CN111166315B - Method for calculating instantaneous mode-free ratio and resting state diastolic pressure ratio based on contrast image - Google Patents
Method for calculating instantaneous mode-free ratio and resting state diastolic pressure ratio based on contrast image Download PDFInfo
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- CN111166315B CN111166315B CN201811344060.XA CN201811344060A CN111166315B CN 111166315 B CN111166315 B CN 111166315B CN 201811344060 A CN201811344060 A CN 201811344060A CN 111166315 B CN111166315 B CN 111166315B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
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- G06T17/00—Three dimensional [3D] modelling, e.g. data description of 3D objects
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Abstract
The invention discloses a method for calculating instantaneous no-wave type ratio and resting state diastolic pressure ratio based on a contrast image, which comprises the following steps: measuring the pressure P at the coronary ostia of the heart in diastole a (ii) a Acquiring the two-dimensional caliber and the length of a blood vessel through a radiography image, generating a three-dimensional blood vessel grid model through two radiography images and acquiring the three-dimensional caliber and the length of the blood vessel; during diastole, the time taken by blood containing a contrast agent from a starting point to an ending point of a specified blood vessel is measured, and the blood flow velocity V is calculated from the time and the three-dimensional length of the blood vessel 1 (ii) a Calculating to obtain the blood flow velocity V in the resting state 2 (ii) a Will V 2 As the flow rate at the coronary artery inlet, the pressure drop Δ P from the coronary artery inlet to the distal stenosis of the coronary artery, the mean pressure P in the distal coronary artery of the stenosis, was calculated d =P a - Δ P, calculating the instantaneous wave-free ratio and the resting diastolic pressure ratio. The iFR, dFR and DFR can be obtained by conventional contrast imaging without using vasodilators.
Description
Technical Field
The invention relates to the field of coronary artery imaging evaluation, in particular to a method for determining an instantaneous wave-free ratio (iFR) and a resting state diastolic pressure ratio (dFR and DFR) only through an image and an aorta pressure.
Background
Fractional Flow Reserve (FFR) can indicate the effect of coronary stenosis on distal blood flow, and diagnosis whether myocardial ischemia is present has become a recognized indicator for functional assessment of coronary stenosis. FFR is defined as the ratio of the maximum blood flow provided by a narrowed coronary artery to the myocardium in the innervation area to the maximum blood flow provided to the myocardium in the normal state of the same coronary artery.Can be simplified into the narrow distal coronary artery internal pressure equalizing (P) under the maximal hyperemia state of the cardiac muscle d ) And the mean pressure (P) of the coronary artery and the oral aorta a ) I.e. FFR = P d /P a 。
When the FFR is determined, the FFR is calculated by obtaining the mean pressure in the coronary artery at the distal end of the stenosis by different means based on the blood flow velocity in the maximal hyperemia state of the myocardium and the mean pressure in the aorta at the mouth of the coronary artery. However, maximal myocardial hyperemia requires coronary or intravenous injection of adenosine or ATP, which causes a decrease in aortic pressure and has certain side effects such as atrioventricular block, dou Huan, sinus arrest, etc., contraindications including 2 or 3 degree atrioventricular block, sinoatrial node disease, tracheal or bronchial asthma, and adenosine hypersensitivity.
The instantaneous waveform-free ratio (iFR) can provide coronary intra-arterial pressure measurements similar to Fractional Flow Reserve (FFR). The iFR does not need a vasodilator, is simple to operate and can be more applied to coronary intervention treatment. The ADVISE study found that the intracoronary microvascular resistance was relatively most stable and minimal during a certain time of diastole (referred to as the no-waveform phase), similar to the mean resistance achieved during coronary hyperemia with vasodilatory drugs such as adenosine. As shown in fig. 1, i.e., iFR = P dWave-free period /P aWave-free period (P dWave-free period : the stenosis is the mean pressure of the distal coronary during the absence of the waveform. P aWave-free period : the mean aortic pressure during the absence of the waveform. Operation time of the instantaneous waveform-free period: 25% of the time after the start of the waveform-free period in diastole, and stop counting at the time 5ms before the start of systole). A study article was published in top-grade medical journal NEJM that the IFR-directed revascularization strategy was not inferior to the FFR-directed reconstruction strategy in patients with stable angina or acute coronary syndrome, and was similar in the incidence of major adverse cardiac events over 12 months.
The resting diastolic pressure ratio (dFR and DFR) as shown in fig. 2 can be expressed as: dFR = P dDiastolic period /P aDiastolic period (P dDiastolic period : in thatMean coronary pressure distal to the stenotic lesion during the diastolic phase. P aDiastolic period : aortic average pressure during diastolic state); as shown in fig. 3, DFR = P dDiastolic hyperemia free period /P aDiastolic hyperemia free period (P dDiastolic hyperemia free period : in the interval from the aorta pressure being less than the average aortic pressure to the minimum aortic pressure, the coronary artery pressure at the distal end of the stenosis is averaged. P aDiastolic hyperemia free period : the mean aortic pressure in the interval from the aortic pressure being less than the mean aortic pressure to the aortic pressure being the lowest). Further studies have shown that the resting diastolic pressure ratio (dFR and DFR) is substantially fully equivalent to the instantaneous waveform-free ratio (iFR). Therefore, we can obtain iFR ≡ DFR ≡ dFR = P dDiastolic period /P aDiastolic period 。
At present, the existing methods for measuring the instantaneous wave-free ratio (iFR) and the resting diastolic pressure ratio (dFR and DFR) mainly comprise: and measuring corresponding diastolic intervals in the resting state of the pressure guide wire to determine iFR, dFR and DFR. The measurement needs to be carried out by depending on a pressure guide wire, the tail end of a blood vessel needs to be intervened when the pressure guide wire is used for measurement, the operation difficulty and risk are increased, and meanwhile, the large-scale application of the pressure guide wire is limited due to the expensive price of the pressure guide wire.
Disclosure of Invention
In order to solve the technical problems, the invention aims to: a method for calculating the instantaneous wave-free ratio and the resting diastolic pressure ratio based on contrast images is provided, which is used for detecting myocardial ischemia in coronary heart disease patients through conventional coronary angiography, i.e., without using vasodilator (i.e., without using myocardial maximal hyperemia state and without using adenosine or ATP). The instantaneous mode-free ratio (iFR), resting diastolic pressure ratio (dFR and DFR) were calculated from the conventional contrast images, aortic pressure and blood flow.
The technical scheme of the invention is as follows:
a method of calculating an instantaneous mode-free ratio and a resting-state diastolic pressure ratio based on a contrast image, comprising the steps of:
s01: measurement by blood pressure sensor in diastolePressure P of coronary ostia of heart a ；
S02: acquiring the two-dimensional diameter and length of a blood vessel through a radiography image, generating a three-dimensional blood vessel grid model through two radiography images with an included angle of more than 30 degrees, and acquiring the three-dimensional diameter and length of the blood vessel;
s03: during diastole, the time taken by blood containing a contrast agent to reach the end point from the start point of a specified blood vessel is measured, and the blood flow velocity V is calculated from the time and the three-dimensional length of the blood vessel 1 ；
S04: calculating the blood flow velocity V in the rest state according to the following calculation formula 2 The calculation formula is as follows:
when V is 1 When the thickness is less than or equal to 100mm/s, V 2 ＝0.53*V 1 +20；
When the thickness is 100mm/s<V 1 When the thickness is less than or equal to 200mm/s, V 2 ＝0.43*V 1 +35；
When V is 1 >At 200mm/s, V 2 ＝0.35*V 1 +55；
S05: the blood flow velocity V under the contrast state obtained by calculation 2 As the flow rate at the coronary artery inlet, the pressure drop Δ P from the coronary artery inlet to the distal stenosis of the coronary artery, the mean pressure P in the distal coronary artery of the stenosis, was calculated d ＝P a - Δ P, via the formula iFR ≡ DFR ≡ dFR = P d /P a The instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dFR and DFR) were calculated.
In a preferable technical scheme, the step S01 includes that a pressure tube of a blood pressure sensor is connected to a multi-connected tee joint, and then is connected with a coronary artery port of the heart through an angiography catheter, saline is filled in the pressure tube of the blood pressure sensor, the blood pressure sensor and the heart are kept at the same horizontal position, a pressure wave measured by the blood pressure sensor is a pressure wave of the coronary artery port of the heart, and an average value of instantaneous pressure is P in diastole a 。
In a preferred embodiment, the method for generating a three-dimensional blood vessel mesh model in step S02 includes the following steps:
s21: performing three-dimensional reconstruction on 2D structure data of two segmented blood vessels with a mapping relation on two X-ray coronary angiography images with an included angle of more than 30 degrees to obtain 3D structure data of the segmented blood vessels;
s22: and repeating the step S21 until the three-dimensional reconstruction of all the segmented blood vessels is completed, and combining the reconstructed segmented blood vessels to obtain a complete three-dimensional blood vessel mesh model.
In a preferred embodiment, the blood flow velocity V is calculated in step S03 1 The specific method comprises the following steps:
s31: the heart rate of a specified patient is acquired as H times/minute, the image frequency is acquired from contrast image information as S frames/second, and the calculation formula of the frame number X is as follows: x = (1 ÷ (H ÷ 60)) × S;
s32: respectively obtaining a starting point and an ending point of a diastolic period of a heartbeat cycle on images corresponding to a two-dimensional starting frame and an ending frame according to the number of frames of images in the diastolic period of the heartbeat cycle, and then intercepting the blood vessel length of the diastolic period of the heartbeat cycle in a three-dimensional blood vessel mesh model according to the starting point and the ending point;
s33: by the formula V 1 = L ÷ P, the blood flow velocity V is calculated 1 L is the length of the blood vessel, P is the time taken for the diastolic phase of one heart cycle, P = X ÷ S.
In a preferred technical solution, the specific method for calculating the pressure drop Δ P from the coronary artery entrance to the distal end of the coronary artery stenosis in step S05 is as follows:
s41: solving a basic formula of the incompressible flow based on the blood flow velocity and the three-dimensional blood vessel mesh model, solving the three-dimensional blood vessel mesh model, and solving continuity and a Navier-Stokes equation by using a numerical method:
wherein
P, rho and mu are respectively flow velocity, pressure, blood flow density and blood flow viscosity;
the inlet boundary condition is the blood flow velocity, and the outlet boundary condition is the out-flow boundary condition;
s42: the pressure drop ap from the entrance to various points downstream along the centerline of the vessel is calculated.
Compared with the prior art, the invention has the advantages that:
myocardial ischemia is detected by conventional coronary angiography procedures in patients with coronary heart disease, i.e., without the use of vasodilators (i.e., without the need for maximal hyperemia of the myocardium and without the use of adenosine or ATP). The instantaneous mode-free ratio (iFR), resting diastolic pressure ratio (dFR and DFR) were calculated from the conventional contrast images, aortic pressure and blood flow. The pressure guide wire does not need to be additionally inserted for measurement, the operation is simple and convenient, the operation difficulty and risk are greatly reduced, and the method can be clinically popularized and applied in a large scale.
Drawings
The invention is further described with reference to the following figures and examples:
FIG. 1 is a schematic illustration of instantaneous waveless ratio (iFR);
FIG. 2 is a schematic representation of the resting diastolic pressure ratio (dFR);
FIG. 3 is a schematic representation of resting diastolic pressure ratio (DFR);
FIG. 4 is a flow chart of a method of the present invention;
FIG. 5 is a two-dimensional blood vessel image;
FIG. 6.1 is an image of the body position-one contrast agent flow to the catheter port;
FIG. 6.2 is an image of body position one contrast agent flowing to the distal end of the vessel;
FIG. 6.3 is an image of the second contrast agent flow to the catheter port;
FIG. 6.4 is an image of the second contrast agent flow to the distal end of the vessel;
FIG. 7 is a cross-sectional screen shot of a grid;
fig. 8 is a cross-sectional view of a grid.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail with reference to the accompanying drawings in combination with the embodiments. It should be understood that the description is intended to be exemplary only, and is not intended to limit the scope of the present invention. Moreover, in the following description, descriptions of well-known structures and techniques are omitted so as to not unnecessarily obscure the concepts of the present invention.
As shown in fig. 4, a method of determining the instantaneous mode-free ratio (iFR), the resting-state diastolic pressure ratio (dFR and DFR) only from a contrast image and aortic pressure according to the present invention includes the following steps.
Step S1: measuring the pressure P of the coronary ostia of the heart in diastole by means of a blood pressure sensor a The specific method comprises the following steps:
the pressure tube using the blood pressure sensor is connected to a multi-connected tee joint and then connected with a coronary ostium of the heart through an angiography catheter, saline is filled in the pressure tube of the blood pressure sensor, the blood pressure sensor and the heart are kept at the same horizontal position, the pressure wave measured by the blood pressure sensor is the pressure wave of the coronary ostium of the heart, and the average value of the instantaneous pressure is P in diastole a 。
Step S2: acquiring the two-dimensional diameter and length of a blood vessel through a radiography image, as shown in fig. 5, generating a three-dimensional blood vessel mesh model through two radiography images with an included angle of more than 30 degrees, and acquiring the three-dimensional diameter and length of the blood vessel;
the specific method of the three-dimensional blood vessel mesh model is as follows:
performing three-dimensional reconstruction on the 2D structural data of two segmented blood vessels in a mapping relation on the X-ray coronary angiography images at two different angles to obtain the 3D structural data of the segmented blood vessels;
repeating the above steps until the three-dimensional reconstruction of all the segmented blood vessels is completed, and then combining the reconstructed segmented blood vessels to obtain the complete three-dimensional blood vessel, as shown in fig. 7 and 8.
And step S3: as shown in fig. 6.1-6.4, during diastole, the measured blood (containing contrast agent) goes from a starting point (6.1, 6.3) of a segment of a designated blood vessel (including a possible criminal blood vessel) toThe time taken to end the points (6.2, 6.4) and the blood flow velocity V is calculated from this time and the three-dimensional length of the vessel 1 The specific method comprises the following steps:
the heart rate of a specified patient is acquired as H times/minute, the image frequency is acquired from contrast image information as S frames/second, and the calculation formula of the frame number X is as follows: x = (1 ÷ (H ÷ 60)) × S;
respectively obtaining a starting point and an ending point of a heartbeat cycle diastole on images corresponding to a two-dimensional starting frame and an ending frame, such as fig. 6.1 and 6.2 or fig. 6.3 and 6.4, according to the frame number of the images in the heartbeat cycle diastole, and then intercepting the blood vessel length of the heartbeat cycle diastole from the three-dimensional synthetic data according to the starting point and the ending point;
assuming that the length of the intercepted blood vessel is L and the time taken for the diastole of one heart cycle is P, the method is represented by the formula 1: p = X ÷ S; equation 2: v 1 = L ÷ P, the blood flow velocity V is obtained 1 。
And step S4: calculating the blood flow velocity V at rest 2 ；
Blood flow velocity V in its resting state 2 The calculation formula of (c) is as follows:
when V is 1 V is less than or equal to 100 millimeters per second (mm/s) 2 ＝0.53*V 1 +20；
When the thickness is 100mm/s<V 1 When the thickness is less than or equal to 200mm/s, V 2 ＝0.43*V 1 +35；
When V is 1 >At 200mm/s, V 2 ＝0.35*V 1 +55；
Step S5: using the blood flow velocity V2 in the contrast state calculated in step S4 as a coronary artery inlet flow velocity, calculating a pressure drop Δ P from a coronary artery inlet to a distal end of a coronary stenosis, and calculating an instantaneous non-waveform ratio (iFR) and a resting state diastolic pressure ratio (dFR and DFR) by using the formula iFR ≦ DFR ≦ dFR = Pd/Pa in the distal coronary artery in the diastolic stenosis.
The specific method for calculating the pressure drop Δ P from the coronary artery entrance to the distal end of the coronary stenosis in step S5 is as follows:
solving a basic formula of the incompressible flow based on the blood flow velocity and the three-dimensional blood vessel mesh model, solving the three-dimensional blood vessel mesh model, and solving continuity and a Navier-Stokes equation by using a numerical method:
wherein
P, rho and mu are respectively flow velocity, pressure, blood flow density and blood flow viscosity;
the inlet boundary condition is the blood flow velocity, and the outlet boundary condition is the out-flow boundary condition;
the pressure drop ap from the entrance to various points downstream along the centerline of the vessel is calculated.
It should be understood that the above-described embodiments of the present invention are merely illustrative of or explaining the principles of the invention and are not to be construed as limiting the invention. Therefore, any modifications, equivalents, improvements and the like which are made without departing from the spirit and scope of the present invention shall be included in the protection scope of the present invention. Further, it is intended that the appended claims cover all such variations and modifications as fall within the scope and boundaries of the appended claims or the equivalents of such scope and boundaries.
Claims (5)
1. A method of calculating a transient aneroid ratio and a resting diastolic pressure ratio based on a contrast image, comprising the steps of:
s01: measuring the pressure P of the coronary ostia of the heart in diastole by means of a blood pressure sensor a ；
S02: acquiring the two-dimensional diameter and length of a blood vessel through a radiography image, generating a three-dimensional blood vessel grid model through two radiography images with an included angle of more than 30 degrees, and acquiring the three-dimensional diameter and length of the blood vessel;
S03：during diastole, the time taken by blood containing a contrast agent from a starting point to an ending point of a specified blood vessel is measured, and the blood flow velocity V is calculated from the time and the three-dimensional length of the blood vessel 1 ；
S04: calculating to obtain the blood flow velocity V in the resting state according to the following calculation formula 2 The calculation formula is as follows:
when V is 1 When the thickness is less than or equal to 100mm/s, V 2 ＝0.53*V 1 +20；
When the thickness is 100mm/s<V 1 When the thickness is less than or equal to 200mm/s, V 2 ＝0.43*V 1 +35；
When V is 1 >At 200mm/s, V 2 ＝0.35*V 1 +55；
S05: calculating the blood flow velocity V in the rest state 2 Calculating the pressure drop DeltaP from the coronary artery inlet to the distal coronary stenosis and the mean pressure P in the distal coronary artery d ＝P a - Δ P, via the formula iFR ≡ DFR ≡ dFR = P d /P a The instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dFR and DFR) were calculated.
2. The method for calculating the ratio of the instantaneous voltage-free mode to the resting diastolic pressure based on the angiographic image of claim 1, wherein step S01 comprises connecting the pressure tube of the blood pressure sensor to the multi-tee, connecting the pressure tube to the coronary ostium of the heart through the angiographic catheter, filling the pressure tube of the blood pressure sensor with saline, and maintaining the blood pressure sensor at the same level as the heart, wherein the pressure wave measured by the blood pressure sensor is the pressure wave at the coronary ostium of the heart, and wherein the average value of the instantaneous pressure during the diastolic period is P a 。
3. The method of calculating the instantaneous no-wave type ratio and the resting state diastolic pressure ratio based on the contrast image as set forth in claim 1, wherein the method of generating the three-dimensional blood vessel mesh model in step S02 includes the steps of:
s21: performing three-dimensional reconstruction on 2D structural data of two segmented blood vessels with a mapping relation on two X-ray coronary angiography images with an included angle of more than 30 degrees to obtain 3D structural data of the segmented blood vessels;
s22: and repeating the step S21 until the three-dimensional reconstruction of all the segmented blood vessels is completed, and combining the reconstructed segmented blood vessels to obtain a complete three-dimensional blood vessel mesh model.
4. The method of calculating the instantaneous no-wave type ratio and the resting state diastolic pressure ratio based on the contrast image as set forth in claim 1, wherein the blood flow velocity V is calculated in step S03 1 The specific method comprises the following steps:
s31: the heart rate of a specified patient is acquired as H times/minute, the image frequency is acquired from contrast image information as S frames/second, and the calculation formula of the frame number X is as follows: x = (1 ÷ (H ÷ 60)) × S;
s32: respectively obtaining a starting point and an ending point of a diastolic period of a heartbeat cycle on images corresponding to a two-dimensional starting frame and an ending frame according to the number of frames of images in the diastolic period of the heartbeat cycle, and then intercepting the length of a blood vessel in the diastolic period of the heartbeat cycle in a three-dimensional blood vessel mesh model according to the starting point and the ending point;
s33: by the formula V 1 Calculating to obtain blood flow velocity V 1 L is the length of the blood vessel, P is the time taken for the diastolic phase of one heart cycle, P = X ÷ S.
5. The method for calculating the instantaneous no-wave type ratio and the resting diastolic pressure ratio based on the contrast image as set forth in claim 1, wherein the specific method for calculating the pressure drop Δ P from the coronary artery entrance to the distal end of the coronary stenosis in step S05 is as follows:
s41: solving a basic formula of the incompressible flow based on the blood flow velocity and the three-dimensional blood vessel mesh model, solving the three-dimensional blood vessel mesh model, and solving continuity and a Navier-Stokes equation by using a numerical method:
wherein
P, ρ, μ is flow velocity, pressure, blood flow density, blood flow viscosity, respectively;
the inlet boundary condition is the blood flow velocity, and the outlet boundary condition is the out-flow boundary condition;
s42: the pressure drop ap from the entrance to various points downstream along the centerline of the vessel is calculated.
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| CN201811344060.XA CN111166315B (en) | 2018-11-13 | 2018-11-13 | Method for calculating instantaneous mode-free ratio and resting state diastolic pressure ratio based on contrast image |
| PCT/CN2019/071205 WO2020098139A1 (en) | 2018-11-13 | 2019-01-10 | Method for calculating instantaneous wave-free ratio and resting diastolic pressure ratio on basis of contrast image |
| CN201980040566.8A CN112384137B (en) | 2018-11-13 | 2019-11-13 | Method and device for acquiring blood vessel assessment parameters in resting state based on contrast image |
| PCT/CN2019/118058 WO2020098705A1 (en) | 2018-11-13 | 2019-11-13 | Method and device for obtaining vascular assessment parameters in resting state on basis of angiographic image |
| CN201980040404.4A CN112384136A (en) | 2018-11-13 | 2019-11-13 | Method, device and system for obtaining blood vessel evaluation parameters based on radiography images |
| PCT/CN2019/118053 WO2020098704A1 (en) | 2018-11-13 | 2019-11-13 | Method, apparatus and system for acquiring vascular assessment parameter on basis of angiographic image |
| EP19885173.5A EP3881758A4 (en) | 2018-11-13 | 2019-11-13 | Method, apparatus and system for acquiring vascular assessment parameter on basis of angiographic image |
| JP2021523637A JP7162934B2 (en) | 2018-11-13 | 2019-11-13 | Method, apparatus and system for obtaining vascular assessment parameters based on contrast-enhanced images |
| US17/237,662 US20210236000A1 (en) | 2018-11-13 | 2021-04-22 | Method, device and system for acquiring blood vessel evaluation parameters based on angiographic image |
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| CN111166315A (en) | 2020-05-19 |
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