CN110367965B - Method, device and system for conveniently measuring coronary artery blood vessel evaluation parameters - Google Patents
Method, device and system for conveniently measuring coronary artery blood vessel evaluation parameters Download PDFInfo
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Abstract
The application provides a method, a device and a system for conveniently measuring coronary artery blood vessel evaluation parameters, wherein the measuring method comprises the following steps: measurement of pressure P distal to a coronary stenosis by a pressure guidewiredAnd/or coronary inlet pressure Pa(ii) a Performing coronary angiography on the measured blood vessel; selecting a first volume angiogram and a second volume angiogram of a measurement vessel; selecting a section of blood vessel from the proximal end to the distal end of the coronary artery for segmentation, and performing three-dimensional modeling to obtain a three-dimensional blood vessel model of the coronary artery; injecting contrast agent, and obtaining average time T of contrast agent from the entrance to the exit of the blood vessela(ii) a According to a fluid mechanics formula, obtaining the time T of the contrast agent from the entrance to the exit of the blood vessel section in the maximum expansion statemax(ii) a Coronary vessel assessment parameters were obtained. The method and the device can be used for modeling according to the contrast images at any time in the cardiac cycle, the three-dimensional modeling is convenient, the injection time of the expansion medicine is shortened, the measurement process is simple, and the test result is accurate.
Description
Technical Field
The invention relates to the technical field of coronary artery medicine, in particular to a method and a device for conveniently measuring coronary artery vessel evaluation parameters, a coronary artery analysis system and a computer storage medium.
Background
The heart is a high energy consuming organ. Under the resting state, the oxygen uptake of myocardial metabolism can reach 60 to 80 percent of the oxygen content of blood. Therefore, under stress conditions such as exercise, it is difficult for the heart to satisfy the demand for increased myocardial oxygen deficiency by increasing the oxygen uptake capacity of the tissues, and most of the demand for oxygen for myocardial metabolism is ensured by increasing myocardial blood flow. The myocardial microcirculation accounts for 95% of the coronary circulation, and the effect of regulating myocardial blood flow is achieved through various factors such as local metabolites, endothelium, neuroendocrine, myogenesis and the like. Research shows that coronary artery microcirculation dysfunction is an important prediction factor for long-term poor prognosis of patients with coronary heart disease.
The guideline has migrated in 2013 to indicate that "for patients suspected of microvascular angina, if no significant abnormalities are seen in coronary angiography, one can consider intracavitary acetylcholine or adenosine injection during angiography for doppler measurements, calculate CFR from either endothelial dependence or non-endothelial, and specify the presence or absence of microcirculation/epicardial vasospasm", and list this as a class IIB recommendation.
The guideline in 2019 increased 1 class IIA recommendation and 2 class IIB recommendations. It is proposed that "for patients with persistent symptoms but normal or moderate coronary angiography stenosis and retained iwfr/FFR values, CFR and/or microcirculation resistance measurements based on guidewire measurements should be considered and listed as a class IIA recommendation.
Coronary microvascular function is accomplished by detecting microvascular response to vasodilators. The changes in these two aspects are also indicative of the importance of coronary microvascular dysfunction. The measurement index adopted by the function of the Coronary artery microvasculature refers to the maximum dilation degree of the Coronary artery microvasculature, namely Coronary Flow Reserve (CFR), and the used vasodilators mainly comprise non-endothelium-dependent vasodilators acting on vascular smooth muscle and endothelium-dependent vasodilators acting on vascular endothelial cells, wherein the vasodilators comprise adenosine and acetylcholine.
For patients with coronary angiography where no significant stenosis is seen but coronary heart disease (CAD) is suspected, our previous examination has been to inject adenosine and acetylcholine to detect microvascular response to vasodilators. The current examination method mainly comprises coronary artery blood flow reserve fraction (FFR) and microcirculation resistance Index (IMR), wherein the IMR synchronously records coronary artery pressure and temperature through a soft pressure guide wire, the time difference of temperature change detected by two temperature sensors on a guide wire rod can know the average conduction time (Tmn) of saline from a guide catheter to the temperature sensor at the head end of the guide wire, and the IMR value can be obtained according to the product of pressure Pd and Tmn which define the far end of the coronary artery. But generally speaking, few methods are now available for assessing microcirculation. The existing checking means simplifies the flow, improves the safety and optimizes the result, so that the recommendation level of the guide is improved compared with the prior art. In addition, the non-invasive examination including chest doppler ultrasound, radionuclide imaging, and magnetic resonance imaging is valuable in the diagnosis of microcirculation diseases, but all have different degrees of deficiency, and cannot be a recommended method for evaluating microcirculation function.
The existing CFR measurement method includes: (1) the Doppler guide wire measuring method is characterized in that the Doppler guide wire is sent into a coronary artery blood vessel (a pathological distal end) to directly measure the blood flow velocity in the coronary artery under the states of rest and maximum hyperemia, and then the CFR can be calculated. (2) The thermodilution curve measuring method is characterized in that a temperature-pressure sensor is embedded in a dual induction guide wire, the temperature change in the coronary artery can be directly sensed, the thermodilution curve in the coronary artery under the resting and maximum hyperemia states can be obtained, and the CFR is calculated by replacing the flow velocity of the coronary artery with the average conduction time of blood flow.
The measurement of IMR and CFR by pressure wire sensors has the following problems: (1) tmn, measured too close to the coronary ostium by the pressure wire sensor, is too small resulting in a somewhat poor IMR result. Too far in turn, too much Tmn is measured resulting in large IMR results; (2) 6 times of saline is injected in the rest state and the maximum hyperemia state, if the position of the pressure guide wire sensor moves, the result of each measurement is not comparable, and the measurement process is complicated; (3) the Tmn difference which can be obtained by injecting the saline every time is large, if the difference between a certain value and other 2 values exceeds 30%, the saline needs to be injected again for measurement, and the saline injection times are increased; (4) the pressure wire sensor measures that the temperature of the injected saline is reduced rapidly enough to cause that the numerical value cannot be recorded, and the injection speed is increased, the injection amount is increased, and the saline with lower temperature is used. Too many influencing factors; (5) failure to restore the original value quickly enough after injection can also be mistaken, from the start of injection to a time when the temperature returns to normal (too long (>0.6 seconds); it may be too slow, uneven, too large an injection, etc. Therefore, the distance of the pressure guide wire sensor, the saline injection speed, the injection amount and the temperature of saline can directly influence the measurement result, so that the result is inaccurate and the measurement process is complicated; and the dilating drugs are injected continuously for a long time, which has great influence on patients and causes serious discomfort.
Disclosure of Invention
The invention provides a method and a device for conveniently measuring coronary artery vessel evaluation parameters, a coronary artery analysis system and a computer storage medium, which are used for solving the problems that in the prior art, when CFR and IMR are measured through a pressure guide wire, a long-time continuous injection of an expansion medicament exists, serious discomfort is caused to a patient due to large influence, the measurement process of the pressure guide wire is complicated, and the measurement result is inaccurate.
To achieve the above object, in a first aspect, the present application provides a method for conveniently measuring coronary artery blood vessel evaluation parameters, comprising:
measurement of pressure P distal to a coronary stenosis by a pressure guidewiredAnd/or coronary inlet pressure Pa；
Performing coronary angiography on the measured blood vessel;
selecting a first volume angiogram and a second volume angiogram measuring the blood vessel;
selecting a section of blood vessel from the proximal end to the distal end of the coronary artery for segmentation, and obtaining a coronary artery three-dimensional blood vessel model according to the first volume mapping image and the second volume mapping image through three-dimensional modeling;
injecting contrast agent, and obtaining the average time T of the contrast agent from the entrance to the exit of the blood vessel section according to the coronary artery three-dimensional blood vessel modela；
According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmax；
According to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
Optionally, the method for facilitating measurement of a coronary vessel assessment parameter described above, the coronary vessel assessment parameter comprising: coronary flow reserve CFR, microcirculation resistance coefficient IMR, when coronary flow increases from a resting state to a hyperemic state.
Optionally, the method for facilitating measurement of a coronary vessel assessment parameter as described above, wherein CFR ═ Ta/Tmax(ii) a And/or
Said IMR ═ Pd×Tmax。
Optionally, the method for facilitating measurement of coronary vessel assessment parameters described above, said obtaining said contrast agent from a vesselAverage time T elapsed from entrance to exit of segmentaThe method comprises the following steps:
obtaining the time T elapsed from the entrance to the exit of the contrast agent in the first volume angiogram1Obtaining the time T elapsed from the entrance to the exit of the contrast agent in the second angiographic image2，
Alternatively, the method for facilitating measurement of a coronary vessel assessment parameter as described above, the time T1And T2The number of frames of the partial area image into which the heart cycle area is divided is calculated from the ratio of the number of frames per second transmission frames.
Alternatively, the above method for conveniently measuring coronary artery vessel evaluation parameters obtains the time T elapsed from the entrance to the exit of the contrast agent in the maximum expansion statemaxThe method comprises the following steps:
measuring the length L of the selected segmented vessel;
according to the coronary artery three-dimensional vessel model, Pa and Pd, the blood flow velocity V in the expansion state is deduced by a fluid mechanics calculation method;
according to the formula TmaxL/V, obtaining the time T of the contrast agent from the entrance to the exit of the blood vessel section in the maximum expansion statemax。
Optionally, the method for conveniently measuring coronary artery blood vessel evaluation parameters described above, wherein the method for deriving the blood flow velocity V in the expanded state by using a fluid mechanics calculation method according to the coronary artery three-dimensional blood vessel model, Pa, Pd comprises:
obtaining the diameter D of the blood vessel section once every t timet；
Acquiring the pressure P of the distal end of the coronary artery stenosis once every t time through the pressure guide wiredAnd coronary artery inlet pressure Pa；
According to Dt、Pa、PdEvery t time is calculated to obtain oneFFRtThe value is solved according to the FFR definition and the blood flow velocity V is obtainedtA value;
injecting an expanding drug, measuring the FFR value in the expanded state, and comparing the FFR value in the expanded state with the FFR value in real timetComparing values to obtain the blood flow velocity VtThe value is the blood flow velocity V value in the expansion state.
Optionally, the above method for conveniently measuring coronary vessel assessment parameters, wherein the first posture is at an angle greater than 30 ° to the second posture.
Optionally, the method for conveniently measuring coronary artery blood vessel assessment parameters, wherein the obtaining a coronary artery three-dimensional blood vessel model according to the three-dimensional modeling of the first volume mapping image and the second volume mapping image comprises:
removing interfering blood vessels of the first and second volume mapping images to obtain a result image;
extracting a coronary centerline and a diameter of each of the result images along an extending direction of the coronary artery;
and projecting each coronary artery central line and diameter on a three-dimensional space for three-dimensional modeling to obtain a coronary artery three-dimensional vessel model.
In a second aspect, the present application provides a measuring device for conveniently measuring coronary artery blood vessel assessment parameters, which is used in the above method for conveniently measuring coronary artery blood vessel assessment parameters, and comprises: the device comprises a pressure guide wire measuring unit, an extraction coronary angiography unit, a three-dimensional modeling unit and a parameter measuring unit, wherein the extraction coronary angiography unit is connected with the three-dimensional modeling unit, and the parameter measuring unit is connected with the pressure guide wire measuring unit and the three-dimensional modeling unit;
the pressure guide wire measuring unit is used for measuring the pressure P at the far end of the coronary artery stenosis through the pressure guide wiredAnd coronary artery inlet pressure Pa；
The coronary angiography extracting unit is used for selecting a first angiogram image and a second angiogram image of the measured blood vessel;
the three-dimensional modeling unit is used for receiving the first volume mapping image and the second volume mapping image transmitted by the coronary angiography extraction unit, and three-dimensional modeling is carried out to obtain a coronary artery three-dimensional blood vessel model;
the parameter measuring unit is used for receiving the coronary artery three-dimensional vessel model transmitted by the three-dimensional modeling unit and obtaining the average time T of the contrast agent passing from the entrance to the exit of the vessel sectiona(ii) a According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmax(ii) a According to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
Optionally, the above-mentioned measuring device for conveniently measuring coronary artery blood vessel assessment parameters, the parameter measuring unit comprises: a coronary flow reserve module, a microcirculation resistance coefficient module, and/or a coronary flow reserve fraction module; the coronary blood flow reserve module and the microcirculation resistance coefficient module are connected with the three-dimensional modeling unit; the microcirculation resistance coefficient module and the coronary artery blood flow reserve fraction module are both connected with the pressure guide wire measuring unit;
the coronary blood flow reserve module is used for measuring the CFR (CFR ═ T) of the coronary blood flow reserve when the coronary blood flow is increased from the rest state to the hyperemia statea/Tmax；
The microcirculation resistance coefficient module is used for measuring the microcirculation resistance coefficient IMR (intrinsic mode response), wherein the IMR is Pd×Tmax；
The coronary flow reserve fraction module is used for measuring the coronary flow reserve fraction FFR (the FFR is P)d/Pa。
In a third aspect, the present application provides a coronary artery analysis system comprising: a measurement device for facilitating measurement of a coronary vessel assessment parameter as claimed in claim 10 or 11.
In a fourth aspect, the present application provides a computer storage medium, a computer program being executed by a processor for implementing the above-mentioned method for facilitating measurement of a coronary vessel assessment parameter.
The beneficial effects brought by the scheme provided by the embodiment of the application at least comprise:
the application provides a method for conveniently measuring coronary artery vessel evaluation parameters, which can be used for modeling according to an angiogram at any time in a cardiac cycle, and is convenient and fast in three-dimensional modeling; when the FFR is tested only in the expansion state, the expansion medicine is injected, the expansion medicine is not required to be injected in other processes, the injection time of the expansion medicine is greatly reduced, then, three-dimensional modeling is carried out through a coronary angiography image, and the average time T of the contrast agent passing from the entrance to the exit of the blood vessel section is obtained according to the coronary artery three-dimensional blood vessel modela(ii) a According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmaxAccording to Ta、TmaxAnd/or PdAnd/or PaThe method has the advantages of simple measurement process and accurate test result when measuring coronary artery blood vessel evaluation parameters such as IMR, CFR and the like, and solves the problem when measuring the coronary artery blood vessel evaluation parameters such as IMR, CFR and the like by using pressure guide wires.
Drawings
The accompanying drawings, which are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description serve to explain the invention and not to limit the invention. In the drawings:
FIG. 1 is a flow chart of one embodiment of a method of facilitating measurement of a coronary vessel assessment parameter of the present application;
FIG. 2 is a flow chart of another embodiment of the method of the present application for facilitating measurement of coronary vessel assessment parameters;
FIG. 3 is a flowchart of step S400 of the present application;
FIG. 4 is a flowchart of step S600 of the present application;
FIG. 5 is a flowchart of step S620 of the present application;
FIG. 6 is a block diagram of a measuring device for measuring coronary artery vessel assessment parameters according to the present application;
FIG. 7 is a block diagram of a parameter measurement unit according to the present application;
FIG. 8 is a block diagram of the structure of one embodiment of a three-dimensional modeling unit of the present application;
FIG. 9 is a block diagram of another embodiment of a three-dimensional modeling unit of the present application;
FIG. 10 is a block diagram of the image processing module of the present application;
FIG. 11 is a reference image;
FIG. 12 is a target image to be segmented;
FIG. 13 is another target image to be segmented;
FIG. 14 is an enhanced catheter image;
FIG. 15 is a binarized image of catheter feature points;
FIG. 16 is an enhanced target image;
FIG. 17 is an image of a region where a coronary artery is located;
FIG. 18 is a resulting image;
FIG. 19 is two postural contrast images;
FIG. 20 is a three-dimensional model of the coronary arteries generated from FIG. 19 in conjunction with postural angles and coronary centerlines;
the following reference numerals are used for the description:
the coronary artery blood flow measurement device comprises a pressure guide wire measurement unit 110, an extraction coronary angiography unit 120, a three-dimensional modeling unit 130, an image reading module 131, a segmentation module 132, a blood vessel length measurement module 133, a three-dimensional modeling module 134, an image processing module 135, an image denoising module 1350, a catheter characteristic point extraction module 1351, a coronary artery extraction module 1352, a coronary artery center line extraction module 136, a blood vessel diameter measurement module 137, a parameter measurement unit 140, a coronary artery blood flow reserve module 141, a microcirculation resistance coefficient module 142 and a coronary artery blood flow reserve fraction module 143.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the technical solutions of the present invention will be clearly and completely described below with reference to the specific embodiments of the present invention and the accompanying drawings. It is to be understood that the described embodiments are merely exemplary of the invention, and not restrictive of the full scope of the invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
In the following description, for purposes of explanation, numerous implementation details are set forth in order to provide a thorough understanding of the various embodiments of the present invention. It should be understood, however, that these implementation details are not to be interpreted as limiting the invention. That is, in some embodiments of the invention, such implementation details are not necessary.
As shown in fig. 1, the present application provides a method for conveniently measuring coronary vessel assessment parameters, comprising:
s100, measuring the pressure P at the far end of the coronary artery stenosis through a pressure guide wiredAnd/or coronary inlet pressure Pa；
S200, performing coronary angiography on the measured blood vessel;
s300, in a resting state, selecting a first volume radiography image and a second volume radiography image for measuring the blood vessel;
s400, selecting a section of blood vessel from the proximal end to the distal end of the coronary artery for segmentation, and carrying out three-dimensional modeling according to the first volume mapping image and the second volume mapping image to obtain a coronary artery three-dimensional blood vessel model;
s500, injecting contrast agent, and obtaining the average time T of the contrast agent from the entrance to the exit of the blood vessel section according to the coronary artery three-dimensional blood vessel modela；
S600, obtaining the time T of the contrast agent from the entrance to the exit of the blood vessel section under the maximum expansion state according to the coronary artery three-dimensional blood vessel model and a fluid mechanics formulamax；
S700, according to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
In one embodiment of the present application, the coronary artery blood vessel assessment parameters in S700 include: crownCoronary flow reserve CFR, microcirculation resistance coefficient IMR, when the blood flow increases from a resting state to a hyperemic state. In one embodiment of the present application, CFR ═ Ta/Tmax；IMR＝Pd×Tmax。
The application provides a method for conveniently measuring coronary artery vessel evaluation parameters, when FFR is tested in an expansion state, an expansion drug is injected, the injection of the expansion drug is not needed in other processes, the injection time of the expansion drug is greatly reduced, then three-dimensional modeling is carried out through a coronary angiography image, and the average time T of the contrast agent passing from the entrance to the exit of a vessel section is obtained according to the coronary artery three-dimensional vessel modela(ii) a According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmaxAccording to Ta、TmaxAnd/or PdAnd/or PaThe method has the advantages of simple measurement process and accurate test result when measuring coronary artery blood vessel evaluation parameters such as IMR, CFR and the like, and solves the problem when measuring the coronary artery blood vessel evaluation parameters such as IMR, CFR and the like by using pressure guide wires.
It should be noted that: injecting a dilation drug comprises: the intravenous injection or the intracoronary injection of the expanding medicine comprises the following driving modes: the expanding medicament can be mixed with the contrast agent and injected into veins or coronary arteries, and also can be injected at intervals in a sub-division manner, so that the expanding medicament is in the protection scope of the application; drugs including adenosine, ATP, etc. that can exert an expanding effect are within the scope of the present application.
As shown in fig. 2, in an embodiment of the present application, after S100 and before S200, the method includes: s110, a contrast agent is injected into the blood vessel.
As shown in fig. 3, in one embodiment of the present application, S400 includes:
s410, removing interfering blood vessels of the first and second volume angiograms to obtain a result image, specifically:
removing interfering blood vessels of the first and second volumetric angiograms;
denoising a coronary angiography image, comprising: static noise and dynamic noise;
defining a first frame of segmentation image with a catheter as a reference image, defining a k frame of segmentation image with a complete coronary artery as a target image, wherein k is a positive integer greater than 1;
subtracting the target image from the reference image, and extracting a feature point O of the catheter, wherein the specific method comprises the following steps: subtracting the target image from the reference image; denoising, including: static noise and dynamic noise; carrying out image enhancement on the denoised image; carrying out binarization processing on the enhanced catheter image to obtain a binarized image with a group of catheter characteristic points O;
subtracting the reference image from the target image, and extracting a region image of the position where the coronary artery is located, wherein the specific method comprises the following steps: subtracting the reference image from the target image; denoising, including: static noise and dynamic noise; carrying out image enhancement on the denoised image; determining and extracting a region of a coronary artery according to the position relation between each region in the enhanced target image and the catheter feature point, wherein the region is a region image of the position of the coronary artery;
the region image takes the feature points of the catheter as seed points to carry out dynamic growth to obtain the result image, and the specific method comprises the following steps: performing binarization processing on the region image of the coronary artery position to obtain a binarization coronary artery image; performing morphological operation on the binary coronary artery image, taking the feature point of the catheter as a seed point, and performing dynamic region growth on the binary coronary artery image according to the position of the seed point to obtain a result image;
s420, extracting the coronary artery central line and the diameter of each result image along the extension direction of the coronary artery;
s430, projecting each coronary artery central line and diameter on a three-dimensional space for three-dimensional modeling to obtain a coronary artery three-dimensional vessel model, wherein the specific method comprises the following steps:
acquiring a posture shooting angle of each coronary angiography image;
and projecting each coronary artery central line on a three-dimensional space in combination with the posture shooting angle, and performing projection to generate a coronary artery three-dimensional blood vessel model.
In one embodiment of the present application, S500 includes: obtaining the time T elapsed from the entrance to the exit of the contrast agent in the first volume angiogram1Obtaining the time T elapsed from the entrance to the exit of the contrast agent in the second angiographic image2，
Time T1And T2Calculating according to the ratio of the number of frames of the image of the local area into which the heartbeat period area is divided to the number of frames transmitted per second, namely: t is N/fps, N represents the number of frames of the image of the local region into which the heart cycle region is divided, fps represents the number of frames played per second of picture, in colloquial terms, the number of pictures of animation or video, T represents the time T that the contrast agent in a certain volume contrast image passes from the entrance to the exit of the blood vessel segment, and therefore T represents the time T that the contrast agent in a certain volume contrast image passes from the entrance to the exit of the blood vessel segment1And T2Can be calculated according to the formula. In one embodiment of the application, fps is 10-30; preferably fps 15.
Due to T1And T2The CFR is measured through the coronary artery three-dimensional blood vessel model obtained based on the contrast image, and therefore the CFR is measured through the coronary artery three-dimensional blood vessel model without depending on a pressure guide wire sensor, the problems that the pressure guide wire sensor is easy to move under the impact of saline and the measurement is inaccurate are solved, and the saline does not need to be injected when the measurement is based on the contrast image, so that the influence of the saline injection speed, the injection amount and the saline temperature on the CFR measurement result is avoided, and the measurement accuracy is improved.
The measurement of IMR is based on a pressure guidewire and a contrast image, due to the pressure P measured by the pressure guidewire distal to the stenosis of the coronary arterydMore accurate, and then measuring time T based on the contrast image2The injection time of the expanding medicament is shortened, the injection times of saline are reduced, the influence of the saline on the test result is reduced, the accuracy of the IMR measurement result is improved, and the test process is simple.
As shown in fig. 4, in an embodiment of the present application, S600 includes:
s610, measuring the length L of the selected and segmented blood vessel;
s620, according to the coronary artery three-dimensional vessel model and Pa、PdThe blood flow velocity V in the expanded state is deduced by a fluid mechanics calculation method;
s630, according to the formula TmaxL/V, obtaining the time T of the contrast agent from the entrance to the exit of the blood vessel section in the maximum expansion statemax。
As shown in fig. 5, in an embodiment of the present application, the method of S620 includes:
s621, the diameter D of the blood vessel section is obtained once every t timet；
S622, acquiring the pressure P of the distal end of the coronary artery stenosis through the pressure guide wire at intervals of the time tdAnd coronary artery inlet pressure Pa；
S623 according to Dt、Pa、PdEvery t time, an FFR is calculatedtThe value is solved according to the FFR definition and the blood flow velocity V is obtainedtA value;
s624, injecting an expanding medicine, measuring an FFR value in an expanding state, and comparing the FFR value in the expanding state with the FFR value in real timetComparing values to obtain the blood flow velocity VtThe value is the blood flow velocity V value in the expansion state. The injection quantity and the injection times of the expanding medicine are reduced, and the expanding medicine is safer and more reliable.
In one embodiment of the present application, the coronary artery blood vessel assessment parameters in S600 include: fractional coronary flow reserve FFR, FFR ═ Pd/Pa。
In an embodiment of the present application, an angle between the first posture selected in the first posture image and the second posture selected in the second posture image in S300 is greater than 30 °. According to the method and the device, any two body position images with included angles larger than 30 degrees can be selected for three-dimensional reconstruction, the shooting difficulty of the body position images is reduced, the process is simplified, and modeling is convenient and rapid.
As shown in fig. 6, the present application provides a measuring apparatus 100 for conveniently measuring a coronary artery blood vessel evaluation parameter, which is used in the above-mentioned method for conveniently measuring a coronary artery blood vessel evaluation parameter, and comprises: the coronary angiography extraction device comprises a pressure guide wire measuring unit 110, a coronary angiography extraction unit 120, a three-dimensional modeling unit 130 and a parameter measuring unit 140, wherein the coronary angiography extraction unit 120 is connected with the three-dimensional modeling unit 130, and the parameter measuring unit 140 is connected with the pressure guide wire measuring unit 110 and the three-dimensional modeling unit 130; a pressure guide wire measuring unit 110 for measuring the pressure P at the distal end of the coronary stenosis by means of the pressure guide wiredAnd coronary artery inlet pressure Pa(ii) a An extraction coronary angiography unit 120 for selecting a first and a second angiogram image of the measured vessel; the three-dimensional modeling unit 130 is used for receiving the first volume mapping image and the second volume mapping image transmitted by the coronary angiography unit, and three-dimensional modeling is carried out to obtain a coronary artery three-dimensional blood vessel model; a parameter measurement unit 140 for receiving the three-dimensional vessel model of coronary artery delivered by the three-dimensional modeling unit and obtaining the average time T of the contrast agent passing from the entrance to the exit of the vessel segmenta(ii) a According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmax(ii) a According to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
As shown in fig. 7, in one embodiment of the present application, the parameter measurement unit 140 includes: the coronary blood flow reserve module 141, the microcirculation resistance coefficient module 142 and/or the coronary blood flow reserve fraction module 143, the coronary blood flow reserve module 141 and the microcirculation resistance coefficient module 142 are connected with the three-dimensional modeling unit 130; the microcirculation resistance coefficient module 142 and the coronary artery blood flow reserve fraction module 143 are both connected with the pressure guide wire measuring unit 110; the coronary flow reserve module 141 is used to measure the coronary flow reserve CFR when the coronary flow increases from the resting state to the hyperemic state, where CFR is Ta/Tmax(ii) a The micro-circulation resistance coefficient module 142 is used for measuring the micro-circulation resistance coefficient IMR, where IMR is Pd×Tmax(ii) a The coronary flow reserve fraction module 143 is configured to measure a coronary flow reserve fraction FFR, FFR ═ Pd/Pa。
The parameter measurement unit 140 further includes: t is1Measurement module, T2A measurement module and a CFR measurement module, both connected to the three-dimensional modeling unit 130, and T1Measurement module, T2The measuring modules are connected with the CFR measuring module.
As shown in fig. 8, in an embodiment of the present application, the three-dimensional modeling unit 130 includes an image reading module 131, a segmentation module 132, a blood vessel length measurement module 133, and a three-dimensional modeling module 134, and the segmentation module 132 is connected to the image reading module 131, the blood vessel length measurement module 133, and the three-dimensional modeling module 134; the image reading module 131 is used for reading a contrast image; the segmentation module 132 is configured to select a heart cycle region of the coronary angiography image; the blood vessel length measuring module 133 is configured to measure a length L of a blood vessel in the heart cycle region, and transmit the length L of the blood vessel to the segmentation module 132; the three-dimensional modeling module 134 is configured to perform three-dimensional modeling according to the coronary angiography image selected by the segmentation module 132, so as to obtain a three-dimensional coronary artery model.
As shown in fig. 9, in an embodiment of the present application, the three-dimensional modeling unit 130 further includes: the coronary artery three-dimensional model measuring device comprises an image processing module 135, a coronary artery central line extracting module 136 and a blood vessel diameter measuring module 137, wherein the image processing module 135 is connected with the coronary artery central line extracting module 136, and a three-dimensional modeling module 134 is connected with the coronary artery central line extracting module 136 and the blood vessel diameter measuring module 137. The image processing module 135 is configured to receive the coronary angiography images of at least two body positions transmitted by the segmentation module 132, and remove interfering blood vessels of the coronary angiography images to obtain a result image as shown in fig. 17; the coronary artery centerline extraction module 136 is configured to extract a coronary artery centerline of each of the result images shown in fig. 17 along the extending direction of the coronary artery; the vessel diameter measurement module 137 is used for measuring the vessel diameter D; the three-dimensional modeling module 134 is configured to project each coronary artery centerline and diameter onto a three-dimensional space for three-dimensional modeling, so as to obtain a coronary artery three-dimensional blood vessel model. The method and the device realize the synthesis of the coronary artery three-dimensional blood vessel model according to the coronary angiography image, make up the blank in the industry, and have positive effects on the technical field of medicine.
In an embodiment of the present application, the image processing module 135 is internally provided with an image denoising module 1350, for denoising the coronary angiography image, including: static noise and dynamic noise. The denoising module 1350 is used to remove the interference factors in the coronary angiography image, thereby improving the quality of image processing.
As shown in fig. 10, in an embodiment of the present application, a catheter feature point extraction module 1351 and a coronary artery extraction module 1352, both connected to the coronary centerline extraction module 136, are disposed inside the image processing module 135, and the catheter feature point extraction module 1351 is connected to the coronary artery extraction module 1352 and the image denoising module 1350; the catheter feature point extraction module 1351 is configured to define a first frame of segmented images with a catheter appearing as a reference image as shown in fig. 11, define a k-th frame of segmented images with a complete coronary artery appearing as a target image as shown in fig. 12 and fig. 13, where k is a positive integer greater than 1, and enhance the target image as shown in fig. 12 and 13 to obtain enhanced images as shown in fig. 14 and 16; subtracting the target images shown in fig. 12 and 13 from the reference image shown in fig. 11, extracting the feature points O of the catheter shown in fig. 15; the coronary artery extraction module 1352 is configured to subtract the reference image shown in fig. 11 from the target image shown in fig. 12 and fig. 13, and determine and extract a region of a coronary artery according to a position relationship between each region in the enhanced target image and a feature point of the catheter shown in fig. 16, that is, a region image of a position where the coronary artery is located shown in fig. 17; the region image shown in fig. 17 was dynamically grown with the feature points of the catheter shown in fig. 15 as seed points, and the resultant image shown in fig. 18 was obtained.
The image processing module 135 is also internally provided with a binarization processing module for performing binarization processing on the image to obtain a three-dimensional coronary artery blood vessel model.
The present application will be described in detail with reference to the following specific examples:
example 1:
as shown in fig. 19, a coronary angiography image of two positions taken for one patient; the left image is the posture angle is the right anterior oblique RAO: 25 ° and head CRA: a 23 ° contrast image; the right diagram is the posture angle is the right anterior oblique RAO: 3 ° and head CRA: a 30 ° contrast image;
placing a pressure guidewire sensor at the distal coronary end of the patient (5 cm away from the opening of the guiding catheter); introducing dilating medicine into blood vessel to make blood vessel reach and maintain maximum dilating state (ensuring that pressure guide wire sensors before and after introducing dilating medicine are at the same position), and measuring P by pressure guide wirea＝87Hg，Pd＝86mmHg；
The length L of the blood vessel of the coronary artery three-dimensional blood vessel model is 120 mm; the generated coronary artery three-dimensional vessel model is shown in fig. 20; the diameter D of the blood vessel is 2-4 mm, T1＝N1/fps1＝14/15＝0.93s；T2＝N2/fps2＝17/15＝1.13s；Ta1.03 ═ 1.13+ 0.93)/2; in the expanded state, V ═ L/(N)max/fps)＝120/(2/15)＝900mm/s；
Tmax＝120/900＝0.13s；
CFR＝Ta/Tmax＝1.03/0.13＝7.90；
Thus IMR 86 × 0.13 ═ 9.46;
FFR＝86/87＝0.99。
comparative example 1:
the same coronary angiography image was taken for both comparative example 1 and example 1 in the same patient as for example 1;
placing a pressure guide wire sensor at the distal end of coronary artery (5 cm away from the opening of the guide catheter), injecting 3ml of physiological saline into blood vessel via the catheter, if it is detected that the blood temperature returns to normal value, injecting 3ml of physiological saline into blood vessel via the catheter again, repeating the above process for 3 times, and recording T1，T10.83 s; introducing dilating medicine into blood vessel to make blood vessel reach and maintain maximum dilating state (ensuring that pressure guide wire sensors before and after introducing dilating medicine are at the same position), injecting 3ml of physiological saline into blood vessel via catheter, and if detecting that blood temperature returns to normal value, then adding dilating medicine into blood vesselThe above procedure was repeated 3 times by injecting 3ml of physiological saline into the blood vessel through the catheter, and then T was recorded2，T2The pressure P at the distal coronary end was measured for 0.11sd84mmHg, coronary inlet pressure Pa＝85mmHg；
CFR＝0.83/0.11＝7.54；
IMR＝Pd×T2＝84×0.11＝9.24；
FFR＝84/85＝0.988。
By comparing example 1 with comparative example 1, the difference is about 0.5, and it can be seen that the IMR measurement results are substantially the same, so the measurement results of example 1 are accurate, and the examples of the present application use a pressure guide wire to measure the pressure at the distal end, but do not use saline, T1、T2Measuring through a three-dimensional blood vessel model; the measurement of IMR is realized through the radiography image, the blank in the industry is made up, the operation is simpler, the measurement of FFR is also realized, the physiological saline is not needed, the problem that the position of the pressure guide wire is difficult to control under the impact force of the physiological saline of the pressure guide wire sensor is solved, the problem of inaccurate measurement of the far-end pressure is solved, the physiological saline does not need to be injected for many times, and the process is simple, convenient and quick.
The present application provides a coronary artery analysis system comprising: the measurement device 100 described above facilitates measurement of coronary vessel assessment parameters.
The present application provides a computer storage medium, a computer program being executed by a processor for implementing the above-mentioned method for facilitating measurement of a coronary vessel assessment parameter.
As will be appreciated by one skilled in the art, aspects of the present invention may be embodied as a system, method or computer program product. Thus, various aspects of the invention may be embodied in the form of: an entirely hardware embodiment, an entirely software embodiment (including firmware, resident software, micro-code, etc.) or an embodiment combining hardware and software aspects that may all generally be referred to herein as a "circuit," module "or" system. Furthermore, in some embodiments, aspects of the invention may also be embodied in the form of a computer program product in one or more computer-readable media having computer-readable program code embodied therein. Implementation of the method and/or system of embodiments of the present invention may involve performing or completing selected tasks manually, automatically, or a combination thereof.
For example, hardware for performing selected tasks according to embodiments of the invention could be implemented as a chip or a circuit. As software, selected tasks according to embodiments of the invention could be implemented as a plurality of software instructions being executed by a computer using any suitable operating system. In an exemplary embodiment of the invention, one or more tasks according to exemplary embodiments of the methods and/or systems as described herein are performed by a data processor, such as a computing platform for executing a plurality of instructions. Optionally, the data processor comprises volatile storage for storing instructions and/or data and/or non-volatile storage for storing instructions and/or data, e.g. a magnetic hard disk and/or a removable medium. Optionally, a network connection is also provided. A display and/or a user input device, such as a keyboard or mouse, is optionally also provided.
Any combination of one or more computer readable media may be utilized. The computer readable medium may be a computer readable signal medium or a computer readable storage medium. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any combination of the foregoing. More specific examples (a non-exhaustive list) of the computer readable storage medium would include the following:
an electrical connection having one or more wires, a portable computer diskette, a hard disk, a Random Access Memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or flash memory), an optical fiber, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the context of this document, a computer readable storage medium may be any tangible medium that can contain, or store a program for use by or in connection with an instruction execution system, apparatus, or device.
A computer readable signal medium may include a propagated data signal with computer readable program code embodied therein, for example, in baseband or as part of a carrier wave. Such a propagated data signal may take many forms, including, but not limited to, electro-magnetic, optical, or any suitable combination thereof. A computer readable signal medium may also be any computer readable medium that is not a computer readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device.
Program code embodied on a computer readable medium may be transmitted using any appropriate medium, including but not limited to wireless, wireline, optical fiber cable, RF, etc., or any suitable combination of the foregoing.
For example, computer program code for carrying out operations for aspects of the present invention may be written in any combination of one or more programming languages, including an object oriented programming language such as Java, Smalltalk, C + + or the like and conventional procedural programming languages, such as the "C" programming language or similar programming languages. The program code may execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer or entirely on the remote computer or server. In the case of a remote computer, the remote computer may be connected to the user's computer through any type of network, including a Local Area Network (LAN) or a Wide Area Network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet service provider).
It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the computer program instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable medium that can direct a computer, other programmable data processing apparatus, or other devices to function in a particular manner, such that the instructions stored in the computer-readable medium produce an article of manufacture including instructions which implement the function/act specified in the flowchart and/or block diagram block or blocks.
The computer program instructions may also be loaded onto a computer (e.g., a coronary artery analysis system) or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer, other programmable apparatus or other devices to produce a computer implemented process such that the instructions which execute on the computer, other programmable apparatus or other devices provide processes for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks.
The above embodiments of the present invention have been described in further detail for the purpose of illustrating the invention, and it should be understood that the above embodiments are only illustrative of the present invention and are not to be construed as limiting the present invention, and any modifications, equivalents, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.
Claims (11)
1. A system for facilitating measurement of coronary vessel assessment parameters, characterized in that it performs a method comprising:
measurement of pressure P distal to a coronary stenosis by a pressure guidewiredAnd/or coronary inlet pressure Pa；
Selecting a first volume angiogram and a second volume angiogram measuring the blood vessel;
selecting a section of blood vessel from the proximal end to the distal end of the coronary artery for segmentation, and obtaining a coronary artery three-dimensional blood vessel model according to the first volume mapping image and the second volume mapping image through three-dimensional modeling;
obtaining the average time T of the contrast agent from the entrance to the exit of the blood vessel section according to the coronary artery three-dimensional blood vessel modela ；
Measuring the length L of the selected segmented vessel; according to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmaxWherein, according to the formula Tmax= L/V, the time T elapsed from the entrance to the exit of the contrast agent in the maximum dilated state is obtainedmax(ii) a The method of blood flow velocity V in the expanded state comprises: obtaining the diameter D of the blood vessel section once every t timet(ii) a Acquiring the pressure P of the distal end of the coronary artery stenosis once every t time through the pressure guide wiredAnd coronary artery inlet pressure Pa(ii) a According to Dt、Pa、PdEvery t time, an FFR is calculatedtThe value is solved according to the FFR definition and the blood flow velocity V is obtainedtA value; measuring the FFR value under the expansion state, and comparing the FFR value under the expansion state with the real-time FFRtComparing values to obtain the blood flow velocity VtThe value is the blood flow velocity V value in the expansion state;
according to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
2. The system for facilitating measurement of coronary vessel assessment parameters according to claim 1, wherein said coronary vessel assessment parameters comprise: coronary flow reserve CFR, microcirculation resistance coefficient IMR, when coronary flow increases from a resting state to a hyperemic state.
3. The system for facilitating measurement of coronary artery vessel assessment parameters according to claim 2, wherein said coronary flow reserve CFR = Ta / Tmax(ii) a And/or
The microcirculation resistance coefficient IMR= Pd ×Tmax 。
4. A system for facilitating measurement of coronary vessel assessment parameters according to any of claims 1 to 3, wherein said average time T elapsed from the entrance to the exit of said contrast agent from the vessel segment is obtainedaThe method comprises the following steps:
obtaining the time T elapsed from the entrance to the exit of the contrast agent in the first volume angiogram1Obtaining the time T elapsed from the entrance to the exit of the contrast agent in the second angiographic image2，
。
5. The system for facilitating measurement of coronary vessel assessment parameters according to claim 4, wherein said time T is1And T2The number of frames of the partial area image into which the heart cycle area is divided is calculated from the ratio of the number of frames per second transmission frames.
6. The system for facilitating measurement of coronary vessel assessment parameters according to any of claims 1 to 3, wherein the angle between said first body position and said second body position is greater than 30 °.
7. The system for conveniently measuring coronary artery blood vessel assessment parameters according to any one of claims 1 to 3, wherein said obtaining a coronary artery three-dimensional blood vessel model based on said first and second volumetric angiograms comprises:
removing interfering blood vessels of the first and second volume mapping images to obtain a result image;
extracting a coronary centerline and a diameter of each of the result images along an extending direction of the coronary artery;
and projecting each coronary artery central line and diameter on a three-dimensional space for three-dimensional modeling to obtain a coronary artery three-dimensional vessel model.
8. A measuring device for conveniently measuring coronary artery blood vessel assessment parameters, which is used for the system for conveniently measuring coronary artery blood vessel assessment parameters according to any one of claims 1-7, and is characterized by comprising: the device comprises a pressure guide wire measuring unit, an extraction coronary angiography unit, a three-dimensional modeling unit and a parameter measuring unit, wherein the extraction coronary angiography unit is connected with the three-dimensional modeling unit, and the parameter measuring unit is connected with the pressure guide wire measuring unit and the three-dimensional modeling unit;
the pressure guide wire measuring unit is used for measuring the pressure P at the far end of the coronary artery stenosis through the pressure guide wired And coronary artery inlet pressure Pa；
The coronary angiography extracting unit is used for selecting a first angiogram image and a second angiogram image of a measured blood vessel;
the three-dimensional modeling unit is used for receiving the first volume mapping image and the second volume mapping image transmitted by the coronary angiography extraction unit, and three-dimensional modeling is carried out to obtain a coronary artery three-dimensional blood vessel model;
the parameter measuring unit is used for receiving the coronary artery three-dimensional vessel model transmitted by the three-dimensional modeling unit and obtaining the average time T of the contrast agent passing from the entrance to the exit of the vessel sectiona (ii) a According to the coronary artery three-dimensional vessel model and the fluid mechanics formula, the time T of the contrast agent from the entrance to the exit of the vessel section in the maximum expansion state is obtainedmax(ii) a According to the Ta、TmaxAnd/or PdAnd/or PaCoronary vessel assessment parameters were obtained.
9. The measurement device for facilitating measurement of coronary vessel assessment parameters according to claim 8, wherein said parameter measurement unit comprises: a coronary flow reserve module, a microcirculation resistance coefficient module, and/or a coronary flow reserve fraction module; the coronary blood flow reserve module and the microcirculation resistance coefficient module are connected with the three-dimensional modeling unit; the microcirculation resistance coefficient module and the coronary artery blood flow reserve fraction module are both connected with the pressure guide wire measuring unit;
the coronary blood flow reserve module is used for measuring the CFR of the coronary blood flow reserve when the coronary blood flow is increased from the rest state to the hyperemia state, wherein CFR = Ta / Tmax；
The microcirculation resistance coefficient module is used for measuring the microcirculation resistance coefficient IMR, wherein IMR = Pd ×Tmax；
The coronary fractional flow reserve module is used for measuring the fractional flow reserve of coronary artery FFR, FFR = Pd/Pa 。
10. A coronary artery analysis system, comprising: a measurement device for facilitating measurement of a coronary vessel assessment parameter as claimed in claim 8 or 9.
11. A computer storage medium, characterized in that a computer program is executed by a processor for implementing a system for facilitating measurement of coronary vessel assessment parameters according to any of claims 1 to 7.
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| CN201910835038.3A CN110367965B (en) | 2018-09-19 | 2019-09-05 | Method, device and system for conveniently measuring coronary artery blood vessel evaluation parameters |
| JP2022514827A JP7324547B2 (en) | 2018-09-19 | 2019-11-01 | Measuring device for simply measuring coronary artery vascular rating parameters and coronary artery analysis system including the measuring device |
| EP19944607.1A EP4026492A4 (en) | 2019-09-05 | 2019-11-01 | Method, device and system for conveniently and quickly measuring assessment parameter for coronary artery |
| PCT/CN2019/115043 WO2021042479A1 (en) | 2019-09-05 | 2019-11-01 | Method, device and system for conveniently and quickly measuring assessment parameter for coronary artery |
| US17/684,604 US20220183644A1 (en) | 2019-09-05 | 2022-03-02 | Method, apparatus and system for conveniently measuring coronary artery vascular evaluation parameters |
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| CN201811093192X | 2018-09-19 | ||
| CN201811093192.XA CN109363651A (en) | 2018-09-19 | 2018-09-19 | It is a kind of for measuring blood flow reserve score when obtain aortic pressure device |
| CN201910206541.2A CN109770888A (en) | 2019-03-19 | 2019-03-19 | The method instantaneously without waveform ratio is calculated based on pressure sensor and contrastographic picture |
| CN2019102065412 | 2019-03-19 | ||
| CN201910835038.3A CN110367965B (en) | 2018-09-19 | 2019-09-05 | Method, device and system for conveniently measuring coronary artery blood vessel evaluation parameters |
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