多排螺旋CT在心外科的臨床應用

多排螺旋CT在心外科的

臨床應用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CTA5～20例

阜外醫(yī)院每天冠狀動脈CTA平均45例Light-speedVCT,GE阜外醫(yī)院的CT設備DualSourceCT,SiemensSUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDisease35.1%(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%狹窄的病變導致(Circulation1995;92:657)51%不穩(wěn)定病變呈現“正性重構”，(Circulation2000;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：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%冠心病診斷MDCT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

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小時完全阻塞性病變，指導PCI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34例MDCT與SPECT對照研究結果(阜外醫(yī)院資料):敏感性=93.3%(14/15),特異性=84.2%(16/19)，準確率=88.2%(30/34).早期探測急性心內膜下心肌梗塞平掃

動脈期增強掃描

5分鐘延遲掃描

前降支結扎后3小時CT掃描

“首過法”

MRA同位素SPECTTTC染色冠狀動脈搭橋術后隨訪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＝0.52MDCT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.男性,75歲,高危險因素無OMI,CABG適應癥心功能研究

DSCT,UCG和MRI對照研究DSCTMRICourtesyofSDImageInstitute,China輻射劑量管理實現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）

SUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesMDCT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例術前和術后均行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前后Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementSUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.CT診斷先心病的優(yōu)勢和適應癥觀察肺動脈發(fā)育和體肺側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＋動脈導管未閉右肺動脈起自升主動脈＋動脈導管未閉

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年諾貝爾生理和醫(yī)學獎獲得者

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

下一個有前途的應用將會是冠狀動脈成像……

HounsfieldGN.計算機醫(yī)學成像.

諾貝爾獲獎感言,1979年.12.8日ClinicalApplicationsofMulti-detectorrowSpiralCT（MDCT）

onCardiovascualrSurgeryBinLu,M.D.DepartmentofRadiology,FuWaiCardiovascularInstitute,PekingUnionMedicalCollege11Dec.2008MDCTandDSCTinChina16-MDCT(550),64-MDCT(350),DSCT(36)

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

45casesofCCTAperformedinFuWaiperdayLight-speedVCT,GECTScannersinFuWaiHospitalDualSourceCT,SiemensSUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCoronaryArteryDisease35.1%(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-clinicalCoronaryAtherosclerosisonChinesePopulation1.2CoronaryArteryPlaqueImaging

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

GrantedbytheNaturalScienceFundationofChinaTranscatherterAngiographyonNewZealandWhiteRabbitModelsDetectionofplaquewithoutstenosis

FibrousplaqueMale,41years,UnstableanginaThin-fibrouscapandbigfattycore64-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%1.3DiagnosisofCAD

ComparisonofMDCTwithConventionalCoronaryAngiography

（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

1.4AcuteCoronarySyndromeMale,42years,currentsmoking,HighLDL,onsetofunstableanginain16hoursCoronaryTotalOcclusionCanstatinsinhibitvulnerable/softplaqueprogression?Whichisbetter?Medication?PCI?1.5PlaqueF-UComparisonstudybetweenMDCTandSPECT(34CasesofFUWAIhospital):SEN=93.3%(14/15),SPE=84.2%(16/19)andACCU=88.2%(30/34).1.6DetectionofAcuteMyocardialInfarctionPlainScans

First-passCTA

Late-enhancementof5mins

3HourslaterofLADLigation

First-passMRASPECTTTC染色1.7Follow-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＝0.52EvaluationofCABGRestenosisbyMDCTSENSPEPPVNPVGregory70%92%89%77％Sigurdsson86%99%81％99％GregorySA,etal.AmJCardiol2006;98:877-884.SigurdssonG,etal.JAmCollCardiol2006;48:772-778.Male,75years,highrisksNon-MI,indicationforCABG1.8HeartFunctionEvaluations

ComparisonstudyamongDSCT,UCGandMRIDSCTMRICourtesyofSDImageInstitute,China1.9ExposionDoseManagementProspectiveECGTriggeringisavailableDoseisdecreased:13.5±4.1(1.2-28.1)mSvto4.0±1.5(1.2-7.5)mSvSUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesAorticDiseasesAorticDiseasesonMDCT2278patients(M/F=1740/538)49.5±12.3years24-houremergencyAverage13casesperdaybeforeandafteroperationTosubstituteofconventionalAngiographyMIP/CPRReconstructedImagesMale,42years.AbdominalAorticAneurysm.Beforeandafterintraluminalstentingisolation.Female,35years.Marfan’ssyndromeStanfordBaorticdisection.David＋aortareplacementSUBTITLESCoronaryArteryDiseaseAorticDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesCongenitalHeartDiseasesonMDCT774patients(M/F=425/349,14.8±18.3years3daysto79years;223pt.1yearSupplementaltoolforcardiacechoandcatheterizations.AdvantagesandIndicationsofCTforCHDPulmonary