血管内超声基础知识

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1、血管内超声基础知识阜外医院钱杰南方会2008血管内超声基础知识一、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VH南方会2008RotatingElementDriveShaftMulti-elementArrayTherearetwotypesofimagingsystems:Mechanical(rotatingtransducer)andElectronicArray南方会2008HighfrequencysoundwavesechooffvesselwallsandaresentbacktosystemSysteme

2、lectronicsprocessthesignal南方会2008Intimaldisease(plaque)isdenseandwillappear‘white’Mediaismadeofhomogeneoussmoothmusclecellsanddoesnotreflectultrasound(appearsdark)Adventitiahas‘sheets’ofcollagenthatreflectalotofultrasound(appearswhite)南方会2008南方会2008CalciumBrightechoes(brighter

3、thantheadventitia)Obstructsthepenetrationofultrasound(acousticshadowing)onlytheleadingedgeisdetectedandthicknesscannotbedetermined.Resultsinreverberations-theoscillationofultrasoundbetweentransducerandcalciumcausingrepeating‘arcs’南方会200880°SuperficialDeepDeepCalciumisquantifie

4、dbymeasuringthe“arc”itencompassesCalciumisclassifiedbyitslocationwithintheplaqueSuperficialcalciumisclosertothelumenthantotheadventitiaDeepcalciumisclosertotheadventitiathantothelumen南方会2008FibroticPlaqueAsbrightorbrighterthantheadventitia(hyperechoic)Majorityofatherosclerotic

5、lesionsarefibroticVerydense,fibrousplaquesmaycausesomuchacousticshadowingthattheycouldbemisclassifiedascalcified南方会2008SoftPlaqueNotasbrightastheadventitia(hypoechoic)“Soft”referstothelowechogenicity,generallyduetohighlipidcontentinamostlycellularlesion.Reducedechodensitymayal

6、sobedueto:necroticzonewithinplaqueintramuralhemorrhagethrombus南方会2008VulnerablePlaqueFibrousCapLipidCore南方会2008MixedPlaque南方会2008014mmExampleofThrombus南方会2008BasicMeasurements(I)Externalelasticmembrane(EEM)crosssectionalarea(CSA)=totalarterialCSA=‘media’areatracingtheboundaryb

7、etweenthedarkmediaandthebrightadventitia(i.e.,theapparentouteredgeofthemediastripe)LumenCSAMaxandminlumendiametersStentCSAMaxandminstentdiametersPlaque+media(P+M)CSA=EEM-LumenCSAinnon-stentedlesions=EEM-stentCSAinstentedlesionsIntimalhyperplasiaCSA=Stent-LumenCSA南方会2008BasicM

8、easurements(II)Eccentricity=maximum/minimumP+MthicknessPlaque