Koroner arter stenozu

Özet

Göğüs ağrısı veya bilinen aterosklerozu olan hastada koroner darlık, miyokardın kanlanmasını sınırlayabilecek lümen kaybını gösterir. Koroner BT anjiyografi (K-BTA), plakla birlikte damar lümenini invaziv olmayan biçimde değerlendirir ve darlığı hasta düzeyinde sınıflandırır. Darlık derecesi tek başına iskemi kanıtı değildir; klinik bağlamda işlevsel değerlendirme gerekebilir. Sol ana koroner darlığı prognostik açıdan önemlidir; ciddi üç damar hastalığı da yüksek riskli K-BTA bulguları arasındadır.

Faz ve pencere

BTA tanısal

Koroner arterler iyotlu kontrastla opaklaşırken plak düzeyindeki en dar lümen kısa eksen ve damar eksenine paralel rekonstrüksiyonlarda ölçülür; stenoz, hastalıklı lümenin çapının uygun referans segmente göre yüzde çap azalması olarak tahmin edilir. Bu inceleme stenozu gösterir, tek başına fizyolojik anlamını kanıtlamaz.

Kontrastsız

Kalsiyum skorlama çekimi kalsifiye plağı ve koroner kalsiyum yükünü saptar; lümen opaklaşmadığı için lümen stenoz yüzdesini ölçemez.

Önerilen pencereler: Anjiyo (G 600 / M 150), Mediasten (G 350 / M 50).

BT bulguları

• Plakla ilişkili fokal ya da uzun segment lümen daralması; kalsifiye, nonkalsifiye veya mikst plak bileşenini belirt.
• Koroner BT anjiyografide stenoz şiddeti yüzde çap darlığı olarak nicelendirilebilir.
• Darlığın ostium, proksimal segment, bifürkasyon veya yan dal ağzıyla ilişkisini belirt.
• Koroner BT anjiyografide koroner lümen ve darlık değerlendirilir.
• Kalsiyum blooming gerçek lümen çapını olduğundan küçük gösterebilir; yoğun kalsifik segmentte kesin derece güvenilmez olabilir.
• Hareket, gürültü, yetersiz kontrastlanma veya stent metal artefaktı varsa segmenti tanısal olmayan olarak işaretle.

Ölçütler ve sınıflamalar

CAD-RADS 2.0 stenoz kategorileri

Kaynaklarda desteklenen CAD-RADS stenoz kategorileri: 0: koroner hastalık bulgusu yok; 1: %1–24; 2: %25–49; 3: %50–69; 4: %70–99; 5: tam oklüzyon.

CAD-RADS 2.0 stenoz derecesi

CAD-RADS, hasta düzeyindeki görüntüleme sonucunu en ciddi koroner lezyona göre özetler. CAD-RADS 0 hem plak hem darlık yokluğunu ifade eder.

Normalde

CAD-RADS 0, koroner BT anjiyografide koroner arter hastalığına ilişkin bulgu olmadığını ifade eder. Koroner damarlar, eğrisel çok düzlemli rekonstrüksiyonda ardışık kesitlerle incelenebilir. CAD-RADS 0 için hem koroner plak hem de lümen darlığı bulunmamalıdır; yalnızca darlık görülmemesi, nonobstrüktif plağı dışlamaz.

Ayırıcı tanı

Koroner spazm

fokal daralma plak olmaksızın görülebilir; tek anlık BT görüntüsü spazmı aterosklerozdan kesin ayıramayabilir.

Spontan koroner arter diseksiyonunda OCT'de intramural hematom ve yalancı lümen morfolojisi tanıyı destekler.

Miyokard köprüsü

özellikle LAD orta segmentinde intramiyokardiyal seyir ve sistolik sıkışma görünümü verir.

Koroner arter anomalisi

beklenmedik çıkış veya seyir darlık gibi izlenebilir; damar ostiumu ve üç boyutlu seyri takip edilir.

Tuzaklar

• Yoğun kalsifik plağın blooming artefaktı lümeni örter ve stenozu fazla tahmin ettirebilir; bu segmentte kesin yüzde yerine değerlendirme kısıtını raporla.
• Koroner BT anjiyografide kalsiyum bloomingi ve sınırlı uzaysal çözünürlük, stenoz derecesinin fazla tahmin edilmesine yol açabilir.
• Hareket basamaklanması küçük koroner dallarda lümen sınırını bozabilir; kesinti tek düzlemdeyse ardışık faz ve rekonstrüksiyonları kontrol et.
• Anatomik darlık, iskemiyle eş anlamlı değildir; CAD-RADS stenoz kategorisini fizyolojik test sonucuyla karıştırma.

Kendini dene

1. Koroner BT anjiyografide aşırı vasküler kalsifikasyonlar hangi artefakte yol açar ve bunun etkisi nedir?

   • A) Beam-hardening artefaktı, görüntüyü netleştirir
   • B) Blooming artefaktı, stenozu abartabilir
   • C) Aliasing artefaktı, damarı kopuk gösterir
   • D) Streak artefaktı, kontrastı artırır
   Cevabı göster

   B) Blooming artefaktı, stenozu abartabilir. S2 kaynağında, aşırı kalsifikasyonların kalsiyum blooming artefaktına neden olarak pozitif prediktif değeri düşürdüğü ve stenoz derecesinin abartılabileceği ifade edilmiştir.

2. Koroner BT anjiyografinin anatomik değerlendirmesini işlevsel değerlendirmeyle tamamlayabilen teknikler hangileridir?

   • Tek enerji spektroskopi
   • CT-MPI ve CT-FFR
   • PET-CT
   • Kontrastsız kalsiyum skoru
   Cevabı göster

   CT-MPI ve CT-FFR. CT-MPI ve CT-FFR, koroner BT anjiyografiye ek olarak miyokard perfüzyonunu veya lezyonun fizyolojik sonuçlarını değerlendirebilir.

İlgili konular

• CAD-RADS 2.0 raporlama kavramı
• Koroner plak tipleri: kalsifiye, kısmen kalsifiye ve kalsifiye olmayan

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.