血管内超声基础知识.pptxVIP

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2008There are two types of imaging systems: Mechanical (rotating transducer) and Electronic ArrayRotating ElementDrive ShaftMulti-element Array南方会2008High frequency sound waves echo off vessel walls and are sent back to systemSystem electronics process the signal南方会2008Intimal 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)南方会2008南方会2008Bright 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’南方会2008Calcium80°DeepDeepSuperficialCalcium is quantified by measuring the “arc” it encompassesCalcium is classified by its location within the plaqueSuperficial calcium is closer to the lumen than to the adventitiaDeep calcium is closer to the adventitia than to the lumen南方会2008As bright or brighter than the adventitia (hyperechoic)Majority of atherosclerotic lesions are fibroticVery dense, fibrous plaques may cause so much acoustic shadowing that they could be misclassified as calcified南方会2008Fibrotic PlaqueSoft PlaqueNot 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 plaqueintramural hemorrhagethrombus南方会2008Vulnerable PlaqueLipid CoreFibrous Cap南方会2008Mixed Plaque南方会200804mm1南方会2008Example of ThrombusExternal elastic membrane (EEM) cross sectional area (CSA) = total arterial CSA = ‘media’ areatracing the boundary between the dark media and thebright adventitia (i.e., the apparent outer edge of the media stripe)Lumen CSAMax and min lumen diameter