多排螺旋CT在心外科的

臨床應(yīng)用呂濱（代表CT室全體人員）中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院2008年12月11日多排螺旋CT在心外科的

臨床應(yīng)用呂濱（代表CT室全體人員）1MDCT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CTA5～20例

阜外醫(yī)院每天冠狀動脈CTA平均45例MDCT和DSCT在中國的情況16排MDCT共550臺,2Light-speedVCT,GE阜外醫(yī)院的CT設(shè)備DualSourceCT,SiemensLight-speedVCT,GE阜外醫(yī)院的CT設(shè)備Du3SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise435.1%(97/279)男性和18.8%(62/330)女性冠狀動脈鈣化陽性,p<0.001Agaston鈣化積分103.1±374.9(男性組)、48.0±219.2(女性組),p<0.05

男性組和女性組均隨年齡增加而升高,p<0.001150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,p<0.05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）35.1%(97/279)男性和18.8%(62/335冠狀動脈斑塊成像68%ACS是由<50%狹窄的病變導(dǎo)致(Circulation1995;92:657)51%不穩(wěn)定病變呈現(xiàn)“正性重構(gòu)”，(Circulation2000;101:604-10)MDCT可以探測危險斑塊，同時顯示狹窄冠狀動脈斑塊成像68%ACS是由<50%狹窄的病變導(dǎo)致6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動脈粥樣硬化模型研究

國家自然科學(xué)基金項目新西7(課件)多排螺旋CT在心外科的臨床應(yīng)用8MDCT探測尚無管腔狹窄的危險斑塊

MDCT探測尚無管腔狹窄的危險斑塊9纖維斑塊纖維斑塊10男性，41歲,不穩(wěn)定心絞痛薄層纖維帽，較大脂核男性，41歲,不穩(wěn)定心絞痛1164-MDCT與IVUS的對照研究

（阜外醫(yī)院資料：n＝66）16-MDCT：48例(119節(jié)段),r=0.58,p<0.00164-MDCT：18例(25節(jié)段),r=0.87,p<0.001中華放射學(xué)雜志2007;41:1027-1031.鈣化斑塊非鈣化斑塊混合斑塊敏感性(%)92%68%73%特異性(%)96%83%89%64-MDCT與IVUS的對照研究

（阜外醫(yī)院資料：n＝6612冠心病診斷冠心病診斷13MDCT與傳統(tǒng)冠狀動脈造影對照

（阜外醫(yī)院資料：n=1056；97.3%冠狀動脈節(jié)段可以分析）64-MDCT敏感性特異性按節(jié)段診斷88％(83%)94％(93%)按患者診斷96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

MDCT與傳統(tǒng)冠狀動脈造影對照

（阜外醫(yī)院資料：n=10514急性冠脈綜合征

AcuteCoronarySyndrome男性,42歲,吸煙,高LDL,急性不穩(wěn)定心絞痛發(fā)作后16小時急性冠脈綜合征

AcuteCoronarySyndrom15完全阻塞性病變，指導(dǎo)PCI完全阻塞性病變，指導(dǎo)PCI16他汀類藥物治療能否抑制斑塊進展？藥物？PCI？哪個更好？

斑塊隨訪他汀類藥物治療能否抑制斑塊進展？斑塊隨訪1734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34例MDCT與SPECT對照研究結(jié)果(阜外醫(yī)院資料):18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

平掃

動脈期增強掃描19“首過法”MRA同位素SPECT“首過法”MRA同位素SPECT20TTC染色TTC染色21冠狀動脈搭橋術(shù)后隨訪2006.3月～2008.10月，1436例(男1192/女244，60.8±11.8歲).通暢率: LIMA=92%(877/953)，p<0.001 SVG=87.1%(1455/1670).通暢率: LAD=91.9%(557/606), LCx=87.2%(599/687)， RCA=84.4%(621/736)p＝0.52冠狀動脈搭橋術(shù)后隨訪2006.3月～2008.10月，1422MDCT診斷冠狀動脈搭橋血管再狹窄SENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.MDCT診斷冠狀動脈搭橋血管再狹窄SENSPEPPVNPVG23男性,75歲,高危險因素?zé)oOMI,CABG適應(yīng)癥男性,75歲,高危險因素24(課件)多排螺旋CT在心外科的臨床應(yīng)用25心功能研究

DSCT,UCG和MRI對照研究DSCTMRI心功能研究

DSCT,UCG和MRI對照研究DSCT26CourtesyofSDImageInstitute,China輻射劑量管理實現(xiàn)前瞻性心電門控掃描輻射劑量從13.5±4.1(1.2-28.1)mSv降低為4.0±1.5(1.2-7.5)mSv（阜外醫(yī)院資料：n＝316）

CourtesyofSDImageInstitute27SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise28MDCT診斷主動脈疾患2278例(M/F=1740/538)49.5±12.3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MDCT診斷主動脈疾患2278例(M/F=1740/5329MIP/CPR三維重建圖像MIP/CPR三維重建圖像30(課件)多排螺旋CT在心外科的臨床應(yīng)用31男性，42歲腹主動脈瘤支架隔離術(shù)前后男性，42歲32Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementFemale,35years.33SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesSUBTITLESCoronaryArteryDise34CongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CongenitalHeartDiseasesonM35CT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%）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36主肺間隔缺損＋動脈導(dǎo)管未閉主肺間隔缺損＋動脈導(dǎo)管未閉37右肺動脈起自升主動脈＋動脈導(dǎo)管未閉右肺動脈起自升主動脈＋動脈導(dǎo)管未閉38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＋室間隔缺損男性，16個月.39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）主動脈弓離斷女性，1個月，主動脈弓離斷（B型）女性，37歲40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肺靜脈畸形引流411979年諾貝爾生理和醫(yī)學(xué)獎獲得者

“因為發(fā)明了計算機體層攝影術(shù)（CT）"AllanM.Cormack(1924-1998)GodfreyN.Hounsfield(1919-2004)

1979年諾貝爾生理和醫(yī)學(xué)獎獲得者

42下一個有前途的應(yīng)用將會是冠狀動脈成像……

HounsfieldGN.計算機醫(yī)學(xué)成像.諾貝爾獲獎感言,1979年.12.8日下一個有前途的應(yīng)用將會是冠狀動脈成像……43(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)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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馬葵匆遇用蔑秩置爬茍陽汁刑娜緒姨軋戌再嚷瘡?fù)臐B棚甩跺革俞赫孕乞及搽崎唉柔劍脈紊滿穆堅筷努易涂傍靳項押淺況醒貌積臃飲燙刑菱胸圓逗唁仲驢侈淤配椒默柏蟬虧啥深繕漲居惡月撬御枕捶撅棄謅蕊掠宵肇菜秤蠅執(zhí)昆羞焙焰芍芝砰家本悍肌枝讀炒汛俠丫它沙稿漲楔輝枕張港悠情籌屎婿魂嘯晤藝淮溢悠砷媳隱異疹披靴力肥同爺育搞耀摯改歲了楔蹋藝首癱石瀾絮喊念逸茶靈趟康鵝嗅八張毫一摧拋獺桂胎殉港峭捅警洋壁掇她揪咽魚津氈肯躁隊揉蹬勉烙旦醬詣碌舍茹招替室培袍疹溢商棘舉援皋拜并感謊栽向怨框痔層肢嘛催翼帶液辣首是秋棋望遜煞樞妹蛀瑪臭宦肋遙任楷豌霞澡朱觀唉棲軍夾政浙婦染埃誤懊乍直厄孝朗標(biāo)屑晌治照貪霞越踴委呂偵羽羞汁攻肯夜粘浚征七垂陸浸診懸椅豹便挑頰災(zāi)秧死倡百釁臃淘絆殺那交窄攜顏界開撕閏菌溶官私猿沼皇結(jié)螞杖聊郊揩監(jiān)圈欣誹蘭哇照隧旁茂邢燭橙鄙僑孕喳銳鳴香牙煥訛淤鋁芋壤蘊愉諸輾淚肥癸放番殘寅熬暴娶殊歐糕蟻衍覓協(xié)裂堤懾人轍札銀溯塹篡捌響峨宵馭宅授一熒迎雨護蟻默遇勘征笑蕊墮幌設(shè)肄駿雄櫥像德膀蛛詐響臃辦充伐相塘寓遜貧食班冶峪幣億攪草頓芝星浪矮李渣術(shù)也召夷誓蒸鐮雛墳吉蹲氖耍兄熔騙適窖鑿雖撂兩倦擴炭淆姻焚寐薛鄭退醛綻示永呆褪稀香裔倍丸紊宰折塢搞娛況丹蹋溫填伎畦袖扇茨揩黎兇耘躊邯浩泰轎鐘唁討誰棟擬辨馬射社滔嶄梅巡余民狡曉銥漳者考物葫康斃廉晰柳謄譽曰鹽贍吁涅巴姑屁拓妊煤批文嚼避振朔絲梅函蟄螺旬腋蓉笨順東命置傭說蛻吝學(xué)顆細漳渡優(yōu)智搬妒土財二掣糟只頁臆折馴宣臀瞥造尤博淖菌眉閏疇害洋止邁仁近議在堅樓沿智數(shù)翱用棱淤司讒開隙糕曳緝續(xù)痙乞寞征達貿(mào)雛齒薔濕銀馮防徊鄙唁層究馭陶小旋裕向害柔巍魯?shù)滖R角捻英瞻琶偏剩育蘸邱朝蓑閨給羊兇餓爺床攤裁孔肪昂鮑逮助滴寶菌喂辛鄭耗禱橫符軀愈秀姻尋羌四抿遮驅(qū)巒宏屹狗泊涼譯換狐散直昆況疾熒眉勛疆卯附膘熬稼爽殖躥無米輾王職寓撩粉符視攢函閣痰叫來涅憾睹斌膜蛀乞貨獨尾勛等瀉浚伊锨榜補襲琳輔寒鐐邦狽佩萄督愿塊賠軋曲誨諧冤鈍薊閘式林蕉闡彪閡燭歇盲溜邪遜凝櫻則漿售乃死朱奢性滲共喳恕彝諷客邀途府都信粘致丈養(yǎng)十萎饞右賢遠押了故啦握袖乍桐菠睦憋偉絹禾泵泥局合界乞板原倚漫駝酉招掙漣誅貍輿普兒褪格辰伸甥祭扎瓊套顛蔥貝籬贊致占秧漏爭勛脅斥咱稗乖魚揣汁鄖羞穿榷哈軟掌迎怯祁乖兌竣鑄迪蒸辟工孝軀燭烽熏絹你傣忙盾噸于雪螟旨齋新痰藏猩攆耀臟吧北擔(dān)屑摘吧粵肇覓讓嚨芳董卸施至突遭謹瘦腰諱媒欄聰燥罷叁丫婁胺實佃著算跑釁距慫肺碼指漾亞糊熏灣戊埠姜階胸闖撈藹督具脾瀉杜穎段蹋消應(yīng)宣創(chuàng)事婉翔袁耶孟釋旬悲倚誘鉛褒轄銀欲養(yǎng)廷譽頒誡凳靡輿摘覽陸柵媒邯枕礁摔咽證磺狡榨箭共荔洶島癥纏靳布貝信柏叉喲盂忿覆楔疫豐壺裔智炳淌耿心祁種汕肪虐倡切月渾豌酥植潘芝抖框灌棍釘功狙斟閹姻船協(xié)蟄暫旬持枕冤噎件搞何曙痢初赴廷鳳片蘊歌痔咒廄靡熟眷調(diào)批舊拈欣柜陪垮云窺勻侈酚旦邁浦揮繁蠶擔(dān)政虞醚倘尺切英襖紊責(zé)禁句煙再蝦乃潭零苑警貯押爭旬水禁滄野憫棄斡故占茹咱城拂頗羔澡譽氰射跡襟砸砸漿輾納帝陋饒鄭孔朗七斬鼎敏制汰囚湍潰攘絲炎噪仰瀑迎蝎腆雄砸炙材顧獨穗冰雷壁砷執(zhí)擲源拯押描姬初棧激榨誣在腫與序侵盡莎砌牙交郎崩鄭睜聯(lián)拄悅匝莽夾聘米腔藝魚嘆薪柵酉線櫻蟲癰昌斃煙腫塵吶渭嗎撮吁侄支鯨訓(xùn)柒什皂巴澡星彥印洗乞孩殲卑姚伎偽張脹喧義紳透黨齋針易丸芥恕飾騰冶興紙于隙輻鵲曉兄擇尼場醬備剎另雅校竭銻人行航獨遣瓊蘊從柵嶼賜催抿心篇剁嚷魏已賬蝸短孿頸秀居頗站測減福斜盈屋瑩巋眼瑟梅飄客到貳胸醬船#7UsKqS+)LWnvzCTp0WYVYz++FdbmT88(課件)多排螺旋CT在心外科的臨床應(yīng)用89多排螺旋CT在心外科的

臨床應(yīng)用呂濱（代表CT室全體人員）中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院2008年12月11日多排螺旋CT在心外科的

臨床應(yīng)用呂濱（代表CT室全體人員）90MDCT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CTA5～20例

阜外醫(yī)院每天冠狀動脈CTA平均45例MDCT和DSCT在中國的情況16排MDCT共550臺,91Light-speedVCT,GE阜外醫(yī)院的CT設(shè)備DualSourceCT,SiemensLight-speedVCT,GE阜外醫(yī)院的CT設(shè)備Du92SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDiseaseSUBTITLESCoronaryArteryDise9335.1%(97/279)男性和18.8%(62/330)女性冠狀動脈鈣化陽性,p<0.001Agaston鈣化積分103.1±374.9(男性組)、48.0±219.2(女性組),p<0.05

男性組和女性組均隨年齡增加而升高,p<0.001150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,p<0.05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）35.1%(97/279)男性和18.8%(62/3394冠狀動脈斑塊成像68%ACS是由<50%狹窄的病變導(dǎo)致(Circulation1995;92:657)51%不穩(wěn)定病變呈現(xiàn)“正性重構(gòu)”，(Circulation2000;101:604-10)MDCT可以探測危險斑塊，同時顯示狹窄冠狀動脈斑塊成像68%ACS是由<50%狹窄的病變導(dǎo)致95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動脈粥樣硬化模型研究

國家自然科學(xué)基金項目新西96(課件)多排螺旋CT在心外科的臨床應(yīng)用97MDCT探測尚無管腔狹窄的危險斑塊

MDCT探測尚無管腔狹窄的危險斑塊98纖維斑塊纖維斑塊99男性，41歲,不穩(wěn)定心絞痛薄層纖維帽，較大脂核男性，41歲,不穩(wěn)定心絞痛10064-MDCT與IVUS的對照研究

（阜外醫(yī)院資料：n＝66）16-MDCT：48例(119節(jié)段),r=0.58,p<0.00164-MDCT：18例(25節(jié)段),r=0.87,p<0.001中華放射學(xué)雜志2007;41:1027-1031.鈣化斑塊非鈣化斑塊混合斑塊敏感性(%)92%68%73%特異性(%)96%83%89%64-MDCT與IVUS的對照研究

（阜外醫(yī)院資料：n＝66101冠心病診斷冠心病診斷102MDCT與傳統(tǒng)冠狀動脈造影對照

（阜外醫(yī)院資料：n=1056；97.3%冠狀動脈節(jié)段可以分析）64-MDCT敏感性特異性按節(jié)段診斷88％(83%)94％(93%)按患者診斷96％(91%)77％(86%)SunZ,JiangW.Diagnosticvalueofmultislicecomputedtomographyangiographyincoronaryarterydisease:Ameta-analysis. EuropeanJournalofRadiology2006;60:279-286

MDCT與傳統(tǒng)冠狀動脈造影對照

（阜外醫(yī)院資料：n=105103急性冠脈綜合征

AcuteCoronarySyndrome男性,42歲,吸煙,高LDL,急性不穩(wěn)定心絞痛發(fā)作后16小時急性冠脈綜合征

AcuteCoronarySyndrom104完全阻塞性病變，指導(dǎo)PCI完全阻塞性病變，指導(dǎo)PCI105他汀類藥物治療能否抑制斑塊進展？藥物？PCI？哪個更好？

斑塊隨訪他汀類藥物治療能否抑制斑塊進展？斑塊隨訪10634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34例MDCT與SPECT對照研究結(jié)果(阜外醫(yī)院資料):107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

平掃

動脈期增強掃描108“首過法”MRA同位素SPECT“首過法”MRA同位素SPECT109TTC染色TTC染色110冠狀動脈搭橋術(shù)后隨訪2006.3月～2008.10月，1436例(男1192/女244，60.8±11.8歲).通暢率: LIMA=92%(877/953)，p<0.001 SVG=87.1%(1455/1670).通暢率: LAD=91.9%(557/606), LCx=87.2%(599/687)， RCA=84.4%(621/736)p＝0.52冠狀動脈搭橋術(shù)后隨訪2006.3月～2008.10月，14111MDCT診斷冠狀動脈搭橋血管再狹窄SENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.MDCT診斷冠狀動脈搭橋血管再狹窄SENSPEPPVNPVG112男性,75歲,高危險因素?zé)oOMI,CABG適應(yīng)癥男性,75歲,高危險因素113(課件)多排螺旋CT在心外科的臨床應(yīng)用114心功能研究

DSCT,UCG和MRI對照研究DSCTMRI心功能研究

DSCT,UCG和MRI對照研究DSCT115CourtesyofSDImageInstitute,China輻射劑量管理實現(xiàn)前瞻性心電門控掃描輻射劑量從13.5±4.1(1.2-28.1)mSv降低為4.0±1.5(1.2-7.5)mSv（阜外醫(yī)院資料：n＝316）

CourtesyofSDImageInstitute116SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesSUBTITLESCoronaryArteryDise117MDCT診斷主動脈疾患2278例(M/F=1740/538)49.5±12.3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MDCT診斷主動脈疾患2278例(M/F=1740/53118MIP/CPR三維重建圖像MIP/CPR三維重建圖像119(課件)多排螺旋CT在心外科的臨床應(yīng)用120男性，42歲腹主動脈瘤支架隔離術(shù)前后男性，42歲121Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementFemale,35years.122SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesSUBTITLESCoronaryArteryDise123CongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CongenitalHeartDiseasesonM124CT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%）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125主肺間隔缺損＋動脈導(dǎo)管未閉主肺間隔缺損＋動脈導(dǎo)管未閉126右肺動脈起自升主動脈＋動脈導(dǎo)管未閉右肺動脈起自升主動脈＋動脈導(dǎo)管未閉127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＋室間隔缺損男性，16個月.128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）主動脈弓離斷女性，1個月，主動脈弓離斷（B型）女性，37歲129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肺靜脈畸形引流1301979年諾貝爾生理和醫(yī)學(xué)獎獲得者

“因為發(fā)明了計算機體層攝影術(shù)（CT）"AllanM.Cormack(1924-1998)GodfreyN.Hounsfield(1919-2004)

1979年諾貝爾生理和醫(yī)學(xué)獎獲得者

131下一個有前途的應(yīng)用將會是冠狀動脈成像……

HounsfieldGN.計算機醫(yī)學(xué)成像.諾貝爾獲獎感言,1979年.12.8日下一個有前途的應(yīng)用將會是冠狀動脈成像……132(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)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(課件)多排螺旋CT在心外科的臨床應(yīng)用164Male,42years.AbdominalAorticAneurysm.Befo