CoronaryCTA:coronaryanatomy&terminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity冠脈CTA：冠脈解剖

JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment動脈的描述起點：起始點/valsalva竇行程分支名稱大小（口徑及分布）：小、中、大支配區域合適的圖像質量：總體，每條血管，每個層面NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LAD&LCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoff左冠狀動脈主干（LM)起點：左valsalva竇（左冠竇）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中間支10-15%關鍵問題：狹窄致局部供血不足冠狀動脈口疾病動脈瘤，（內膜）不規則剝離LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventricula

groovetowardapex2variationsinterminationBranches:Diagonals

septalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff左前降支（LAD）起點：95－99％起源于LM1-3%直接開口于左冠竇行程：心室前方經室間溝達心尖最后分為兩支分支：角支室間隔支關鍵問題：冠狀動脈近端或冠狀動脈口疾病心肌橋動脈瘤，（內膜）不規則剝離

NormalAnrtomy（LAD)LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)起點：96-98%起源于LM5-2%單獨開口LCX起源于右冠竇或RCA約0.4%行程：沿著左房室溝下降分支：鈍緣支左后外側支（營養后外側壁）左后降支(左側優勢）關鍵問題：左側優勢（15%-20%)NormalAnatomy(LCX)NormalAnatomy(LCX)Ramusintermedius（中間支）NormalRightcoronaryartery

(RCA)Origin:rightsinusofvalsalva(lowerthanLM)AnomalousformLSV=0.1%Course:downdistalrightAVgroove

towardcruxofheartBranchesRightposteriordescending(85%)AcutemarginalbranchesRightposteriorlateralCriticalissues:dominance(15-20%)右冠狀動脈(RCA)起點：左valsalva竇（右冠竇）0.1%起源于左心室行程：沿右房室溝下降至房室交點分支：后降支PDA（85%）銳緣支AM右室后側支PL

關鍵問題：右側優勢（85%）Normalanatomy(RCA)Normalanatomy(RCA)OtherbranchesSAnodalArtery-Approx60%RCA40%LCXAVNodalArtery-RCAConusArtery-RCA-Proximalmanywithseparateorigin-Maysupplycollateral其他分支竇房結動脈：約60%起源于RCA,40%LCX房室結動脈：RCA圓錐動脈：RCARightdominanceLeftdominanceLesiondescriptionLocation-Ostial(first2-3mm)-Proximal-Mid-DistalBifurcationLength(stenosis)-Discrete/focallesion(<10mm)-Long/diffuse(>20mm)Concentric/eccentricTortuosityThrombussoftplaqueca