A☀️姚遥😷

Coronary Arteries

三峡医学影像:

冠状动脉 Coronary Arteries


 

冠状动脉解剖

冠状动脉 Coronary Arteries: Branches

Some of the arteries that extend from the main coronary arteries include:

  • 右冠状动脉 Right Coronary Artery - Supplies oxygenated blood to the walls of the ventricles and the right atrium.

  • 后室间支,亦称后降支 Posterior Descending Artery - Supplies oxygenated blood to the inferior wall of the left ventricle and the inferior portion of the septum.

  • 左冠状动脉 Left Main Coronary Artery - Directs oxygenated blood to the left anterior descending artery and the left circumflex. 

  • 左前降支 也称前室间支 Left Anterior Descending Artery - Supplies oxygenated blood to the anterior portion of the septum as well as to the walls of the ventricles and the left atrium (front region of the heart). 

  • 旋支 Left Circumflex Artery - Supplies oxygenated blood to the walls of the ventricles and the left atrium (back region of the heart).

冠状动脉 分段

CT images of normal heart in 53-year-old man.主动脉根部 Ao = aortic root,冠状窦 CS = coronary sinus, 左心房 LA = left atrium,左前降支 LAD = left anterior descending artery, 左旋支 LCx = left circumflex artery,左冠状动脉主干 LM = left main coronary artery,左心室 LV = left ventricle,后降支 PDA = posterior descending artery,右心房 RA = right atrium,右冠状动脉 RCA = right coronary artery,右心室 RV = right ventricle,右室流出道 RVOT = right ventricular outflow tract. Axial 5-mm maximum-intensity-projection (MIP) image shows left main coronary artery as it arises from left coronary cusp.

左冠状动脉LCA(黑箭),左前降支LAD(白箭头),

左旋支LCx(黑箭头),右冠状动脉RCA(白箭) 

左冠状动脉LCA (黑箭),左旋支LCx(箭头),左前降支LAD(白箭)

左前降支 LAD(箭头)

左前降支 LAD(箭头)

室间隔支(黑色箭头),对角支(白色箭头)

左前降支(黑箭头),回旋支(白箭头)中间支(对角支)(箭)

右冠状动脉(黑箭),动脉圆锥支 (箭头)来自主动脉,锐缘支(白箭)

锐缘支(白箭)

窦房结支(箭头)

圆锥支的解剖变异

AO =主动脉根部,LA =左心房,LAD =左前降支,LM =左冠状动脉主干,LV =左心室,RA =右心房,RCA =右冠状动脉,RVOT=右室流出道,SAN =窦房结支。

Ao = aortic root, LA = left atrium, LAD = left anterior descending artery, LM = left main coronary artery, LV = left ventricle, RA = right atrium, RCA = right coronary artery, RVOT = right ventricular outflow tract, SAN = sinoatrial node branch.

窦房结支的变异:

窦房结支(箭头),来自右冠状动脉近端

窦房结支(箭头 ),来自左回旋支

AO =主动脉根部,D1 =第一对角支,GCV =心大静脉,LA =左心房,LAD =左前降支,LCx =左回旋支,LM =左冠状动脉主干,OM1 =第一钝缘支,RCA =右冠状动脉,RVOT=右室流出道,SVC =上腔静脉。

 

LAD =左前降支,LV =左心室,RCA =右冠状动脉,RV =右心室。右缘支(箭)

Ao=主动脉根部,AVN=房室结支,IMB=下缘支,LCx=左回旋支,LV=左心室,PDA=后降支,PLB=后外侧支,RCA=右冠状动脉,RVOT=右室流出道

CS =冠状窦,LV =左心室,MCV =心中静脉,PDA =后降支,PLB=后外侧支,PLV=后外侧静脉,RA =右心房,RCA =右冠状动脉,RV =右心室

Ao=主动脉根部,AVGA =房室沟动脉,CS =冠状窦,LA =左心房,OM =钝缘支,PDA =后降支,PLB=后外侧支,RA=右心房,RCA =右冠状动脉

LV =左心室,PDA =后降支,PLB=后外侧支,RCA =右冠状动脉,RV =右心室

左冠状动脉解剖 AVGA=房室沟动脉,PDA=后降支

左冠状动脉主干分叉  AVGA =房室沟动脉,D1 =第一对角支,LAD =左前降支,LCx=左回旋支,LM =左冠状动脉主干,OM1 =第一钝缘支,SAN =窦房结支

中间支解剖

LAD =左前降支left anterior descending artery,LCx=左回旋支left circumflex artery,LM =左冠状动脉主干left main coronary artery,RI=中间支动脉ramus intermedius artery

前降支

LA =左心房 left atrium, LV =左心室 left ventricle

Myocardial bridge and septal perforator branch 心肌桥和室间隔穿支

LA =左心房 left atrium, LAA =左心耳 left atrial appendage, LV =左心室 left ventricle, S1, S2, S3 = first, second, and third septal perforators第一、二、三室间隔穿支,心肌桥覆盖第二室间隔穿支以远左前降支(箭)

心肌桥 左前降支(箭)

对角支

D1 =第一对角支 first diagonal, D2 =第二对角支 second diagonal, LAD =左前降支 left anterior descending artery, LCx =左回旋支 left circumflex artery, LM =左冠状动脉主干 left main coronary artery, LV =左心室 left ventricle, RI =中间支 ramus intermedius artery, SP =室间隔穿支 septal perforator branches

Nondominant left circumflex artery anatomy

AVGA =房室沟动脉atrioventricular groove artery,CS =冠状窦coronary sinus,D1 =第一对角支first diagonal,GCV =心大静脉great cardiac vein,LAD =左前降支left anterior descending artery,LCx=左回旋支left circumflex artery,OM1 =第一钝缘支first obtuse marginal

Dominant left circumflex artery anatomy

AVGA =房室沟动脉atrioventricular groove artery,LCx=左回旋支left circumflex artery,LM =左冠状动脉主干left main coronary artery,OM1 =第一钝缘支first obtuse marginal,OM2 =第二钝缘支second obtuse marginal,PDA =后降支posterior descending artery,PLB=后外侧支posterior lateral branch,RI =中间支动脉ramus intermedius artery

右冠状动脉和左主冠状动脉异常起源 Anomalous origin of right coronary artery and left main coronary artery

Ao =主动脉根部 aortic root, LAD =左前降支 left anterior descending artery, LM =左冠状动脉主干 left main coronary artery, RCA =右冠状动脉 right coronary artery, RVOT =右室流出道 right ventricular outflow tract

左心室(黑*),左心房(白*),左心耳(白箭),二尖瓣(MV)(黑箭),冠状窦CS(箭头)

左心室(大黑*),左心房(小黑*),右心房(RA)(小白*),二尖瓣MV(黑箭),三尖瓣(白箭)和心包(箭头)


重庆三峡中心医院放射科

重庆市万州区新城路165号

新浪微博 http://weibo.com/ctmri

腾讯微博 http://t.qq.com/ctmri999

微信公众帐号 xctmri999

Email:ctmri@qq.com

肝的分叶、分段

三峡医学影像:

2014-08-21医学影像

单纯根据肝外形的沟裂,将肝分为左叶、右叶、尾状叶、方叶,此与肝内管道的分布并不完全符合。而根据腐蚀标本,依据肝内管道系统的分布并结合肝的外形可以看到叶与叶之间或段与段之间存在明显的裂隙。据此肝有三个叶间裂,三个段间裂。叶间裂包括肝中裂、左叶间裂、右叶间裂。段间裂有左外叶段间裂、右后叶段间裂和尾状叶段间裂。由这些裂将肝分为右半肝、左半肝,五个叶(右前叶、右后叶、左内叶、左外叶与尾状叶)、六个段(左外叶上、下段,右后叶上、下段,尾状叶左、右段)。现代肝脏外科即依据这些分叶及分段方式,施行半肝、肝叶或肝段切除术。

Couinaud根据肝内门静脉干和肝静脉的分布范围,将肝脏分为八段,门静脉分支分布于肝段内,而肝静脉位于肝段间。具体如下:以肝中静脉所在纵行平面将肝脏分为左右半肝,以肝左静脉为界将左半肝纵行分为左内与左外叶,而左外叶以门静脉左支为界水平分为上下两段,以肝右静脉纵向、门静脉右支横向将肝右叶分为上下前后四段,而肝尾叶为单独的一段,即S1为尾状叶,S2为左外叶上段,S3为左外叶下段,S4为左内叶,S5为右前叶下段,S6为右后叶下段,S7为右后叶上段,S8为右前叶上段 

五叶八段是根据门静脉和肝静脉在肝内的行程划分

Segmental anatomy

Segmental anatomy according to Couinaud.

Couinaud classification

The Couinaud classification of liver anatomy divides the liver into eight functionally indepedent segments. 
Each segment has its own vascular inflow, outflow and biliary drainage.
In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct.
In the periphery of each segment there is vascular outflow through the hepatic veins.

Right hepatic vein divides the right lobe into anterior and posterior segments.
Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.
Left hepatic vein divides the left lobe into a medial and lateral part.

Portal vein divides the liver into upper and lower segments.
The left and right portal veins branch superiorly and inferiorly to project into the center of each segment.

Because of this division into self-contained units, each segment can be resected without damaging those remaining. For the liver to remain viable, resections must proceed along the vessels that define the peripheries of these segments. This means, that resection-lines parallel the hepatic veins,
The centrally located portal veins, bile ducts, and hepatic arteries are preserved.

 

Clockwise numbering of the segments

Segments numbering

There are eight liver segments.
Segment 4 is sometimes divided into segment 4a and 4b according to Bismuth.
The numbering of the segments is in a clockwise manner (figure).
Segment 1 (caudate lobe) is located posteriorly. It is not visible on a frontal view.

 

On a frontal view of the liver the posteriorly located segments 6 and 7 are not visible.

 

The illustrations above are schematic presentations of the liversegments. 
In reality however the proportions are different.
On a normal frontal view the segments 6 and 7 are not visible because they are located more posteriorly. 
The right border of the liver is formed by segment 5 and 8.
Although segment 4 is part of the left hemiliver, it is situated more to the right.

Couinaud divided the liver into a functional left and right liver (in French 'gauche et droite foie') by a main portal scissurae containing the middle hepatic vein. This is known as Cantlie's line. 
Cantlie's line runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly.

On this illustration it looks as if the medial part of the left lobe is separated from the lateral part by the falciform ligament. However it actually is the left hepatic vein, that separates the medial part (segment 4) from the lateral part (segments 2 and 3).
The left hepatic vein is located slightly to the left of the falciform ligament.

 

Transverse anatomy

The far left figure is a transverse image through the superior liver segments, that are divided by the hepatic veins.

The right figure shows a transverse image at the level of the left portal vein.
At this level the left portal vein divides the left lobe of the liver into the superior segments (2 and 4A) and the inferior segments (3 and 4B).
The left portal vein is at a higher level than the right portal vein.

LEFT: above the level of the left portal vein.RIGHT: at the level of the left portal vein.

LEFT: at the level of the right portal vein.RIGHT: at the level of the splenic vein.

提供一个比较简便好记的方法: 第一肝门以上顺时针:7 8 4 2 第一肝门以下顺时针:6 5 4 3

 

微信扫一扫
获得更多内容