心血管系统x线影像学.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Today a variety of simple and sophisticated imaging,procedures are available to provide detailed information,about the structure and function of the heart.,These include:,chest films,fluoroscopy,echocardiography,angiography,computed tomography,magnetic-resonance imaging,radioisotope examinations,cardiac enlargement,pulmonary vascular abnormalities,(cardiac calcifications),myocardial thickness and motion,precise chamber size,the presence of valvular disease coronary artery disease,pericardial disease,cardiac function,1.Reontgenologic Examination,Conventional,Fluoroscopy,Advantage:different projection view,pulsation,Shortage:temporary record,not clear,Teleradiography,target-film distance 2 meters,to avoid the distortion,taken at the end of inspiration,Method of examination and Normal x-ray anatomy,posterior-anterior projection,(P-A view,后前位),“Face to face”,Left lateral view，,左侧位,The left lateral view,Anterior,border,the ascending aorta,right ventricle,Posterior,border,left atrium,left ventricle,inferior vena cave,Aortic,window,the retrosternal precardiac space,right ventricle,（右室）,left atrium,left ventricle,（左房左室）,inferior vena cave,（下腔静脉）,ascending aorta,（升主动脉）,retrocardio-preesophageal space,Left anterior oblique view,(LAO),The left anterior oblique view,Anterior border,ascending aorta,right ventricle,appendage of RA,Posterior border,left atrium,left ventricle,left bronchus,esophagus filled with barium,“a drop of water”,Right anterior oblique view,(RAO),The right anterior oblique view,Anterior border,3 arcs,the ascending aorta,infundibulum,pulmonary artery,Posterior border,left atrium,esophagus filled with barium,the retrosternal precardiac space,right ventricle,left ventricle,Angiocardiography,Right sided angiocardiography,superior vena cave,pulmonary artery,right atrium,right ventricle,right ventricle,pulmonary artery,Left ventriculography Aortography,descending aorta,ascending aorta,left atrium,left ventricle,A-P projection,Left lateral view,The heart size and shape,（心脏大小和形状）,The physical factors influencing the contour of the heart,（影响心脏轮廓的因素）,1).The body built,（体型）,transverse heart oblique heart vertical heart,the cardiac thoracic ratio,（心胸比例）,CTR=0.5,横位心 斜位心 垂直心,2).Respiration,（呼吸）,on expiration on inspiration,呼气 吸气,3).Posture,（体位）,4).Other facters,on erect position,立位,on recumbent position,（卧位）,The section of the arch o and above it,（主动脉弓层面和弓上层面）,The normal manifestation,The section of the trachea bifurcation,and,right main bronchi,（T,4,level）,(,气管分叉水平,、右主支气管水平,）,AAo,DAo,LPA,SVC,AAo,DAo,SVC,奇静脉（azygous v.),Es.,The section of the branching right(,右中间支气管,),and left upper bronchi,(左上叶支气管),AAo,DAo,RPA,SVC,LPA,The sections of the atria,（,心房层面,）,LA,RA,RVOT,Ao,Ao,The sections of the ventricular（心室层面）,pericardium,（心包),IVC,Ao,LV,RV,RA,es,es,Normal:seen near the base of the heart,(outside),lung,pleural,the pad of fat,pericardium,(parietal,visceral membrane),the subepicardial fat tissue,myocardium,(inside),subepicardial fatty,Normal pericardium,the pad of fat,Pericardium,Ao,IVC,fat,Vertebral,body,Magnetic,resonance,imaging,（MRI）,Basic X-ray features in diseases of the heart and great vessels,Enlargement of the heart,Change in the pulmonary circulation,Enlargement of the heart(,position,contour,),Left ventricular enlargement,to the left and posterior inferiorly,1.P-A view:Elongation of the left lower border,(Apex extends to the left and downward,The point of opposite pulsation shifts upward),The shape of the heart is like that of a sabot-,aortic configuration,2.LAO view:the posterior and inferior border extends to the left and backward,overlapping the spine,Left lateral view:backward and inferiorly,The,retrocardiac,space in front of the esophagus is obliterated.,P-A LAO L-L,normal,Left ventricular enlargement,IVC,Right ventricular enlargement-,upward,both sides,anteriorly,1.P-A view:,Prominent,infundibulum,and the main pulmonary segment,The point of opposite pulsation pushed,dawnward,Apex of the heart blunt and,elerated,well above the diaphragm,due to rotation of the heart to the left,apex formed by the RV,The shape of the heart is like a pear-,mitral,configuration,2.RAO view:The right ventricle and,infundibulum,bulging out,the,retrosternal,precardiac,space narrowed.,3.LAO view and,L-L view,Encroachment of the,retrosternal,space,Backward and upward displacement of the,interventricular,groove(LAO),P-A RAO LAO L-L,right ventricular enlargement,IVC,normal,Left,atrial,enlargement-,posteriorly,1.P-A view:,Double,atrial,contour on right border of the heart,Double density at the base in a penetrated film,4 arcs on the left border du to the bulging of the LA as the 3,rd,arc,2.RAO view and L-L view:,Mild degree-pressure sign on the anterior wall of the esophagus,Moderate degree-impression and displacement of the esophagus,Severe degree-marked displacement and pressure on the esophagus,3.LAO view:Left main bronchus elevated,P-A RAO LAO L-L,normal,LA and RV enlargement,Right,atrial,enlargement-right and,anteriorly,1.P-A view:Extension to the right side and the lower arc elongated,longer than the upper arc,2.LAO view:Bulging of the upper segment of the anterior border,and elongation of the arc,The angle with the aorta is getting smaller,even as a right angle.,P-A RAO LAO,normal,RA enlargement,General enlargement of the heart,the enlargement of one or more chambers may be more significant,1.P-A view-enlargement to both sides,2.RAO and L-L view,Retrosternal,(,precardiac,)space narrowed,Posterior compression and displacement of the esophagus generally,Preesophageal,or,retrocardiac,space obliterated in lateral view,3.LAO view Trachea bifurcation splayed,Trachea displaced in children,Change of pulsation of the heart and aorta,1.In aortic valve,insuffiency,-pulsation of the left ventricle and,the aorta increased markedly,2.In,pericarditis,-pulsation may disappear completely,3.Other situation,General enlargement of the heart,心肌病,Pulmonary hila 肺门-,projection of the root of lung,Lung markings,（肺纹理）,自肺门肺野呈放射状分布的树枝状影（A、V等）,Lung markings,Normal Pulmonary Vasculature,Increased Pulmonary Vasculature,Normal Pulmonary Vasculature,Pulmonary Arterial Hypertension,Normal Pulmonary Vasculature,decreased Pulmonary Vasculature,Normal Pulmonary Vasculature,Pulmonary Venous Hypertension,(redistribution),A,B,A:the patient had lymphatic spread of carcinoma,B:the patient with mitral valvular disease and a history of repeated episodes of congestive failure,Kerley,s B-lines represent thickened interlobular septa seen close to the chest wall,Normal Pulmonary Vasculature,Increased Pulmonary Vasculature,Pulmonary Venous Hypertension,(redistribution),Pulmonary Arterial Hypertension,肺水肿,Principles in radiological diagnoses of heart disease:,1)changes in the pulmonary vasculature,2)size and contour of the heart,size of different chambers,3)changes of the aorta,4)pulsations of the heart and great vessels,5)correlation with clinical information(,murmu,),What is the most difficult for,radiologic,diagnosis,in the heart disease?,Diagnosis of the common diseases of cardiovascular system,Mitral,stenosis(MS,),Rheumatic lesion involve the,mitral,valve mostly.Simple,stenosis,is about 50%of,all cases of rheumatic disease.,x-ray signs:,a.Pulmonary Venous Hypertension,-,enlarged blurred,hilar,shadows,redistribution of pulmonary blood flow,septal,lines can be seen.,b.LA and RV enlarged.LV and aorta small.,Enlargement and,mitral,configuration of the heart,with prominent waist,c.As pulmonary venous,hypertention,progresses,all signs of pulmonary arterial,hypertention,may appear.,d.,Hemosiderosis,appear in long standing case as,miliary,shadows of 1-2mm,in size.,normal,MS:,Pulmonary Venous Hypertension,LA and RV enlargement,normal,MS:,Pulmonary Venous Hypertension,LA and RV enlargement,MS+MI(41.7%):MS+LV enlargement,Aortic Insufficiency(AI),a.LV enlarged.,b.Ascending aorta dilated.Heart enlarged as boot shape.,c.Forcible pulsation of LV and aorta(Fallen pulse).,MD+AI,MD+,bootshaped,heart,LV more large,Ascending aorta dilated,Fallen pulse,Hypertensive heart disease,definition,a.Heart enlarged with aortic configuration.,b.LV enlarged with bulged border,rounding and elongation,of the ventricle at first,then extending to the left and downward.,Point of opposite pulsation moves upward.,c.Generalized widening of the aorta with increased pulsation of the LV and AO,e.In LAO the LV extends,posterioly,and aortic window widened.,Coronary heart disease,Plain film:,Normal;,Enlargement of the heart with,pulmonary venous hypertension;,Ventricular aneurysm;,Coronary artery anatomy,Anteror decending branch,Coronary arteriography,carried out commonly in patients with,symptoms of ischemic heart disease,RAO,LAO,A-P projection,Coronary artery anatomy,Left coronary arteriogram(RAO),Diffusely atherosclerotic left coronary artery:,the luminal narrowing of the entire arterialtree,multiple sites of stenosis,the formation of collateral branches,Normal,Left coronary arteriogram(LAO),Right coronary arteriogram(LAO),Atherosclerotic right coronary artery,in a patient with an acute myocardial,infarction,catheter tip,Intraluminal thrombus,stenosis,catheter tip,Normal,Intraluminal,thrombus,stenosis,Angiography of the coronary artery,MRI and CT,CPR(curve planar reconstruction),MIP(maximum intensity projection),VR(volum Recon.),MIP,Paricarditis,A.Pericardiac effusion,No change if the fluid is below 300ml in amount,1)Enlarged in the shape of a flask or of globular shape,with loss of the arcs of the heart,shortness of the aortic pedicle shadow,2)Widening of superior vena cava,and pulmonary markings decreased,3)Pulsation of the heart diminished or disappeared except that of the aorta,The fluid around the contours of the heart,as a circular zone which is,hypodense(,),in comparison to the,myocardium,(),separeted from the subepicardial,fatty tissue,which is present in varying amounts,心包积液与 扩张型心肌病,B.Constrictive pericarditis,Adhesions and fibrosis between the two layers,limitation of the contraction and diastole,1)The arcs of the heart disappeared and,the border become straight.,The heart tends to be of triangle or polygonal,2)Size of heart normal or slightly enlarged.,3)Dilatation of superior vena cava,4)the pulmonary vasculature,5)Calcification of the pericardium is a characteristic sign,occur in about 12-15%of the cases(X-ray film).,6)Pulsation may be redused or absent,generally or locally.,Chronic constrictive pericarditis,CT:thickening and calcifications of the pericardium,with small amounts of fluid,Pericardial,thickening,Pericardial,calcifications,small amounts of fluid,Aortic aneurysm:,true:aortic lumen 4cm,5cm,dissecting,aneurysm,pseudo-aneurysm,Aortic aneurysm,Marfan,Syndrome,pseudo-aneurysm,DeBakey DeBakey DeBakey,Aortic dissection,Type A,Type B,intimal flap,between,the false lumen,and,the true aortic lumen,aortic dissection DeBakey,The dissection begins at the left subclavian artery origin.A radiolucent intimal flap can be seen separating the true lumen from the false lumen.A white contrast injection catheter can be seen within the true lumen.Thoracic aortogram,The injection catheter can be seen within,the somewhat compressed true lumen of,the ascending aorta,which is supplying both coronary arteries.,A cloud of contrast material is seen,flowing into the dilated false lumen,Early-phase digital subtraction aortogram(DSA),aortic dissection DeBakey,Aortic dissection,the true aortic lumen,intimal flap,the false lumen,plain scan,contrast enhancement,DSA,