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1、Coronary CTA:coronary anatomy & terminology-A cardiologists perspectiveJuile Miller MDAssistant professor of Medicine Interventional CardiologyJohns Hopkins University冠脉冠脉CTA：冠脉解剖：冠脉解剖 JuileJuile Miller MD Miller MDAssistant professor of Medicine Interventional CardiologyAssistant professor of Medic
2、ine Interventional CardiologyJohns Hopkins UniversityJohns Hopkins University Artery Descriptionn nOrigin: Originating cusp / sinus of valsalvan nCoursen nBranch namen nSize (caliber and distribution):small medium largen nDominancen nAdequacy of image quality for interpretation overall， per vessel ，
3、per segment动脉的描述动脉的描述n n起点：起始点/valsalva窦n n行程n n分支名称n n大小（口径及分布）：小、中、大n n支配区域n n合适的图像质量：总体，每条血管，每个层面Normal Left Main (LM)n nOriginOrigin-left sinus -left sinus valsalvavalsalva-Absent in 1%-Absent in 1%Separate,adjacentSeparate,adjacent LAD LCXLAD LCX ostiaostia - 0.5 - 0.5%n nBranches: Branches: LA
4、D & LCXLAD & LCX =85 =85% LAD,LCX and LAD,LCX and RamusRamus 10-15% 10-15%n nCritical issues:Critical issues: stenosisstenosis due to risk region due to risk region Presence of Presence of ostialostial disease disease Other: aneurysms anomalous take Other: aneurysms anomalous take off off 左冠状动脉主干（左冠
5、状动脉主干（LM)n n起点： 左valsalva窦（左冠窦）1例外直接分出直接分出LAD LCXLAD LCX占占0.50.5n n分支：分出分支：分出LAD LCXLAD LCX占占58%58% LAD,LCX LAD,LCX 和和 中间支中间支 10-15%10-15%n n关键问题：关键问题：狭窄致局部供血不足狭窄致局部供血不足冠状动脉口疾病冠状动脉口疾病动脉瘤，（内膜）不规则剥离动脉瘤，（内膜）不规则剥离Left Anterior Descending(LAD)n nOrigin:Origin:-Form Left Main 95-99%-Form Left Main 95-99%-
6、1-3% separate -1-3% separate ostiumostium Left sinus Left sinusn nCourseCoursen nAnterior Anterior intraventriculaintraventricula n ngroove toward apexgroove toward apexn n2 variations in termination2 variations in terminationn nBranches:Branches:DiagonalsDiagonals septalseptal perforatorsperforator
7、sn nCritical issuesCritical issuesPresence of Presence of ostialostial/proximal disease/proximal diseaseMyocardial bridgesMyocardial bridgesOther:aneurysmsOther:aneurysms anomalous take anomalous take off off 左前降支（左前降支（LAD）n n起点：95959999起源于起源于LMLM 1-3% 1-3%直接开口于左冠窦直接开口于左冠窦n n行程：心室前方心室前方 经室间沟达心尖经室间沟达
8、心尖 最后分为两支最后分为两支n n分支：角支角支 室间隔支室间隔支n n关键问题：关键问题：冠状动脉近端或冠状冠状动脉近端或冠状 动脉口疾病动脉口疾病 心肌桥心肌桥 动脉瘤，（内膜）不规则动脉瘤，（内膜）不规则 剥离剥离 Normal Anrtomy（LAD)Left Circumflex (LCX) n nOrigin:Origin: Originating form LM in 96-98% Originating form LM in 96-98% 5-2% separate 5-2% separate ostiumostium LCX origin form right sinus
9、or RCA LCX origin form right sinus or RCA (0.4%)(0.4%)n nCourse:downCourse:down distal left AV groove distal left AV grooven nBranchesBranches obtuse marginal obtuse marginal branches branches Left posterior-lateral: define by acute Left posterior-lateral: define by acute marginmargin and supply PL
10、wall and supply PL wall Left posterior descending (if dominant) Left posterior descending (if dominant)n nCritical issues dominance (15-20%) dominance (15-20%)n n起点：96-98%96-98%起源于起源于LMLMn n5-2%5-2%单独开口单独开口n nLCXLCX起源于右冠窦或起源于右冠窦或RCARCA约约0.4%0.4%n n行程：沿着左房室沟下降行程：沿着左房室沟下降n n分支：钝缘支分支：钝缘支 左后外侧支（营养后外侧壁）左
11、后外侧支（营养后外侧壁）n n 左后降支左后降支 ( (左侧优势）左侧优势）n n关键问题：左侧优势（关键问题：左侧优势（15%-20%)15%-20%)Normal Anatomy (LCX)Normal Anatomy (LCX)Ramus intermedius （中间支）（中间支）Normal Right coronary artery(RCA) n nOrigin: Origin: right sinus of right sinus of valsalvavalsalva (lower than LM) (lower than LM)n nAnomalous form LSV =0
12、.1%Anomalous form LSV =0.1%n nCourse: Course: down distal right AV groovedown distal right AV groove toward crux of hearttoward crux of heartn nBranchesBranchesn nRight posterior descending (85%)Right posterior descending (85%)n nAcute marginal branchesAcute marginal branchesn nRight posterior later
13、alRight posterior lateraln nCritical issues: Critical issues: dominance (15-20%)dominance (15-20%)右冠状动脉右冠状动脉(RCA)n n起点：左左valsalvavalsalva窦（右冠窦）窦（右冠窦）n n0.1%0.1%起源于左心室起源于左心室n n行程：沿右房室沟下降至房室行程：沿右房室沟下降至房室交点交点n n分支：后降支分支：后降支 PDAPDA（85%85%）n n 锐缘支锐缘支 AMAMn n 右室后侧支右室后侧支 PLPL n n关键问题：右侧优势（关键问题：右侧优势（85%85%）
14、Normal anatomy(RCA)Normal anatomy(RCA)Other branchesn nSA nodal Artery-Approx 60%RCA 40%LCX-Approx 60%RCA 40%LCXn nAV Nodal Artery-RCAn nConus Artery-RCA-Proximal many with separate origin-Proximal many with separate origin-May supply collateral-May supply collateral其他分支其他分支n n窦房结动脉：约60%起源于RCA,40%LC
15、Xn n房室结动脉：RCAn n圆锥动脉：RCARight dominanceLeft dominanceLesion descriptionn nLocationLocation- -Ostial(firstOstial(first 2-3mm ) 2-3mm )-Proximal-Proximal-Mid-Mid-Distal-Distaln nBifurcationBifurcationn nLength (Length (stenosisstenosis) )-Discrete/focal lesion (10mm)-Discrete/focal lesion (20mm)-Long/
16、diffuse (20mm)n nConcentric/eccentricConcentric/eccentricn nTortuosityTortuosity n nThrombus soft plaque calciumThrombus soft plaque calciumn nUlcerated/concentricUlcerated/concentric病变的描述病变的描述n n定位：开口，邻近，中间，末梢n n分叉n n长度（狭窄）：间断/局灶性病变（20MM)n n同心环/偏心的n n曲折的n n血栓 软粥样斑块 钙化n n溃疡Diffuse LAD DiseaseFocal u
17、lcerated plaqueCoronary anomaliesn nBenign(0.5-1%) (80% of anomalies)n nSeparate LAD/LCX ostian nLCX origin from RSA or RCA LCX origin from RSA or RCA n nLCX courses behind aortaLCX courses behind aortan nAnomalous origin from aortaAnomalous origin from aortan nHigh anterior origin of RCAHigh anteri
18、or origin of RCAn nLMLMn nSmall fistulaSmall fistula冠状动脉异常冠状动脉异常n n良性(0.5-1%) (80% of 异常)n nLAD/LCX 口n nLCX 起源于 RSA or RCAn nLCX 行程在主动脉后n n从主动脉异常起源n n RCA前高位起源n n小的瘘管Coronary anomaliesn nPotentially serious(20% of anomalies)n nOrigin of CA opposite aortics sinus (0.1-0.2%)n nAnomalous origin form PA (0.01%)n nMultiple or Large coronary fistulae n nSingle Coronary arteryn n潜在危险(20% of 异常)n n起源与主动脉窦对面的室壁瘤(0.1-0.2%)n n异常起源于PA (0.01%)n n多发或大的冠状动脉瘘n n单一冠状动脉Coronary anomaliesAbsent Left Main(separate LAD/LCX origins)Anomalous RCAAnomalous LM from RSV
