IVUS基础-阜外医院钱杰.ppt

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1、血管内超声基础和临床应用进展阜外医院钱杰IVUS培训IVUS培训血管内超声基础和进展一、血管内超声基础二、血管内超声和冠脉造影的关系三、主要适应症四、什么是VHIVUS培训RotatingElementDriveShaftMulti-elementArrayTheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkTherearetwotypesofimagingsystems:Mechanical(ro

2、tatingtransducer)andElectronicArrayIVUS培训HighfrequencysoundwavesechooffvesselwallsandaresentbacktosystemSystemelectronicsprocessthesignalTheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训ALA=AxialResolutionL=LateralReso

3、lutionTheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训LowdynamicrangeHighdynamicrangeTheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训Intimaldisease(plaque)isdenseandwillappear‘whi

4、te’Mediaismadeofhomogeneoussmoothmusclecellsanddoesnotreflectultrasound(appearsdark)Adventitiahas‘sheets’ofcollagenthatreflectalotofultrasound(appearswhite)TheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训TheCardiovasc

5、ularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训CalciumBrightechoes(brighterthantheadventitia)Obstructsthepenetrationofultrasound(acousticshadowing)onlytheleadingedgeisdetectedandthicknesscannotbedetermined.Resultsinreverberations

6、-theoscillationofultrasoundbetweentransducerandcalciumcausingrepeating‘arcs’IVUS培训80°SuperficialDeepDeepCalciumisquantifiedbymeasuringthe“arc”itencompassesCalciumisclassifiedbyitslocationwithintheplaqueSuperficialcalciumisclosertothelumenthantotheadventit

7、iaDeepcalciumisclosertotheadventitiathantothelumenTheCardiovascularResearchFoundationLenoxHillHeartandVascularInstituteofNewYorkIVUS培训FibroticPlaqueAsbrightorbrighterthantheadventitia(hyperechoic)MajorityofatheroscleroticlesionsarefibroticVerydense,fibr

8、ousplaquesmaycausesomuchacousticshadowingthattheycouldbemisclassifiedascalcifiedIVUS培训SoftPlaqueNotasbrightastheadventitia(hypoechoic)“Soft”referstothelowechogenicity,generallyduetohighlipidcontentinamostlycellularl