第五章 循环系统
一、目的与要求
1．了解X线平片、CT、MRI、造影检查技术。
2．熟悉心脏大血管X线平片正常影像表现，了解其造影、MRI的正常表现。
3．掌握心脏大血管的基本病变的X线表现，尤其是各房室增大、肺门及肺循环异常的改变。
4．掌握房间隔缺损、动脉导管未闭、法洛四联症、二尖瓣狭窄、心包积液、主动脉夹层的影像学表现，熟悉肺动脉瓣狭窄、高心病、心肌病、肺心病、冠心病的影像学表现；
二、教学内容
第一节 检查方法
了解常规X线检查、CT检查、MRI检查、心血管造影检查的内容及其优势和临床应用；
第二节 正常影像解剖
一、不同体位正常心脏大血管X线影像
熟悉远达片后前位、45°右前斜位、60°左前斜位及左侧位正常心脏及大血管的表现；
二、心脏大血管的正常变异
了解生长发育、体形和胸廓类型、性别、呼吸与横膈高度等因素对心脏及大血管的影响；
三、正常心脏大血管造影所见
了解正常上、下腔静脉和右心房、右心室和肺动脉、肺静脉和左心房、左心室和主动脉及冠状动脉的造影表现；
四、了解正常心脏大血管MRI及MRA表现；
第三节 心脏大血管异常影像学表现
一、心脏增大
熟悉X线平片判断心脏增大的方法，了解心脏外形的变化，掌握各房室增大的表现；
二、胸部大血管异常
了解胸主动脉迂曲延长、扩张、钙化的表现；
三、肺循环异常
掌握肺血增多、肺血减少、肺动脉高压、肺静脉高压、肺动—静脉高压的病因及X线表现；熟悉心力衰竭和肺动脉栓塞及肺梗死的X线表现；
四、心脏大血管造影的异常所见
了解对比剂的充盈顺序、解剖变化和密度的改变；
第四节 先天性心血管病
一、房间隔缺损
结合临床、病理、血流动力学改变，掌握先天性心脏病房间隔缺损的X线表现和诊断、鉴别诊断及比较影像学
二、动脉导管未闭
结合临床、病理、血流动力学改变，掌握先天性心脏病动脉导管未闭的X线、心血管造影、CT及MRI表现，熟悉其诊断、鉴别诊断及比较影像学
三、肺动脉瓣狭窄
结合临床、病理、血流动力学改变，熟悉先天性心脏病肺动脉瓣狭窄的X线、心血管造影表现和诊断、鉴别诊断及比较影像学
四、法乐四联症
掌握法乐四联症的四个畸形，结合临床、病理、血流动力学改变，掌握先天性心脏病法乐四联症的X线、心血管造影表现，了解其CT及MRI表现，熟悉诊断、鉴别诊断及比较影像学
第五节 获得性心脏病
一、风湿性心脏病
掌握二尖瓣狭窄的主要病理、临床和X线表现；熟悉二尖瓣关闭不全的病理、临床和X线表现；了解主动脉瓣狭窄、关闭不全和三尖瓣狭窄及关闭不全的临床及X线表现；
二、冠状动脉粥样硬化性心脏病
熟悉冠心病的病理、临床、X线、心血管造影表现，了解其CT及MRI表现；
三、高血压所致心血管改变
熟悉高血压的病因、诊断标准和临床表现，熟悉其X线、CT、MRI表现及诊断、鉴别诊断及比较影像学；
四、肺源性心脏病
熟悉肺心病的病理、临床及X线、CT表现；
五、心肌病
熟悉心肌病的概念、分型、病理及临床表现，熟悉肥厚性、扩张性心肌病的X线、心血管造影、CT及MRI表现；
第六节 心包炎和心包积液
一、心包炎
了解心包炎的分类、病因及病理改变。
二、心包积液
结合临床、病理、血流动力学改变，掌握心包积液的X线、CT、MRI表现和诊断、鉴别诊断及比较影像学方法；
三、缩窄性心包炎
自学缩窄性心包炎的X线、CT、MRI表现。
第七节 大血管疾病
一、胸主动脉瘤及主动脉夹层
了解主动脉瘤的分型及病理、X线、血管造影表现；掌握主动脉夹层的概念、病理分型、X线、CT、血管造影及MRI表现。
二、大动脉炎
自学大动脉炎的病理、临床、X线、CT及MRI表现。
三、实验内容与要求
通过示教片了解X线平片、CT、MRI、造影等各项影像检查技术；
通过教学示教片熟悉不同体位正常心脏大血管X线影像，了解心脏大血管的正常变异、正常心脏大血管造影所见、了解正常心脏大血管MRI及MRA表现；
通过示教片掌握心脏增大的X线表现、了解胸部大血管异常表现、掌握肺循环异常的X线表现；
用教学示教病例结合临床、病理、血流动力学改变，掌握先天性心脏病房间隔缺损、动脉导管未闭、法洛四联症、二尖瓣狭窄、心包积液、主动脉夹层的影像学表现和诊断、鉴别诊断方法，熟悉肺动脉瓣狭窄、高心病、心肌病、肺心病、冠心病、主动脉瘤的影像表现和诊断、鉴别诊断方法。
四、教学时数分配
（一）理论课学时分配
|
章 节 |
理 论 课 内 容 |
学 时 |
|
第五章 第一节 |
常规X线检查、CT、MRI及心血管造影检查 |
1 |
|
第五章 第二节 |
不同体位正常心脏大血管X线影像，心脏大血管正常变异、正常心脏大血管造影所见、正常心脏大血管MR及MRA表现 |
1 |
|
第五章 第三节 |
心脏增大X线表现、胸部大血管异常表现、肺循环异常表现 |
2 |
|
第五章 第四节 |
房间隔缺损、动脉导管未闭、法洛四联症、肺动脉瓣狭窄 |
1 |
|
第五章 第五节
第六节 第七节 |
风湿性心脏病、冠心病、高心病、肺心病、心肌病、心包炎和心包积液、主动脉瘤及主动脉夹层 |
1 |
|
总 学 时 |
6 |
（二）实验课学时分配
|
序 号 |
实 习 课 内 容 |
实 验 类 型 |
学 时 |
|
1 |
检查方法；正常心脏大血管X线影像，心脏大血管正常变异、正常心脏大血管造影所见、正常心脏大血管MR及MRA表现；心脏增大X线表现、胸部大血管异常表现、肺循环异常表现 |
演示性实验 |
1 |
|
2 |
先天性心血管病、获得性心脏病、大血管疾病 |
演示性实验 |
1 |
|
总 学 时 |
2 |
思考题
1．不同体位正常心脏大血管X线表现是什么？
2．心脏增大的X线表现是什么？
3．肺循环异常的病因及X线表现是什么？
4．常见的先天性心脏病房间隔缺损、动脉导管未闭、法洛四联症、肺动脉瓣狭窄的临床、病理及影像学表现有哪些？
5．常见的获得性心脏病风湿性心脏病、冠心病、高心病、肺心病、心肌病、心包炎和心包
积液的临床、病理及影像学表现是什么？
6．常见的大血管疾病如主动脉瘤及主动脉夹层的临床、病理及影像表现是什么？
Chapter 5 cardiovascular system
一、Objective and requirement
Comprehend imaging techniques of x-ray plain film, CT, MRI and angiography；
Conversant with normal x-ray image appearance of heart and great vessels, comprehend its normal appearance in CT and MRI;
Master image appearance of heart and great vessels’ basic diseases in x-ray film, especially that of chamber enlargement, abnormality of pulmonary hila and circulation.
Master image appearance of atrial septal defect, patent ductus arteriosus, tetralogy of Fallot, mitral stenosis, pericardial effusion, aortic dissection, conversant with image appearance of hypertensive heart disease, cardiomyopathy、pulmonary heart disease and coronary heart disease.
二、Content of teaching
Section 1 Examination method
Comprehend content, advantage and clinical application of conventional x-ray, CT, MRI and angiography.
Section 2 Normal image anatomy
1. X-ray image appearance of normal heart and great vessels in different location
Conversant with normal appearance in routine posteroanterior view, 45°right anterior oblique view, 60°left anterior oblique view and left lateral view.
2. Normal variation of heart and great vessels
Comprehend factors influence on heart and great vessels, such as developing, shape, type of thorax, gender, breath and diaphragm height.
3. angiography appearance of heart and great vessels
Comprehend angiography appearance of superior and inferior vena cava, right atrium and ventricle, pulmonary artery and vein, left atrium and ventricle, aorta and coronary artery.
4. Comprehend image appearance of heart and great vessels in MRI and MRA.
Section 3 Abnormal image appearance of heart and great vessels
1. Heart enlargement
Conversant with method for measuring heart enlargement, comprehend changes in heart shape, master image appearance of each chamber enlargement.
2. Abnormality of thoracic great vessels
Comprehend image appearance of thoracic aorta with prolongation, expansion and calcification.
3. Abnormality of pulmonary circulation
Master pathogenesy and x-ray appearance of increased and decreased volume of blood passing through the lung, pulmonary arterial hypertension, pulmonary venous hypertension, pulmonary arterial- venous hypertension; Conversant with x-ray appearance of heart failure, pulmonary embolism in arteries and pulmonary infarction in veins.
4. Angiographic abnormality of heart and great vessels
Comprehend infusing order, anatomical and density change of contrast agent.
Section 4 Congenital heart disease
1. Atrial septal defe
Combining clinical alteration with its pathology and blood kinetics, master x-ray image appearance, diagnosis, differential diagnosis and comparative imaging of congenital atrial septal defect.
2. Patent ductus arteriosus
Combining clinical alteration with its pathology and blood kinetics, master image appearance of x-ray, angiography, CT and MRI, and conversant with diagnosis, differential diagnosis and comparative imaging of congenital patent ductus arteriosus.
3. Pulmonary stenosis
Combining clinical alteration with its pathology and blood kinetics, conversant with image appearance of x-ray, angiography, diagnosis, differential diagnosis and comparative imaging of congenital pulmonary stenosis.
4. Tetralogy of Fallot
Master the 4 malformations;
Combining clinical alteration with its pathology and blood kinetics, master image appearance of x-ray, angiography;Comprehend image appearance of CT and MRI; Conversant with diagnosis, differential diagnosis and comparative imaging of congenital tetralogy of Fallot.
Section 5 Secondary heart disease
1. Rheumatic heart disease
Master primary pathological principle, clinical and image appearance of mitral stenosis;
Conversant with pathology, clinical and x-ray image appearance of mitral incompetence;
Comprehend clinical and x-ray image appearance of aortic stenisis, aortic imcompetence, tricuspid stenosis and tricuspid incompetence.
2. Coronary atherosclerotic heart disease
Conversant with pathology, clinical and image appearance of x-ray and angiography, comprehend its image appearance of CT and MRI.
3. Variation in heart and vessels induced by hypertension
Conversant with pathogenesis, diagnostic standard and clinical symptom of hypertension, conversant with image appearance in X-ray film, CT and MRI scans, and its diagnosis, differential diagnosis and comparative imaging.
4. Pulmonary heart disease
Conversant with its pathology, clinical and image appearance in CT and MRI scans.
5. Cardiomyopathy
Conversant with concept, classification, pathology and clinical symptom; Conversant with image appearance in X-ray, angiography, CT and MRI scans of dilated cardiomyopathy, and restrictive cardiomyopathy.
Section 6 Pericarditis and pericardial effusion
Comprehend classification, pathogenesis and pathology of pericarditis;
Combining clinical appearance with pathology and blood kinetics, master image appearance of pericardial effusion, comprehend image appearance of constrictive pericarditis.
Section 7 Great vessels disease
Combining clinical appearance with pathogeny, pathology and classification, master image appearance of aortic dissection, conversant with image appearance of aortic aneurysm, comprehend image appearance of great arteritis
三、Experiment content and requirement
By demonstration with typical films, comprehend all kinds of examination techniques, such as x-ray plain film, CT, MRI and angiography.
By demonstration with typical films, master x-ray image appearance of heart enlargement, comprehend normal variation of heart and great vessels and their appearance in angiography, comprehend image appearance of normal heart and great vessels in MRI and MRA scans.
By demonstration with typical x-ray film, master its appearance of heart enlargement and abnormal thoracic great vessels, master image appearance of abnormal pulmonary circulation.
Combining clinical symptom, pathology and blood kinetics, master image appearance, diagnosis and differential diagnosis of congenital heart disease, which including atrial septal defect, patent ductus arteriosus, tetralogy of Fallot, mitral stenosis, pericardial effusion, aortic dissection, conversant with image appearance, diagnosis and differential diagnosis of pulmonary arterial stenosis, hypertensive heart disease, cardiomyopathy、pulmonary heart disease, coronary heart disease and aortic aneurysm.
四、Time distribution of lessons
Time distribution of theory lessons
|
Chapter& section
|
Content of theory lessons |
School hour |
|
Chapter5 section 1 |
Conventional technique of x-ray, CT, MRI and angiography |
1 |
|
Chapter5 section 2 |
X-ray image appearance in different location and that of normal variation, appearance in angiography, MR and MRI scans of heart and great vessels. |
1 |
|
Chapter5 section 3 |
Image appearance of heart enlargement, abnormality of thoracic great vessels and pulmonary circulation in x-ray films |
2 |
|
Chapter 5 section 4 |
Atrial septal defect, patent ductus arteriosus, tetralogy of Fallot, pulmonary arterial stenosis |
1 |
|
Chapter 5 section 5
Section 6
Section 7 |
Rheumatic heart disease, coronary heart disease, hypertensive heart disease, pulmonary heart disease, cardiomyopathy, pericarditis, pericardial effusion, aortic aneurysm and aortic dissection
|
1 |
|
Total hours |
6 |
2. Time distribution of practice lessons
|
Code |
Content of practice lessons |
Practice type |
School hour |
|
1 |
Examination technique, image appearance of normal and variation of heart and great vessels in x-ray film, angiography, MR and MRA |
Demonstration |
1 |
|
2 |
Congenital heart disease, secondary heart disease, and disease of great vessels |
Demonstration |
1 |
|
Total school hours |
2 |