血管内超声ilab-图像培训

1BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyIVUS图像培训2BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally公司简介•公司总部：美国马萨诸塞州波士顿地区的内提克市•全球共有约24,000名员工•业务遍及全球各个国家•作为全球医疗技术行业创新领导者，波士顿科学每年研发投入资金达8.86亿美金•在世界范围内拥有超过15,000项授权专利波士顿科学公司BostonScientific3BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally目录•IVUS的原理•IVUS的组成部分•IVUS图像的解读•IVUS在PCI术中使用过程4BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally目录•IVUS的原理•IVUS的组成部分•IVUS图像的解读5BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally血管内超声基本成像原理示意图6BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1st:AtlantisSRPro240MHz2nd:Opticross40MHz导管成像方式40MHz•机械式探头:探测晶体为单片,在驱动轴上旋转(波士顿公司)40MHz,单片晶体,实时成像7BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally目录•IVUS的原理•IVUS的组成部分•IVUS图像的解读8BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyiLabCartSystem8超声导管超声主机回撤装置：步进马达和一次性滑板9BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally目录•IVUS的原理•IVUS的组成部分•IVUS图像的解读•IVUS在PCI术中使用过程10BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally•基本斑块特性识别与读图步骤11BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally123超声下血管影像•1:Adventitiaiscomposedofcollagenthathighlyreflectedbyultrasound(appearswhite)•2:Mediaismadeofhomogeneoussmoothmusclecellsandisnotreflectedbyultrasound(appearsdark)•3:Intimaisdenseandwillappearasa“white”layerbetweenthemediaandthebloodspeckles.112BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally正常血管影像Normal13BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyDiseased病变血管影像14BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally同心偏心管壁侧均可见斑块附着管壁侧局部可见斑块附着同心病变/偏心病变15BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally软斑块•斑块位于管腔/内膜与外弹力膜（EEL）之间•声影亮度，比外膜暗•斑块不均一16BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally纤维化斑块（低脂质）•斑块位于管腔/内膜与外弹力膜（EEL）之间•声影亮度接近外膜17BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally钙化病变•高回声，呈现高亮影像（比外膜高亮）•阻挡超声波的辐射（回声声影缺失）•只能探测到钙化的浅层区域，无法辨明厚度。17钙化灶Behindcalcium:AcousticShadow18BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声影像识图1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜边5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支19BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜边5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-120BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜边5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-221BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜边5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-322BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-423BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-524BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-625BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally1.导管2.导丝伪影3.血池闪烁斑点(影像中比静止图片更明显)4.内膜5.官腔6.中膜边界/外弹性膜7.动脉粥样化8.外膜9.边支超声影像识图-726BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally•典型病变辨识27BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally钙化斑块致密回声斑块（”纤维”)低回声斑块（“软”）常见斑块性质与病理结果比较28BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally•不同钙化，超声下表现不同•不同钙化深度，治疗策略不同A.钙化(CalcifiedLesion)——浅层VS深层钙化29BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyB.夹层(Dissection)•内膜夹层（IntimalDissection）•中膜夹层（MedialDissection）•壁内血肿（IntramuralHematoma）•壁周损伤（PerivascularDamage）30BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally内膜夹层(Dissection)31BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally夹层(Dissection)内膜夹层中膜夹层32BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally血液在血管壁中层的聚集壁内血肿(Hematoma)33BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally血液在血管壁中层的聚集壁内血肿(Hematoma)34BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyPrePost-Stent壁内血肿(Hematoma)35BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExtern