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1、Cardiac Radiology,北京协和医院学习,北京协和医院,北京协和医院,Heart of radiology,overview,Background Technique Application Future,Application,Conventional X-ray Electric Beam CT MRI MRA Angiography,Normal Imaging of Heart,Different position Normal Heart imaging,Normal Heart,正常胸片，F，46Y,Positions,PA(posteroanterior) LAO(l
2、eft anterior oblique) RAO(right anterior oblique) LAT(lateral),FOUR POSITIONS,PA,RAO,LAO,LAT,Abnormal,Enlargment Shape Lung circulation change,心胸比,法鲁氏四联症,动脉导管未闭,法鲁氏四联症,二尖瓣狭窄,二尖瓣狭窄,Angiography,Seldingers technique Loop technique PTCA,Heart vascular anatomy,RAO,LAO,Seldingers technique,Loop Technique,
3、M，66 PTCA,A,B,Case 1,M，66 PTCA,C,D,Case 1,M，66 PTCA,Case 1,E,F,G,16-slice CT benefit Jin Zhengyu M.D. PUMCH,Multi- channel CTbenefits,benefit of greater speed 4 -20 x faster than current 1- 4 channel systems superior image quality routine use of ultra-thin, microvoxel acquisitions,Multi- channel CTa
4、cquisition speed,scan time dramatically reduced scans in seconds, exams in minutes scan range throughput reduced need for sedation pediatric 3D head study in under 3 seconds contrast saving cardiac application broaden related application PE, vein-angiography for lower extremities,心脏成像,血管成像,灌注成像,全脊柱成
5、像,早期肺癌普查,消化道检查,其他（胰腺等）,Headline,主动脉夹层，多平面重建显示,RAO 30,RAO 60,67y male smoker; asymptomatic,右冠软斑块,CTA显示LAD闭塞,DSA显示LAD闭塞,PTCA术后再通,120Kv, 133effmA 16x0.75 mm 容积漫游重建,冠脉搭桥,MIP图像标准位置,左转反蜘蛛位,左转心前壁位,反蜘蛛位,右转反蜘蛛位,左后斜位,心前壁位,右前斜加头位,前后位,足位,室缺伴大动脉转位,冠状动脉内窺镜,SOMATOM Sensation,评价显示冠脉轻松便捷,评价心功能CT 4D,syngo SOMATOM Sen
6、sation 16,125msec,63msec,Different detail and IQ,大血管成像：主动脉疾患、中动脉疾患 四肢疾病（血管相关性）：四肢血管动静脉疾患,大血管病变,腹主动脉瘤,大血管病变,中动脉疾患,大动脉炎,下肢动静脉,中度狭窄,闭塞,下肢动脉成像,下肢动脉成像,胸部血管成像肺动脉栓塞、血管炎 腹部血管成像 实质性脏器如肝脏、胰腺、肾脏成像 胰胆管成像 空腔脏器如结肠、胃成像 脏器功能性成像,胸部及腹部应用,肺动脉,胸部应用,胸部应用,肺动脉疾病肺栓塞,肺动脉其他疾病,巨细胞动脉炎,胸部应用,肝静脉,腹部血管,门脉,动脉,腹部应用,腹部应用,实质性脏器病变,实质性脏
7、器病变,胰腺癌,腹部应用,将来的螺旋CT,扫描覆盖范围? 空间分辨率? 旋转速度？ 辐射剂量？ 与其他设备的融合？,Black Blood,Tagging,FastCine,Perfusion,Viability,Coronary Imaging,Real-Time Interactive Imaging,30 min Comprehensive Cardiac Exam,Cardiac Applications In MRI,Cardiac Function,心脏运动及形态功能评价,FIESTA 快速电影,2DFIESTA- 优异的血池心肌描绘,FIESTA (SSFP) 采集 20 相位
8、12 秒憋气成像,Fast Imaging Employing STeady State Acquisition,卓越的对比度,FIESTA,2D FIESTA,FIESTA (SSFP) 采集 20 个相位 16 秒憋气完成,高级心血管分析软件,高级心肌 血池描绘 自动探测血池轮廓 快速心脏功能分析,左室轮廓自动检测,心室功能/ 室壁运动,MASS Analysis Package,快速精确的分析,多种报告生成格式,心脏质量 射血分数 每搏输出量 室壁厚度 室壁增厚度 还有更多 . . .,高级心血管分析软件,评价心肌缺血和存活情况,冠心病的磁共振无创检查： 心脏灌注成像,Images fr
9、om Steve Wolff MD PhD, New York,一个R-R间期扫描 8 10 层， 覆盖全心脏范围 一次注射造影剂约20毫升,首次通过法心肌灌注,右侧冠状动脉狭窄导致的缺血区,利用FastCard-ET采集序列进行 血管负荷和休息状态下的心肌 灌注成像 室间隔下部可见缺血区 与ECT及导管介入的结果相符合,Stress,Rest,首次通过法心肌灌注,首次通过法心肌灌注,判断缺血心肌的存活情况,延迟法心肌灌注,梗塞的组织即指细胞已破坏（坏死）,延迟法心肌灌注原理,尽管缺乏造影剂的灌注，坏死细胞外的造影剂 可扩散进入细胞内外间隙,造影剂的聚集使T1弛豫时间降低,在延迟造影剂灌注时不
10、可逆 的梗塞区表现为高信号,Stent intervention Lateral hypokinesia in the CINE images Detection of subendocardial lateral necrosis in the area of hypokinesia,STIR-FSE Pre-Contrast 20 min post contrast,延迟法心肌灌注,5 days after acute posterior myocardial infarction,左前降枝的病变,手术吗 ?,磁共振显示病变部位的心肌已经完全死亡,不要手术！,又一例类似的病人,手术吗 ?,
11、磁共振显示出仅有内膜下的心梗,马上手术！,急诊手术,3天后的恢复情况,MRI,MR Angiography - Elliptical Centric View Ordering,Tracker placed in the R. Ventricle 1 breath hold, 20cc gd, 2 (13 sec) phases,EXIT,HOME,NEXT,PREVIOUS,MRA,aortic valve closed aortic valve open,Cardiac Function,Medis Analysis Package,Cardiac Function - Analysis,
12、Diastole,Systole,Breath-held (18 sec) 2D slice (5mm) Non-contrast enhanced 20 X 4096 matrix 0.52 mm/pixel resolution,High Resolution Spiral MRA,Coronary MRA - High Resolution Spiral Imaging,EXIT,HOME,NEXT,PREVIOUS,Images courtesy of Stanford University.,Stanford, CA,Coronary MRA - High Resolution 3D Spiral Imaging,2D Breath-held spiral 2D Non-breath-held spiral with NAV correction 2D Vessel-Tracked Fastcard & Spiral 3D Non-breath-held with NAV correction,Coronary MRA - Breath-held Spiral Technique,3-D Reconstruction,THANK YOU,
