血管内超声基础知识.pptVIP

血管内超声基础知识 阜外医院 钱杰 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 There are two types of imaging systems: Mechanical (rotating transducer) and Electronic Array Intimal disease (plaque) is dense and will appear ‘white’ Media is made of homogeneous smooth muscle cells and does not reflect ultrasound (appears dark) Adventitia has ‘sheets’ of collagen that reflect a lot of ultrasound (appears white) Calcium Bright echoes (brighter than the adventitia) Obstructs the penetration of ultrasound (acoustic shadowing) only the leading edge is detected and thickness cannot be determined. Results in reverberations - the oscillation of ultrasound between transducer and calcium causing repeating ‘arcs’ Calcium is quantified by measuring the “arc” it encompasses Calcium is classified by its location within the plaque Superficial calcium is closer to the lumen than to the adventitia Deep calcium is closer to the adventitia than to the lumen Fibrotic Plaque As bright or brighter than the adventitia (hyperechoic) Majority of atherosclerotic lesions are fibrotic Very dense, fibrous plaques may cause so much acoustic shadowing that they could be misclassified as calcified Soft Plaque Not as bright as the adventitia (hypoechoic) “Soft” refers to the low echogenicity, generally due to high lipid content in a mostly cellular lesion. Reduced echodensity may also be due to: necrotic zone within plaque intramural hemorrhage thrombus Vulnerable Plaque Mixed Plaque Example of Thrombus Basic Measurements (I) External elastic membrane (EEM) cross sectional area (CSA) = total arterial CSA = ‘media’ area tracing the boundary between the dark media and thebright adventitia (i.e., the apparent outer edge of the media stripe) Lumen CSA Max and min lumen diameters Stent CSA Max and min stent diameters Plaque+media (P+M) CSA = EEM - Lumen CSA in non-stented lesions = EEM - stent CSA in stented lesions Intimal hyperplasia CSA = Stent - Lumen CSA Basic Measurements (II) Eccentricity = maxim