OCT基础与临床分析.pptVIP

Images of Typical Fibrous Cap Erosion Fibrous cap erosion in corresponding images of optical coherence tomography (A), coronary angioscopy (B), and intravascular ultrasound (C). Erosion located on the surface of a plaque (arrows) with intraluminal thrombus (T). Rough surface erosion without disrupted fibrous cap protruding into lumen (arrows). No identification of fibrous cap erosion. Takashi Kubo, MD, Takashi Akasaka, MD, : J Am Coll Cardiol 2007;50:933–9) Macrophage / Foam Cells Initial Macrophage / Foam Cells Discrete foam cells Clustered foam cells Foam cell rich Fatty streaks (intimal xanthoma) Foam cells: Bright High attenuation Shadows beneath Embedded foam cells Macrophage / Foam Cells Surface macrophage inflammation Other Image Proteoglycan-rich growth Other Features Cholesterol crystals (Dr. U.Gerckens, Herzzenturm Siegburg, Germany) Small Side Branch False Lumen (Jie Qian, FuWai Hospital) Clear Tissue Characterization Not so Clear　：　need experiences to judge ?Normal vessel（3 layers） ?Fibrous plaque ?Lipid plaque ?Calcified plaque ?Stent strut ?Stent apposition ?Red White thrombus ?Dissection ?Macrophage ?Cholesterol crystal ?Necrotic core ?Mixed plaque ?Mixed thrombus OCT比较AMI,ACS和SAP患者的斑块特征 AMI ACS SAP P 富含脂质斑块(%) 90 75 59 0.09 平均最小纤维帽厚度(微米) 47.0 53.8 102.6 0.034 纤维帽厚度65微米的频率(%) 72 50 20 0.012 (Jang IK，et al.Circulation，2005，111：1551-1555） DES RS 2 Year Jie Qian, FuWai Hospital DES RS 7 Months Pei Zhang, FuWai Hospital BMS-VLST Yuejin Yang, Jie Qian, FuWai Hospital 影像学技术 IVUS Angioscopy OCT Thermography Spectroscopy Intravascular MRI 分辨率 100μm 不知 10μm 0.5mm 不适用 160μm 纤维帽 + + +++ － + + 脂核 ++ ++ +++ － ++ ++ 钙化 +++ － +++ － ++ ++ 血栓 + +++ ++ － － + +++=灵敏度90%; ++=灵敏度80~90%; +=灵敏度50~80%; －=灵敏度50% 各种影像学技术比较 OCT与IVUS的对比 OCT IVUS 成像原理 近红外光 声波 成像速度 快 慢 分辨率 10μm 100μm 成像轴直径 0.014 0.028 图像识别 较容易 较难 学习曲线 短 长 THANKS Rhombus This is an image of vulnerable plaque announced by Dr Velmani’s group. The thin fibrous cap is accompanied by a lipid pool and