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作者：Geoffrey D. Rubin, MD 作者单位：Duke Clinical Research Institute, 2400 Pratt St 本文发表于：Radiology: Volume 271: Number 3 - June 2014 radiology.rsna.org 翻译：郑颖；校对：张帅、陆伟；整理：梁军 
通过螺旋CT结合图像容积处理，CT血管造影于20年前诞生了。由一系列的CT与图像处理技术的创新所引发的，经过之后的15年，推翻传统血管造影术——此前的70年一直是无可争议的血管疾病的诊断参考标准，CT血管造影术成为了诊断和显示大多数心血管异常首选产品。 Through a marriage of spiral computed tomography & #40;CT& #41; and graphical volumetric image processing, CTangiography 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.
本文回顾了CT血管造影术的演进，从其发展和早期挑战到成熟产品，提供对于心血管疾病发现和治疗独有的视野。所选的临床挑战,包括急性主动脉综合征、周围血管疾病、主动脉支架术、经导管主动脉瓣移植和评估及冠状动脉疾病，这些是关于CT血管造影是如何改变我们对心血管疾病诊断和治疗方法，并呈现了对比的例子。 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.
最后，结合最近推出了多能谱成像的功能，组织灌注成像及由迭代重建致减少辐射剂量等探索，思考对于CT血管造影术持续改进与发展。
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 受卓越的技术进步所驱动，CTA（CT血管造影术）已经成为诊断并管理血管性疾病的主导影像方式。 Driven by profound technologic advances, CT angiography has emerged as the dominant imaging modality fordiagnosis and planning management of vascular diseases.
CTA提供了对急性主动脉综合征病理生理学和自然历史的新见解。 CT angiography has provided new insights into the pathophysiology and natural history of acute aorticsyndromes.
优化的CTA技术可以综合评价外周血管性疾病。 Optimized CT angiographic technique enables comprehensive assessment of peripheral arterial disease.
经导管心血管治疗的进步，包括主动脉支架与主动脉瓣膜植入技术，与CTA所提供的新见解是相关的。 The advancement of trans catheter cardiovascular therapies, including aortic stent-graft deployment and aorticvalve implantation, are linked to insights provided by CT angiography.
CT技术的创新提供了前所未有的机遇，进一步增强了CTA的安全性和临床价值。 Innovations in CT technology are providing unprecedented opportunities to further enhance the safety andclinical value of CT angiography. 
过去的20年，血管性疾病的诊断与定性方面发生巨大的转变。随着CTA（CT血管造影）、对比剂增强法MRA（磁共振血管造影）和主动脉瘤腔内支架修复等技术的引入，20世纪90年代已成为血管性疾病诊断与治疗的黄金时期。 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 & #40;CT& #41; angiography, contrastmaterial–enhanced magnetic resonance & #40;MR& #41; angiography, and endovascular repairof aortic aneurysms using stent-grafts.
1990年代早期，几乎每一例准备接受血管手术、需要确诊肺栓塞、疑似创伤性主动脉损伤、颅内动脉瘤或者肾性高血压的病人，都要进行传统的诊断性血管造影检查，该项技术诞生于1924年（1），并在1953年（2）引入了Seldinger穿刺导丝引导技术之后，被大幅改良并沿用至今。 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 & #40;1& #41; and substantially refined topresent-day technique with the introduction of the Seldinger guidewire in 1953& #40;2& #41;.
结合注射器、胶片（自动）替换盒、透视、平片、减影技术的稳步提高，直接动脉造影术已经发展为各种血管性疾病诊断与定性的参考标准。这项技术的优势在于具有较高的空间分辨率，并且可以同时进行介入诊断与治疗。
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.
它的局限性包括费用、不适和侵入性检查所带来的风险，尤其是无需同时进行干预治疗的时候；不能显示血管壁、血管外周组织和终末器官实质的情况；基于投影采集的性质导致三维（3D）辨别能力差；必须多次注射对比剂和反复曝光来显示空间相互关系；选择性的动脉注射对比剂导致远端管腔显示受限。 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; spatial discrimination owing to 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（磁共振血管造影术）1986年（3、4）首次报道，这是一个令人兴奋的新技术，它依赖于流动-增强模式，待技术进一步改进，它将成为血管性疾病诊断的一种主流模式。
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.
同时，常规CT采集10mm层厚标准（5），已经被视为一项趋于成熟的技术，正广泛应用于医疗诊断中，但是对血管性疾病评价有限，仅可以通过跟踪腹主动脉瘤的横断面图像评估主动脉破裂的风险。 At the same time, conventional CT, acquired with 10 mm-thick sections that were standard for the day& #40;5& #41;, 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.
下期预告：
CTA是如何起源的？最初的瓶颈是什么？是如何改进的？
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