通過螺旋CT結合圖像容積處理，CT血管造影于20年前誕生(shēng)了。由一(yī)系列的CT與圖像處理技術的創新所引發的，經過之後的15年，推翻傳統血管造影術——此前的70年一(yī)直是無可争議的血管疾病的診斷參考标準，CT血管造影術成為了診斷和顯示大(dà)多數心血管異常首選産品。

Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovationsin CT and image processing, over the next 5–15 years, CT angiography toppledconventional angiography, the undisputed diagnostic reference standard forvascular disease for the prior 70 years, as the preferred modality for thediagnosis and characterization of most cardiovascular abnormalities.

本文回顧了CT血管造影術的演進，從其發展和早期挑戰到成熟産品，提供對于心血管疾病發現和治療獨有的視野。所選的臨床挑戰,包括急性主動脈綜合征、周圍血管疾病、主動脈支架術、經導管主動脈瓣移植和評估及冠狀動脈疾病，這些是關于CT血管造影是如何改變我(wǒ)(wǒ)們對心血管疾病診斷和治療方法，并呈現了對比的例子。

This review recounts the evolution of CT angiography from its development and early challenges to a maturingmodality that has provided unique insights into cardiovascular diseasecharacterization and management. Selected clinical challenges, which includeacute aortic syndromes, peripheral vascular disease, aortic stent-graft andtranscatheter aortic valve assessment, and coronary artery disease, arepresented as contrasting examples of how CT angiography is changing ourapproach to cardiovascular disease diagnosis and management.

最後，結合最近推出了多能譜成像的功能，組織灌注成像及由叠代重建緻減少輻射劑量等探索，思考對于CT血管造影術持續改進與發展。

Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiationdose reduction through iterative reconstruction are explored with considerationtoward the continued refinement and advancement of CT angiography.

@RSNA，2014

概要

受卓越的技術進步所驅動，CTA（CT血管造影術）已經成為診斷并管理血管性疾病的主導影像方式。

Driven by profound technologic advances, CT angiography has emerged as the dominant imaging modality fordiagnosis and planning management of vascular diseases.

CTA提供了對急性主動脈綜合征病理生(shēng)理學和自然曆史的新見解。

CT angiography has provided new insights into the pathophysiology and natural history of acute aorticsyndromes.

優化的CTA技術可以綜合評價外(wài)周血管性疾病。

Optimized CT angiographic technique enables comprehensive assessment of peripheral arterial disease.

經導管心血管治療的進步，包括主動脈支架與主動脈瓣膜植入技術，與CTA所提供的新見解是相關的。

The advancement of trans catheter cardiovascular therapies, including aortic stent-graft deployment and aorticvalve         implantation, are linked to insights provided by CT angiography.

CT技術的創新提供了前所未有的機遇，進一(yī)步增強了CTA的安全性和臨床價值。

Innovations in CT technology are providing unprecedented opportunities to further enhance the safety andclinical value of CT angiography.

過去(qù)的20年，血管性疾病的診斷與定性方面發生(shēng)巨大(dà)的轉變。随着CTA（CT血管造影）、對比劑增強法MRA（磁共振血管造影）和主動脈瘤腔内支架修複等技術的引入，20世紀90年代已成為血管性疾病診斷與治療的黃金時期。

The past 20 years have witnessed a remarkable transformation in the diagnosis and characterization of vascular disease. The1990s were a particularly golden period in vascular diagnosis and therapy withthe introduction of computed tomographic(CT) angiography, contrastmaterial–enhanced magnetic resonance (MR) angiography, and endovascular repairof aortic aneurysms using stent-grafts.

1990年代早期，幾乎每一(yī)例準備接受血管手術、需要确診肺栓塞、疑似創傷性主動脈損傷、顱内動脈瘤或者腎性高血壓的病人，都要進行傳統的診斷性血管造影檢查，該項技術誕生(shēng)于1924年（1），并在1953年（2）引入了Seldinger穿刺導絲引導技術之後，被大(dà)幅改良并沿用至今。

In the early 1990s nearly every patient preparing to undergo vascular surgery, requiring confirmation of pulmonary embolism, orsuspected of having traumatic aortic injury, intracranial aneurysm, orrenovascular hypertension underwent conventional diagnostic angiography, atechnique that was born in 1924 (1) and substantially refined topresent-day technique with the introduction of the Seldinger guidewire in 1953(2).

結合注射器、膠片（自動）替換盒、透視、平片、減影技術的穩步提高，直接動脈造影術已經發展為各種血管性疾病診斷與定性的參考标準。這項技術的優勢在于具有較高的空間分(fēn)辨率，并且可以同時進行介入診斷與治療。

Combined with steady improvements in injectors, film changers, and fluoroscopic, radiographic, and subtraction techniques, directarteriography evolved as the reference standard for the diagnosis andcharacterization of all manner of vascular disease. Its strengths were a highspatial resolution and an opportunity for diagnosis and therapeuticintervention during a single session.

它的局限性包括費(fèi)用、不适和侵入性檢查所帶來的風險，尤其是無需同時進行幹預治療的時候；不能顯示血管壁、血管外(wài)周組織和終末器官實質的情況；基于投影采集的性質導緻三維（3D）辨别能力差；必須多次注射對比劑和反複曝光來顯示空間相互關系；選擇性的動脈注射對比劑導緻遠端管腔顯示受限。

Its limitations were the cost, discomfort, and risks of an invasive procedure, particularly when concurrent intervention was notindicated; inability to demonstrate the vessel wall, perivascular tis- sue, andend-organ parenchyma; poor three-dimensional (3D) spatial discrimination owingto the projectional nature of the acquisition; necessity for multiple contrastmaterial injections and repeated doses of ionizing radiation to characterizespatial relationships; and downstream luminal opacification limited byselective arterial injection of contrast material.

MRA（磁共振血管造影術）1986年（3、4）首次報道，這是一(yī)個令人興奮的新技術，它依賴于流動-增強模式，待技術進一(yī)步改進，它将成為血管性疾病診斷的一(yī)種主流模式。

MR angiography, first reported in1986 (3,4) was an exciting new technique that was dependent on flow-related       enhancement, awaiting further technical improvements that wouldmake it a main- stream diagnostic angiographic modality.

同時，常規CT采集10mm層厚标準（5），已經被視為一(yī)項趨于成熟的技術，正廣泛應用于醫療診斷中(zhōng)，但是對血管性疾病評價有限，僅可以通過跟蹤腹主動脈瘤的橫斷面圖像評估主動脈破裂的風險。

At the same time, conventional CT, acquired with 10 mm-thick sections that were standard for the day (5), was viewed as a maturing technology, having made tremendous inroads into abroad spectrum of medical diagnoses, but was limited for the assessment ofvascular disease with only one mainstream application, assessing aortic rupturerisk by tracking the transverse dimension of abdominal aortic aneurysms.