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Diagnostic Radiology of Cardiovascular System Chen, Shaoqiong Acknowledgement : most of the slices are refer to the ppt provided by Dr. Biling Liang is gratefully acknowledged.
Diagnostic Radiology of Cardiovascular System /231 Imaging methods normal appearances abnormities diseases methods normal abnormities diseases
Cadiovascular Anatomy
heart
[object Object],[object Object]
多层螺旋心脏大血管 CTA  (三维重建图)
Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
X-ray---- PA view   ----high KV, 2M /231 X-ray methods normal abnormities diseases
X-ray---- Lat view /231 ,[object Object],X-ray methods normal abnormities diseases
Observing the chest plain film ,[object Object],[object Object],[object Object],methods normal abnormities diseases
Normal  appearance ,[object Object],[object Object],/231 ,[object Object],[object Object],[object Object],methods normal abnormities diseases
Normal  appearance  ----PA View ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 Upper 1/2 Lower 1/2 midline methods normal abnormities diseases 70 20
[object Object],[object Object],[object Object],[object Object]
PA view /231 Left atrium PV PA methods normal abnormities diseases
Normal  appearance  ----   Lat. view ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 The normal R. atrium is not border-forming in this projection methods normal abnormities diseases
Normal  appearance   ----   Lat. view /231 ,[object Object],[object Object],Retrosternal space the anterior heart border  touch  the1/3 of the distance between the diaphagm and the suprasternal notch  RV CT CT X-ray methods normal abnormities diseases
Normal  appearance ----   Lat. view /231 ,[object Object],Barium-filled esophagus methods normal abnormities diseases
Size of the heart and great vessels /231 ,[object Object],[object Object],[object Object],[object Object],methods normal abnormities diseases
Size of the heart and great vessels /231 a b C/T ratio = a+b / T =  ≤  0.5 T methods normal abnormities diseases
Influencing factor of    the normal heart shadow ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Influencing factor of    normal heart shadow --- body type ,[object Object],[object Object],[object Object],/231 classification :  horizontal heart  oblique heart   dropping heart C/T R  > 0.5  ≈0.5  < 0.5 included angle of cardiac longitudinal   < 45 0  ≈45 0  > 45 0 axis and horizontal Heart longest axis methods normal abnormities diseases
normal heart shadow /231 = 45 ° oblique heart horizontal heart dropping heart =  38° =  52° methods normal abnormities diseases
Influencing factor of    normal heart shadow  --  respiration ,[object Object],/231 methods normal abnormities diseases
Influencing factor of    normal heart shadow  --  position ,[object Object],/231 methods normal abnormities diseases
Basic X-ray features ,[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Basic X-ray features   ---  Heart dislocation ,[object Object],/231 methods normal abnormities diseases
Basic X-ray features   Heart dislocation /231 dextrocardia methods normal abnormities diseases
/231 mirror image dextrocardias Basic X-ray features   Heart dislocation methods normal abnormities diseases
Basic X-ray features ,[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 Basic X-ray features   Heart enlargement methods normal abnormities diseases
Left ventricular enlargement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Left ventricular enlargement /231 methods normal abnormities diseases
If we draw a tangent line from the apex of the left ventricle to the aortic knob  (red line)  and measure along a perpendicular to that tangent line  (yellow line) The distance between the tangent and the main pulmonary artery  (between two small green arrows)  falls in a range between 0 mm (touching the tangent line) to as much as 15 mm away from the tangent line
0 mm Main Pulmonary Artery Ao 15 mm Main Pulmonary Artery Ao LV LV Main pulmonary  artery ranges from  0 mm–15mm  from tangent line
Right ventricular enlargement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Right ventricular enlargement /231 methods normal abnormities diseases
Left atrium enlargement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Left atrium enlargement /231 methods normal abnormities diseases
Right atrium enlargement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Right atrium enlargement /231 methods normal abnormities diseases
General  cardiac enlargement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
general cardiac enlargement     -- Pericardial effusion  /231 methods normal abnormities diseases
the five important cardiac contours are:  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Basic X-ray features ,[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Five States of the Pulmonary Vasculature ,[object Object],[object Object],[object Object],[object Object],[object Object]
What We’re Going to Evaluate ,[object Object],[object Object],[object Object],[object Object]
Venous Hypertension  RDPA usually  > 17 mm   Upper lobe vessels equal to or larger than size of lower lobe vessels =  Cephalization
Rapid cutoff in size of peripheral vessels relative to size of central vessels Central vessels appear too large for size of peripheral vessels which come from them =  Pruning Pulmonary Arterial Hypertension   31
Increased Flow   RDPA usually  > 17 mm   All of blood vessels everywhere in lung are bigger than normal
Increased Flow   Normal
Increased Flow   Distribution of flow is maintained as in normal  Lower lobe vessels bigger than upper lobe Gradual tapering from central to peripheral
PAH   Increased Flow
Unrecognizable most of the time  Small hila Fewer than normal blood vessels Decreased Flow
Basic X-ray features ,[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Changes of aortal     shape and density ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Aorta distortion and elongation /231 methods normal abnormities diseases
Aorta calcification /231 methods normal abnormities diseases
Aorta calcification /231 methods normal abnormities diseases
Coronary artery calcification /231 methods normal abnormities diseases
Dissection of aorta ,[object Object],[object Object],[object Object],/231 Medical emergency ,[object Object],[object Object],[object Object],[object Object],methods normal abnormities diseases
Dissection of aorta ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Dissection of aorta ,[object Object],[object Object],[object Object],[object Object],[object Object],/231 methods normal abnormities diseases
Dissection of aorta Usually medically Hypertension Atherosclerosis Descending aorta only  Stanford Type B DeBakey Type III (most common)  Usually surgically* Cystic medial necrosis e.g.Marfan’s  Ehlers-Danlos Ascending aorta only  Stanford Type A (ascending aorta involved)  DeBakey Type II (least common)  Usually surgically* Hypertension Atherosclerosis Involves entire aorta  Stanford Type A (ascending aorta involved) DeBakey Type I   RX Common causes Portion of Aorta Involved Stanford Classification DeBakey Classification
Dissection of aorta True lumen methods normal abnormities diseases
Dissection of aorta True versus false channel methods normal abnormities diseases
Dissection of aorta methods normal abnormities diseases
Aneurysm ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal aortic aneurysm /231 perianeurysmal fibrosis (10%)  methods normal abnormities diseases
Aneurysm  /231 methods normal abnormities diseases
Abdominal aortic aneurysm /231 methods normal abnormities diseases
CTA /231 angiocardiography CT MRI echocardiography X-ray methods normal abnormities diseases
Aneurysm of aorta ( syphilitic  ) /231 methods normal abnormities diseases

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Diagnostic radiology of cardiovascular 2009

  • 1. Diagnostic Radiology of Cardiovascular System Chen, Shaoqiong Acknowledgement : most of the slices are refer to the ppt provided by Dr. Biling Liang is gratefully acknowledged.
  • 2. Diagnostic Radiology of Cardiovascular System /231 Imaging methods normal appearances abnormities diseases methods normal abnormities diseases
  • 5.
  • 6. 多层螺旋心脏大血管 CTA (三维重建图)
  • 7.
  • 8. X-ray---- PA view ----high KV, 2M /231 X-ray methods normal abnormities diseases
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14. PA view /231 Left atrium PV PA methods normal abnormities diseases
  • 15.
  • 16.
  • 17.
  • 18.
  • 19. Size of the heart and great vessels /231 a b C/T ratio = a+b / T = ≤ 0.5 T methods normal abnormities diseases
  • 20.
  • 21.
  • 22. normal heart shadow /231 = 45 ° oblique heart horizontal heart dropping heart = 38° = 52° methods normal abnormities diseases
  • 23.
  • 24.
  • 25.
  • 26.
  • 27. Basic X-ray features Heart dislocation /231 dextrocardia methods normal abnormities diseases
  • 28. /231 mirror image dextrocardias Basic X-ray features Heart dislocation methods normal abnormities diseases
  • 29.
  • 30.
  • 31.
  • 32. Left ventricular enlargement /231 methods normal abnormities diseases
  • 33. If we draw a tangent line from the apex of the left ventricle to the aortic knob (red line) and measure along a perpendicular to that tangent line (yellow line) The distance between the tangent and the main pulmonary artery (between two small green arrows) falls in a range between 0 mm (touching the tangent line) to as much as 15 mm away from the tangent line
  • 34. 0 mm Main Pulmonary Artery Ao 15 mm Main Pulmonary Artery Ao LV LV Main pulmonary artery ranges from 0 mm–15mm from tangent line
  • 35.
  • 36. Right ventricular enlargement /231 methods normal abnormities diseases
  • 37.
  • 38. Left atrium enlargement /231 methods normal abnormities diseases
  • 39.
  • 40. Right atrium enlargement /231 methods normal abnormities diseases
  • 41.
  • 42. general cardiac enlargement -- Pericardial effusion /231 methods normal abnormities diseases
  • 43.
  • 44.
  • 45.
  • 46.
  • 47. Venous Hypertension RDPA usually > 17 mm Upper lobe vessels equal to or larger than size of lower lobe vessels = Cephalization
  • 48. Rapid cutoff in size of peripheral vessels relative to size of central vessels Central vessels appear too large for size of peripheral vessels which come from them = Pruning Pulmonary Arterial Hypertension 31
  • 49. Increased Flow RDPA usually > 17 mm All of blood vessels everywhere in lung are bigger than normal
  • 50. Increased Flow Normal
  • 51. Increased Flow Distribution of flow is maintained as in normal Lower lobe vessels bigger than upper lobe Gradual tapering from central to peripheral
  • 52. PAH Increased Flow
  • 53. Unrecognizable most of the time Small hila Fewer than normal blood vessels Decreased Flow
  • 54.
  • 55.
  • 56. Aorta distortion and elongation /231 methods normal abnormities diseases
  • 57. Aorta calcification /231 methods normal abnormities diseases
  • 58. Aorta calcification /231 methods normal abnormities diseases
  • 59. Coronary artery calcification /231 methods normal abnormities diseases
  • 60.
  • 61.
  • 62.
  • 63. Dissection of aorta Usually medically Hypertension Atherosclerosis Descending aorta only  Stanford Type B DeBakey Type III (most common)  Usually surgically* Cystic medial necrosis e.g.Marfan’s Ehlers-Danlos Ascending aorta only  Stanford Type A (ascending aorta involved)  DeBakey Type II (least common)  Usually surgically* Hypertension Atherosclerosis Involves entire aorta  Stanford Type A (ascending aorta involved) DeBakey Type I   RX Common causes Portion of Aorta Involved Stanford Classification DeBakey Classification
  • 64. Dissection of aorta True lumen methods normal abnormities diseases
  • 65. Dissection of aorta True versus false channel methods normal abnormities diseases
  • 66. Dissection of aorta methods normal abnormities diseases
  • 67.
  • 68. Abdominal aortic aneurysm /231 perianeurysmal fibrosis (10%) methods normal abnormities diseases
  • 69. Aneurysm /231 methods normal abnormities diseases
  • 70. Abdominal aortic aneurysm /231 methods normal abnormities diseases
  • 71. CTA /231 angiocardiography CT MRI echocardiography X-ray methods normal abnormities diseases
  • 72. Aneurysm of aorta ( syphilitic ) /231 methods normal abnormities diseases