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(Microsoft PowerPoint - 01-2\246\277\245\277\244\345 [\260\337

CARDIOVASCULAR IMAGING
江正文
•國泰醫院心臟內科部定教授
•亞洲醫用超音波學會聯盟會長
•亞洲太平洋心臟學會會長
•世界心臟聯盟理事
CARDIOVASCULAR IMAGING
(A) Chest X-ray
(B) Echocardiography (Echo)
(C) Thallium perfusion scan
(D) Computerized tomography (CT)
(E) Magnetic resonance imaging (MRI)
(F) Cardiac catheterization and angiography
(G) Others
CHEST X-RAY (I): NORMAL
• Cardiothoracic ratio ≦0.5
• Angle of carina < 75 °
• RA border < 3cm
CHEST X-RAY(II): CARDIOMEGALY
CHEST X-RAY (III): HEART FAILURE
CHEST X-RAY (IV)
Lung markings in heart failure
(A) Pulmonary venous congestion (pulmonary
capillary wedge pressure 10-12mmHg)
cephalization
(B) Interstitial edema (pcwp 12-18mmHg)
(1) Perivascular and perihilar hazziness
(2) Kerley B lines
(C) Alveolar edema (pcwp>18mmHg)
“bat wing” or “butterfly” appearance
CHEST X-RAY (V)
(A) Advantages
(1) Simple & cheap
(2) Including adjacent structures
(3) Portable
(B) Disadvantages
(1) Radiation
(2) Valves and septa can not be directly visualized
ECHOCARDIOGRAPHY (I)
BASIC PRINCIPLE OF ECHOCARDIOGRAPHY
D(cm) = V × T =1.54 ×106(cm/sec) × time (sec)
• B-mode
• 2-D
• M-mode
• 3-D
(a) Reconstruction from 2D
(b) Matrix transducer
ECHOCARDIOGRAPHY (II)
• Motion-mode echo (M-mode echo)
• Two-dimensional echo (2-D echo)
• Three-dimensional echo (3-D echo)
• Doppler echocardiography
(A) Pulsed-wave Doppler (P-W Doppler)
(B) Continuous-wave Doppler (C-W Doppler)
(C) Color flow mapping (color Doppler)
(D) Tissue Doppler
ECHOCARDIOGRAPHY (III): M-MODE ECHO
Nomal values
IVSt ≦12mm
• LVPWt ≦12mm
• LVEDd ≦52mm
• LADs ≦38mm
• AO ≦38
• LVEF ≧ 50%
•
ECHOCARDIOGRAPHY (VI): 2-D ECHO
ECHOCARDIOGRAPHY (V): 3-D ECHO
ECHOCARDIOGRAPHY (VI): P-W DOPPLER
E/A ≧1
(Normal)
E/A < 1
(Abnormal LV relaxation)
ECHOCARDIOGRAPHY (VII): C-W DOPPLER
PW
aliasing
CW
no aliasing
ECHOCARDIOGRAPHY (VIII): COLOR DOPPLER
ECHOCARDIOGRAPHY (IX)
ECHOCARDIOGRAPHY (X): TISSUE DOPPLER
E’/A’ < 1 (Abnormal LV relaxation)
ECHOCARDIOGRAPHY (XI)
•
Transthoracic echo (TTE)
Transesophageal echo (TEE)
• Intracardiac echo (ICE)
• Intravascular ultrasound (IVUS)
•
ECHOCARDIOGRAPHY (XII)
(A) Advantages
(1) No radiation
(2) Cardiac structures can be directly
visualized
(3) Blood flow information can be obtained
(4) portable
(B) Disadvantage
(1) Interference by bony or air-containing
structures
THALLIUM PERFUSION SCAN (I): NORMAL
THALLIUM PERFUSION SCAN (II): ISCHEMIA
THALLIUM PERFUSION SCAN (III): INFARCTION
THALLIUM PERFUSION SCAN
(A) Advantage
(1) More sensitive than treadmill ECG
(2) Localization is simple
(B) Disadvantages
(1) Radiation to the surrounding persons
(2) Time-consuming
MDCT
(A) Advantages
(1) Non-invasive
(2) 3D images simulating real heart
(3) Mimic coronary angio
(B) Disadvantages
(1) Large radiation dose
(2) Large amount of contrast
(3) Interference by calcification and stents
(4) Interference by tachycardia or arrhythmia
(5) Expensive, no reimbursement
CARDIAC MRI (II)
(A) Advantages
(1) No radiation
(2) Adjacent structures
(B) Disadvantages
(1) Interference by metal devices
(2) Interference by respiration
(3) Expensive, no reimbursement
CARDIAC CATHETERIZATION (I)
(1) Oxygen and pressure measurements
(2) Ventriculography
(3) Coronary angiography
CARDIAC CATHETERIZATION (II)
(A) Advantages
(1) Traditional gold standard
(2) Convenient for guiding interventions
(B) Disadvantages
(1) Risk
(2) Valves and septa can not be directly visualized
REFERENCE
(1) BRAUNWALD’S HEART DISEASE
by Zipes, Libby,Bonow, Braunwald. Elsevier
Saunders
(2) CLINICAL CARDIOVASCULAR IMAGING
A companion to Braunwald’s, Heart disease by St.
John Sutton. Rutherford. Elsevier Saunders