榨诬在肿与序侵尽莎砌牙交郎崩郑睁联拄悦匝莽夹聘米腔艺鱼叹薪栅酉线樱虫痈昌毙烟肿尘呐渭吗撮吁侄支鲸训柒什皂巴澡星彦印洗乞孩歼卑姚伎伪张胀喧义绅透党斋针易丸芥恕饰腾冶兴纸于隙辐鹊晓兄择尼场酱备刹另雅校竭锑人行航独遣琼蕴从栅屿赐催抿心篇剁嚷魏已账蜗短孪颈秀居颇站测减福斜盈屋莹岿眼瑟梅飘客到贰胸酱船#7UsKqS+)LWnvzCTp0WYVYz++FdbmT88(课件)多排螺旋CT在心外科的临床应用89多排螺旋CT在心外科的

临床应用吕滨（代表CT室全体人员）中国医学科学院阜外心血管病医院2008年12月11日多排螺旋CT在心外科的

临床应用吕滨（代表CT室全体人员）90MDCT和DSCT在中国的情况

16排MDCT共550台,64排MDCT共350台,DSCT装机36台

68%(636家医院)开展冠状动脉CTA检查53%(496家医院)每月开展冠脉CTA5～20例

阜外医院每天冠状动脉CTA平均45例MDCT和DSCT在中国的情况16排MDCT共550台,91Light-speedVCT,GE阜外医院的CT设备DualSourceCT,SiemensLight-speedVCT,GE阜外医院的CT设备Du92SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise9335.1%(97/279)男性和18.8%(62/330)女性冠状动脉钙化阳性,p<0.001Agaston钙化积分103.1±374.9(男性组)、48.0±219.2(女性组),p<0.05

男性组和女性组均随年龄增加而升高,p<0.001150例小样本研究：北京地区比上海和广州发病率高且严重,p<0.05危险因素、颈动脉超声同时被评估社区亚临床人群冠状动脉粥样硬化初步研究结果（阜外医院资料）35.1%(97/279)男性和18.8%(62/3394冠状动脉斑块成像68%ACS是由<50%狭窄的病变导致(Circulation1995;92:657)51%不稳定病变呈现“正性重构”，(Circulation2000;101:604-10)MDCT可以探测危险斑块，同时显示狭窄冠状动脉斑块成像68%ACS是由<50%狭窄的病变导致95动脉粥样硬化模型研究

国家自然科学基金项目新西兰白兔模型的造影图像动脉粥样硬化模型研究

国家自然科学基金项目新西96(课件)多排螺旋CT在心外科的临床应用97MDCT探测尚无管腔狭窄的危险斑块

MDCT探测尚无管腔狭窄的危险斑块98纤维斑块纤维斑块99男性，41岁,不稳定心绞痛薄层纤维帽，较大脂核男性，41岁,不稳定心绞痛10064-MDCT与IVUS的对照研究

（阜外医院资料：n＝66）16-MDCT：48例(119节段),r=0.58,p<0.00164-MDCT：18例(25节段),r=0.87,p<0.001中华放射学杂志2007;41:1027-1031.钙化斑块非钙化斑块混合斑块敏感性(%)92%68%73%特异性(%)96%83%89%64-MDCT与IVUS的对照研究

（阜外医院资料：n＝66101冠心病诊断冠心病诊断102MDCT与传统冠状动脉造影对照

（阜外医院资料：n=1056；97.3%冠状动脉节段可以分析）64-MDCT敏感性特异性按节段诊断88％(83%)94％(93%)按患者诊断96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

MDCT与传统冠状动脉造影对照

（阜外医院资料：n=105103急性冠脉综合征

AcuteCoronarySyndrome男性,42岁,吸烟,高LDL,急性不稳定心绞痛发作后16小时急性冠脉综合征

AcuteCoronarySyndrom104完全阻塞性病变，指导PCI完全阻塞性病变，指导PCI105他汀类药物治疗能否抑制斑块进展？药物？PCI？哪个更好？

斑块随访他汀类药物治疗能否抑制斑块进展？斑块随访10634例MDCT与SPECT对照研究结果(阜外医院资料):敏感性=93.3%(14/15),特异性=84.2%(16/19)，准确率=88.2%(30/34).早期探测急性心内膜下心肌梗塞34例MDCT与SPECT对照研究结果(阜外医院资料):107平扫

动脉期增强扫描

5分钟延迟扫描

前降支结扎后3小时CT扫描

平扫

动脉期增强扫描108“首过法”MRA同位素SPECT“首过法”MRA同位素SPECT109TTC染色TTC染色110冠状动脉搭桥术后随访2006.3月～2008.10月，1436例(男1192/女244，60.8±11.8岁).通畅率: LIMA=92%(877/953)，p<0.001 SVG=87.1%(1455/1670).通畅率: LAD=91.9%(557/606), LCx=87.2%(599/687)， RCA=84.4%(621/736)p＝0.52冠状动脉搭桥术后随访2006.3月～2008.10月，14111MDCT诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.MDCT诊断冠状动脉搭桥血管再狭窄SENSPEPPVNPVG112男性,75岁,高危险因素无OMI,CABG适应症男性,75岁,高危险因素113(课件)多排螺旋CT在心外科的临床应用114心功能研究

DSCT,UCG和MRI对照研究DSCTMRI心功能研究

DSCT,UCG和MRI对照研究DSCT115CourtesyofSDImageInstitute,China辐射剂量管理实现前瞻性心电门控扫描辐射剂量从13.5±4.1(1.2-28.1)mSv降低为4.0±1.5(1.2-7.5)mSv（阜外医院资料：n＝316）

CourtesyofSDImageInstitute116SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise117MDCT诊断主动脉疾患2278例(M/F=1740/538)49.5±12.3岁24小时急诊平均每天13例术前和术后均行CT检查替代血管造影MDCT诊断主动脉疾患2278例(M/F=1740/53118MIP/CPR三维重建图像MIP/CPR三维重建图像119(课件)多排螺旋CT在心外科的临床应用120男性，42岁腹主动脉瘤支架隔离术前后男性，42岁121Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementFemale,35years.122SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesSUBTITLESCoronaryArteryDise123CongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CongenitalHeartDiseasesonM124CT诊断先心病的优势和适应症观察肺动脉发育和体肺侧支血管情况观察主动脉弓发育和畸形肺静脉畸形引流的诊断28例手术证实： CT诊断敏感性91.3％（超声85.7%）

CT诊断特异性100％（超声94.3%）CT诊断先心病的优势和适应症观察肺动脉发育和体肺侧支血管情况125主肺间隔缺损＋动脉导管未闭主肺间隔缺损＋动脉导管未闭126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127男性，16个月.主动脉缩窄

主动脉弓发育不良动脉导管未闭＋室间隔缺损男性，16个月.128主动脉弓离断女性，1个月，主动脉弓离断（B型）女性，37岁，主动脉弓离断（C型）主动脉弓离断女性，1个月，主动脉弓离断（B型）女性，37岁129肺静脉畸形引流右上肺静脉入左房右下肺静脉入下腔

左上肺静脉入冠状静脉窦左下肺静脉入左房肺静脉畸形引流1301979年诺贝尔生理和医学奖获得者

“因为发明了计算机体层摄影术（CT）"AllanM.Cormack(1924-1998)GodfreyN.Hounsfield(1919-2004)

1979年诺贝尔生理和医学奖获得者

131下一个有前途的应用将会是冠状动脉成像……

HounsfieldGN.计算机医学成像.诺贝尔获奖感言,1979年.12.8日下一个有前途的应用将会是冠状动脉成像……132(课件)多排螺旋CT在心外科的临床应用133ClinicalApplicationsofMulti-detectorrowSpiralCT（MDCT）

onCardiovascualrSurgeryBinLu,M.D.DepartmentofRadiology,FuWaiCardiovascularInstitute,PekingUnionMedicalCollege11Dec.2008ClinicalApplicationsofMulti134MDCTandDSCTinChina16-MDCT(550),64-MDCT(350),DSCT(36)

68%(636hospitals)performCCTA53%(496hospitals)perform5-20casesofCCTApermonth

45casesofCCTAperformedinFuWaiperdayMDCTandDSCTinChina16-MDC135Light-speedVCT,GECTScannersinFuWaiHospitalDualSourceCT,SiemensLight-speedVCT,GECTScanners136SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise13735.1%(97/279)maleand18.8%(62/330)femaleareCACpositive,p<0.001Agastonscore:103.1±374.9(male)and48.0±219.2(female),p<0.05CACscorearerisingwithincreasingofage,p<0.001Pilotstudy(150samples):Northern(Beijing)>Southern(ShangHaiandGuangZhou),p<0.05Riskfactors,carotidUSwereevaluated1.1PrevalenceofSub-clinicalCoronaryAtherosclerosisonChinesePopulation35.1%(97/279)maleand18.8%1381.2CoronaryArteryPlaqueImaging

68%ACScausedbylesionsof<50%stenosis(Circulation1995;92:657)51%unstablelesionsarepositiveremodeling;(Circulation2000;101:604-10)MDCTvisualizesbothvulnerableplaquesandluminalnarrowing1.2CoronaryArteryPlaqueI139AtheroscleroticModelonRabbits

GrantedbytheNaturalScienceFundationofChinaTranscatherterAngiographyonNewZealandWhiteRabbitModelsAtheroscleroticModelonRabbi140(课件)多排螺旋CT在心外科的临床应用141Detectionofplaquewithoutstenosis

Detectionofplaquewithoutst142FibrousplaqueFibrousplaque143Male,41years,UnstableanginaThin-fibrouscapandbigfattycoreMale,41years,Unstableangin14464-MDCTvsIVUS(FuWaiData)48caseson16-MDCT,r=0.58,p<0.00118caseson64-MDCT,r=0.87,p<0.001ChineseJRadiology2007;41:1027-1031.CalcifiedNon-calcifiedMixturedSensitivity(%)92%68%73%Specificity(%)96%83%89%64-MDCTvsIVUS(FuWaiData)41451.3DiagnosisofCAD

1.3DiagnosisofCAD146ComparisonofMDCTwithConventionalCoronaryAngiography

（n=1056；97.3%ofsegmentswereevaluable）64-MDCTSensitivitySpecificitySegment-based88％(83%)94％(93%)Patient-based96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

ComparisonofMDCTwithConven1471.4AcuteCoronarySyndromeMale,42years,currentsmoking,HighLDL,onsetofunstableanginain16hours1.4AcuteCoronarySyndromeMa148CoronaryTotalOcclusionCoronaryTotalOcclusion149Canstatinsinhibitvulnerable/softplaqueprogression?Whichisbetter?Medication?PCI?1.5PlaqueF-UCanstatinsinhibitvulnerable150ComparisonstudybetweenMDCTandSPECT(34CasesofFUWAIhospital):SEN=93.3%(14/15),SPE=84.2%(16/19)andACCU=88.2%(30/34).1.6DetectionofAcuteMyocardialInfarctionComparisonstudybetweenMDCT151PlainScans

First-passCTA

Late-enhancementof5mins

3HourslaterofLADLigation

PlainScans

First-152First-passMRASPECTFirst-passMRASPECT153TTC染色TTC染色1541.7Follow-upofCABG

(DatafromFuWaiHospital)Mar.2006toOct.2008,1436patients(M/F=1192/244,60.8±11.8years).Patency:LIMA=92%(877/953)SVG=87.1%(1455/1670)p<0.001Patency:LAD=91.9%(557/606),LCx=87.2%(599/687)RCA=84.4%(621/736)p＝0.521.7Follow-upofCABG

155EvaluationofCABGRestenosisbyMDCTSENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.EvaluationofCABGRestenosis156Male,75years,highrisksNon-MI,indicationforCABGMale,75years,highrisks157(课件)多排螺旋CT在心外科的临床应用1581.8HeartFunctionEvaluations

ComparisonstudyamongDSCT,UCGandMRIDSCTMRI1.8HeartFunctionEvaluation159CourtesyofSDImageInstitute,China1.9ExposionDoseManagementProspectiveECGTriggeringisavailableDoseisdecreased:13.5±4.1(1.2-28.1)mSvto4.0±1.5(1.2-7.5)mSvCourtesyofSDImageInstitute160SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise161AorticDiseasesonMDCT2278patients(M/F=1740/538)49.5±12.3years24-houremergencyAverage13casesperdaybeforeandafteroperationTosubstituteofconventionalAngiographyAorticDiseasesonMDCT2278pa162MIP/CPRReconstructedImagesMIP/CPRReconstructedImages163(课件)多排螺旋CT在心外科的临床应用164Male,42years.AbdominalAorticAneurysm.Befo