冠脉CTA冠脉解剖

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment动脉的描述起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoff左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中间支10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventriculagroovetowardapex2variationsinterminationBranches:DiagonalsseptalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff左前降支（LAD）起点：95－99％起源于LM1-3%直接开口于左冠窦行程：心室前方经室间沟达心尖最后分为两支分支：角支室间隔支关键问题：冠状动脉近端或冠状动脉口疾病心肌桥动脉瘤，（内膜）不规则剥离NormalAnrtomy（LAD)LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房室沟下降分支：钝缘支左后外侧支（营养后外侧壁）左后降支(左侧优势）关键问题：左侧优势（15%-20%)NormalAnatomy(LCX)NormalAnatomy(LCX)Ramusintermedius（中间支）NormalRightcoronaryartery(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroovetowardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)右冠状动脉(RCA)起点：左valsalva窦（右冠窦）0.1%起源于左心室行程：沿右房室沟下降至房室交点分支：后降支PDA（85%）锐缘支AM右室后侧支PL关键问题：右侧优势（85%）Normalanatomy(RCA)Normalanatomy(RCA)OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral其他分支窦房结动脉：约60%起源于RCA,40%LCX房室结动脉：RCA圆锥动脉：RCARightdominanceLeftdominanceLesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(10mm)-Long/diffuse(20mm)Concentric/eccentricTortuosityThrombussoftplaquecalciumUlcerated/concentric病变的描述定位：开口，邻近，中间，末梢分叉长度（狭窄）：间断/局灶性病变（10MM)连续/弥漫（20MM)同心环/偏心的曲折的血栓软粥样斑块钙化溃疡DiffuseLADDiseaseFocalulceratedplaqueCoronaryanomaliesBenign(0.5-1%)(80%ofanomalies)SeparateLAD/LCXostiaLCXoriginfromRSAorRCALCXcoursesbehindaortaAnomalousoriginfromaortaHighanteriororiginofRCALMSmallfistula冠状动脉异常良性(0.5-1%)(80%of异常)LAD/LCX口LCX起源于RSAorRCALCX行程在主动脉后从主动脉异常起源RCA前高位起源小的瘘管CoronaryanomaliesPotentiallyserious(20%ofanomalies)OriginofCAoppositeaorticssinus(0.1-0.2%)AnomalousoriginformPA(0.01%)MultipleorLargecoronaryfistulaeSingleCoronaryartery潜在危险(20%of异常)起源与主动脉窦对面的室壁瘤(0.1-0.2%)异常起源于PA(0.01%)多发或大的冠状动脉瘘单一冠状动脉CoronaryanomaliesAbsentLeftMain(separateLAD/LCXorigins)