CN113409286B - Laser ablation evaluation system based on magnetic resonance guidance - Google Patents
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Abstract
The laser ablation evaluation system based on the magnetic resonance guidance comprises an estimation module, a monitoring module and an evaluation module, wherein the estimation module estimates the ablation area and presets ablation implementation parameters by carrying out three-dimensional sketching on an ablation area and a peripheral area, adding corresponding material properties and storing a tissue material property list, and using a fitting function or an energy diffusion simulation model; the monitoring module monitors and ablates and evaluates the ablation process in real time; the evaluation module performs three-dimensional modeling on the real-time recorded evaluation ablation area, automatically fits into an approximate ablation area, or performs registration and contrast analysis on the same sequence images of the preoperative structure phase and the postoperative structure phase, performs highlight identification on the changed area, reconstructs the postoperative ablation area by using a three-dimensional rapid sketching method, and compares the three-dimensional rapid sketching method with the preoperative estimated ablation area so as to evaluate the ablation result; the invention can assist related workers in quick and accurate diagnosis and prediction.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a laser ablation evaluation system based on magnetic resonance guidance.
Background
With the improvement of living standard, the whole life span is prolonged, and the incidence rate of malignant tumors or tissue lesions can be found to be rapidly increased based on different statistical data. The thermal ablation has better curative effect and definite mechanism in the aspects of treating tissue lesions, epilepsy, hamartoma, canceration cell damage and the like, and can precisely ablate single or a plurality of specific lesions so as to lead the lesion cells to generate irreversible damage or coagulation necrosis. In the medical field, the thermal ablation modes are more, such as radio frequency ablation, microwave ablation, laser ablation and the like. In a broad sense, high intensity focused ultrasound and cryoablation may also fall within this technical scope.
Typically, the assessment of ablation results is based on focal tissue temperature and temperature duration to computationally assess heat loss from the tissue. In the existing ablation operation, the biggest limitation is that the ablated area cannot be judged in a very clear and real-time manner, parameters and the ablated area required in the operation process cannot be effectively estimated, and the judgment can be only carried out according to the use experience of related workers. In addition, the main method of the existing ablation is to use CT or perform magnetic resonance to perform postoperative evaluation after ablation is completed, if ablation is incomplete, the ablation operation needs to be performed again, real-time adjustment in the operation cannot be performed, excessive ablation is possibly caused under the condition of ensuring the ablation is complete, and irreversible damage is caused to normal tissues of a patient. With the development of MRI temperature measurement technology, especially in laser ablation, MRI is used for monitoring tissue temperature in real time, so that the approximate judgment of temperature distribution in the operation is solved, and the ablation result is judged through an ablation formula. However, most ablation formulas are subjected to data correction, and the corrected ablation formulas often introduce clinical experience of related workers, so that uncertainty of an ablation judgment result is increased. Meanwhile, the judgment of the ablation result is only carried out in the operation, and the judgment factor of the ablation condition of the tissue is single.
How to monitor the whole process of the ablation result, how to accurately evaluate the ablation result based on accurate temperature, avoid using uncertain factors such as artificial experience data in the ablation process, and the like is a problem to be solved urgently by the technicians in the field.
Disclosure of Invention
The embodiment of the specification aims to provide a laser ablation evaluation system based on magnetic resonance guidance, which carries out parameterized ablation prediction, noninvasive real-time damage evaluation and postoperative image confirmation in three time periods before, during and after operation so as to carry out more accurate thermal ablation on a focus. Meanwhile, the calculation related to real-time ablation can penetrate through the whole operation flow, so that the operation is more controllable.
In order to solve the above technical problems, the embodiments of the present specification are implemented in the following manner.
The invention discloses a laser ablation evaluation system based on magnetic resonance guidance, which comprises an estimation module, a monitoring module and an evaluation module, wherein: the estimating module is used for carrying out at least one of the following processes: creating a planned ablation area, completing the estimation of the planned ablation area and planned ablation parameters, and obtaining a surgical scheme; the monitoring module monitors the digestion process in real time; the evaluation module rebuilds an actual ablation area, and performs contrast analysis on the images of the planned ablation area and the actual ablation area to obtain image evaluation information, wherein the image evaluation information is displayed on the human-computer interaction module; the image evaluation information at least comprises one of the following: percentage of ablation area, tissue shrinkage, tissue expansion, and tissue edema.
Further, the estimating module completes the estimation of the planned ablation parameters through a fitting function based on the planned ablation area and the operation scheme, the fitting function is expressed as a function of the ablation time and the ablation area under the preset laser power and the laser wavelength, and the formula is as follows:
wherein Area (t) is a piecewise function to represent the ablation Area at ablation time t; c (C) 0 Is a first constant, C 1 Is a second constant, C 2 Is a third constant, C 3 Is a fourth constant, wherein C 0 、C 1 、C 2 、C 3 Is a constant obtained in advance; t is the ablation time; c (C) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached.
Further, the fitting function is obtained by: acquiring a plurality of groups of actual ablation experimental data, wherein the actual ablation experimental data comprise laser light output power, ablation time, ablation area, laser wavelength and total energy; and fitting the actual ablation experimental data to obtain the fitting function.
Further, the pre-estimation module will at least complete the following: (1) obtaining a medical image of focus tissue;
(2) confirming the tissue type and the tissue attribute of the focus tissue; (3) acquiring a three-dimensional model of the focal tissue according to the medical image, wherein the three-dimensional model is attached with the tissue type and the tissue attribute; (4) dividing the lesion tissue into a plurality of dividing areas capable of three-dimensional display according to the three-dimensional model and aiming at different tissue types of the lesion tissue; (5) simulating a temperature distribution and/or an ablation damage percentage distribution map of the actual ablation process dynamics based on the tissue properties of each of the segmented regions to determine a surgical plan of the entire three-dimensional model.
Further, the estimation module at least considers a biological heat transfer model and/or an energy simulation model containing blood flow perfusion influence to simulate the dynamic temperature distribution and/or the ablation damage percentage distribution map of the actual ablation process; and/or, the thermal ablation calculation model is an Arrhenius equation or a CEM43 model.
Further, the surgical plan includes at least one of: the optical fiber insertion path, the planned ablation times, the planned ablation area and the planned ablation parameters; and/or
The ablation parameters include at least one of: the laser beam irradiation method comprises the steps of laser beam irradiation power, laser beam irradiation time, laser beam irradiation mode, cooling medium circulation rate, laser beam wavelength and total energy; and/or
The tissue attributes include at least one of: anisotropy of tissue, absorptivity of tissue, reflectivity of tissue, refractive index of tissue, blood flow perfusion rate of tissue, thermal conductivity of tissue, specific heat of tissue, thermal transfer of tissue.
Further, the Arrhenius equation reflects an empirical formula of a relationship between a chemical reaction rate and a temperature, and specifically comprises:
wherein the Arrhenius equation is used for real-time ablation feedback in surgery, R is a universal gas constant, T: is the temperature (k), A is the Arrhenius constant, and the unit is s -1 ，E a Is the activation energy, c (0) is the initial concentration of cells, and c (t) is the concentration of cells at time t.
Further, the real-time monitoring process of the monitoring module comprises: inserting an ablation probe to a respective location according to the surgical plan and the three-dimensional model; setting scanning parameters of magnetic resonance temperature imaging, wherein the monitoring module identifies the size of pixel points by reading information in a DICOM image, and uses each pixel point as an ablation unit for calculation; and under the magnetic resonance thermometry, combining the segmentation of the planned ablation region and the tissue attribute, and performing ablation monitoring.
Further, when the ablation monitoring is performed by using the Arrhenius equation, performing ablation threshold display on the ablation condition of the ablation unit; selecting different colors to mark and display the ablation condition of the ablation unit; alternatively, in the ablation monitoring using the CEM43 model, different colors are used to display ablation thresholds for ablation regions.
Further, when the ablation monitoring is performed by using the Arrhenius model, when the tissue temperature is beyond a first range, the ablation condition of the tissue in the first range is between the condition that the damage is possibly caused and the damage is not completely destroyed, and then an ablation threshold value is displayed on the tissue in the first range.
Further, when the CEM43 model is used for performing the ablation monitoring, the ablation region is displayed in a mask or semi-transparent mode, and after the tissue structure phases are displayed in a superimposed mode in the ablation region, the planned ablation region and the actual ablation region are simultaneously seen.
Further, if the actual ablation area is larger than the planned ablation area, the monitoring module automatically presents a bullet frame to prompt whether to stop ablation; if the actual ablation area exceeds a first percentage, the monitoring module will automatically shut off the energy output.
Further, the evaluating module evaluating the degree of ablation includes: carrying out highlighting identification on the changed ablation area by using a contrast difference method, and reconstructing an actual ablation area after operation by using a three-dimensional rapid sketching method, wherein the actual ablation area is compared with the planned ablation area in percentage and calculated; if the ablation area percentage exceeds a first percentage, over-ablating; insufficient ablation if below a second percentage, wherein the first percentage is greater than the second percentage.
Further, the calculation of the percentage of ablation area simultaneously considers at least one of the following factors: the planned ablation region is an overlapping ablation range, an ablation range outside the planned ablation region, and a non-ablated range within the planned ablation region.
The invention has the following beneficial effects.
The invention can effectively perform ablation prediction before operation, give proper thermal dose in operation and perform real-time ablation evaluation, and can compare the images before operation and the images after operation (still in the same magnetic resonance chamber) so as to judge the ablation effect more accurately. If the ablation effect is poor, the ablation can be continued without secondary operation. The accurate ablation evaluation of real-time monitoring and real-time feedback of the ablation result in the whole process of operation is realized.
The invention predicts the ablation area before operation, and performs operation with more accurate path planning and less trauma.
The invention can perform non-invasive intraoperative ablation prediction in real time, guide doctors to perform more accurate ablation operation, and reduce the influence caused by incomplete ablation or excessive ablation.
The invention can carry out image evaluation and comparison after operation, more rapidly delineate the ablation area and judge the state of the ablation area. Imaging is generally one of the main criteria for determining whether to ablate in the case of excluding tissue biopsies.
The invention creatively provides an evaluation system integrating a prediction module, a monitoring module and an evaluation module, which can assist related workers to perform quick and accurate diagnosis and prediction.
Drawings
In order to more clearly illustrate the embodiments of the present description or the technical solutions in the prior art, the drawings that are required in the embodiments or the description of the prior art will be briefly described below, it being obvious that the drawings in the following description are only some of the embodiments described in the present description, and that other drawings may be obtained according to these drawings without inventive effort for a person skilled in the art.
Fig. 1 is a system block diagram of the present invention.
Fig. 2 is a system workflow diagram of the present invention.
FIG. 3A is a schematic view of a ring-shaped optical fiber according to the present invention.
FIG. 3B is a schematic view of a dispersion fiber according to the present invention.
FIG. 3C is a schematic diagram of a side-emitting fiber of the present invention.
Detailed Description
In order to make the technical solutions in the present specification better understood by those skilled in the art, the technical solutions in the embodiments of the present specification will be clearly and completely described below with reference to the drawings in the embodiments of the present specification, and it is obvious that the described embodiments are only some embodiments of the present specification, not all embodiments. All other embodiments, which can be made by one of ordinary skill in the art without undue burden from the present disclosure, are intended to be within the scope of the present disclosure.
Example 1
A laser ablation evaluation system based on magnetic resonance guidance, comprising an estimation module, a monitoring module and an evaluation module, wherein: the estimating module is used for carrying out at least one of the following processes: creating a planned ablation area, completing the estimation of the planned ablation area and planned ablation parameters, and obtaining a surgical scheme; the monitoring module monitors the digestion process in real time; the evaluation module reconstructs an actual ablation area, registers and compares and analyzes the images of the planned ablation area and the actual ablation area to obtain image evaluation information, and the image evaluation information is displayed on the man-machine interaction module; the image evaluation information at least comprises one of the following: percentage of ablation area, tissue shrinkage, tissue expansion, and tissue edema.
Further, the estimating module completes the estimation of the planned ablation parameters through a fitting function based on the planned ablation area and the operation scheme, the fitting function is expressed as a function of the ablation time and the ablation area under the preset laser power and the laser wavelength, and the formula is as follows:
wherein Area (t) is a piecewise function to represent the ablation Area at ablation time t; c (C) 0 Is a first constant, C 1 Is a second constant, C 2 Is a third constant, C 3 Is a fourth constant, wherein C 0 、C 1 、C 2 、C 3 Is a constant obtained in advance; t is the ablation time; c (C) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached.
Wherein the fitting function is obtained by:
acquiring a plurality of groups of actual ablation experimental data, wherein the actual ablation experimental data comprise laser light output power, ablation time, ablation area, laser wavelength and total energy; and fitting the actual ablation experimental data to obtain the fitting function. The fitting mode may be a piecewise regression mode or other fitting modes, and the writing fitting mode is the prior art and will not be described herein.
Further, the pre-estimation module will at least complete the following:
(1) obtaining a medical image of focus tissue;
(2) confirming the tissue type and the tissue attribute of the focus tissue;
(3) acquiring a three-dimensional model of the focal tissue according to the medical image, wherein the three-dimensional model is attached with the tissue type and the tissue attribute;
(4) dividing the lesion tissue into a plurality of dividing areas capable of three-dimensional display according to the three-dimensional model and aiming at different tissue types of the lesion tissue;
(5) Simulating an actual ablation process based on the tissue attribute of each segmented region to obtain a dynamic temperature distribution and/or an ablation damage percentage distribution map, and acquiring a surgical scheme of the whole three-dimensional model.
The estimation module at least adopts a biological heat transfer model and/or an energy simulation model containing blood flow perfusion influence to simulate the actual ablation process to obtain dynamic temperature distribution and/or an ablation damage percentage distribution map; and/or the thermal ablation calculation model is an Arrhenius 'equation (Arrhenius' algorithm) or a CEM43 model.
Wherein the surgical plan includes at least one of: the optical fiber insertion path, the planned ablation times, the planned ablation area and the planned ablation parameters; and/or, the ablation parameters comprise at least one of: the laser beam irradiation method comprises the steps of laser beam irradiation power, laser beam irradiation time, laser beam irradiation mode, cooling medium circulation rate, laser beam wavelength and total energy; and/or, the tissue attribute comprises at least one of: anisotropy of tissue, absorptivity of tissue, reflectivity of tissue, refractive index of tissue, blood flow perfusion rate of tissue, thermal conductivity of tissue, specific heat of tissue, thermal transfer of tissue; and/or the energy simulation model comprises at least one of the following: a Monte Carlo simulation model and a Maxwell simulation model.
Further, the Arrhenius equation (Arrhenius' equation) reflects an empirical formula of a relationship between a chemical reaction rate and a temperature, specifically:
wherein the Arrhenius equation (Arrhenius' equation) is used for intraoperative real-time ablation feedback, R is a universal gas constant, T: is the temperature (k), A is the Arrhenius' constant, and the unit is s -1 ，E a Is the activation energy, c (0) is the initial concentration of cells, and c (t) is the concentration of cells at time t.
Further, the real-time monitoring process of the monitoring module comprises: inserting an ablation probe to a respective location according to the surgical plan and the three-dimensional model; setting scanning parameters of magnetic resonance temperature imaging, wherein the monitoring module automatically identifies the size of pixel points by reading information in a DICOM image, and calculates by using each pixel point as an ablation unit; ablation monitoring is performed using the Arrhenius' equation or the CEM43 model in combination with segmentation of the planned ablation region and the tissue properties under magnetic resonance non-invasive thermometry.
When the arrhenius equation is used for carrying out ablation monitoring, an ablation threshold value is displayed on the ablation condition of the ablation unit; selecting different colors to mark and display different ablation conditions of the ablation unit, namely displaying an ablation threshold value; alternatively, when using the CEM43 model for the ablation monitoring, the ablation region is displayed with different colors at different equivalent ablation durations of 43 ℃.
For example, in a preferred embodiment of the present invention, the ablation threshold display includes at least one of: when Ω=1, the cell damage rate is 63.2%, and the tissue within the ablation threshold range shows a first color, for example, the first color is yellow; when Ω=4.6, the cell damage rate is 99%, and the tissue within the ablation threshold range shows a second color, for example, red. Further, the worker may set a first range in advance (the setting of the first range may be freely set according to the operation condition), when the tissue temperature exceeds the first range, for example, the first range is 43 ℃ to 50 ℃, the ablation condition of the tissue located in the first range is between the possible damage and the incomplete damage, at this time, the ablation threshold of the tissue located in the first range is displayed, and the ablation threshold of the tissue is displayed as a third color, for example, the third color is green.
Further, the first color, the second color and the third color can be set and selected freely according to the preference of the related worker or the ablation condition. Preferably, the third color may be preferentially displayed on the bottom surface of the ablation region with other color marks, or may be partially covered by the other ablation threshold display region.
Wherein, when using the CEM43 model for the ablation monitoring, the ablation region is a MASK (MASK) display or a semitransparent display, and after the ablation region is superimposed and the tissue structure phase is displayed, the planned ablation region and the actual ablation region can be seen at the same time.
If the actual ablation area is larger than the planned ablation area, the monitoring module automatically proposes a bullet frame to prompt whether to stop ablation; if the actual ablation area exceeds a first percentage, for example, the first percentage is set to 110%, the monitoring module will automatically shut off the energy output.
Wherein, the evaluation module evaluates the ablation degree, specifically: carrying out highlighting identification on the changed ablation area by using a contrast difference method, and reconstructing an actual ablation area after operation by using a three-dimensional rapid sketching method, wherein the actual ablation area is compared with the planned ablation area in percentage and calculated; if the ablation area percentage exceeds a first percentage, for example, the first percentage is set to 110%, then it is considered as overerased; if below a second percentage, for example 90%, the second percentage is considered to be under-ablated. Preferably, the first percentage is greater than the second percentage. The first percentage and the second percentage are not unique, and the worker can freely set according to the operation condition.
Wherein the calculation of the percentage of ablation area simultaneously takes into account at least one of the following factors: the planned ablation region is an overlapping ablation range, an ablation range outside the planned ablation region, and a non-ablated range within the planned ablation region. Preferably, for example, the calculation method of the ablation percentage adopts boolean operation, which is the prior art and will not be described herein.
Example two
The laser ablation evaluation system based on the magnetic resonance guidance comprises an estimation module, a monitoring module and an evaluation module, wherein the estimation module estimates an ablation area and ablation parameters based on a thermal ablation calculation model by carrying out three-dimensional sketching on an ablation area and a peripheral area, adding corresponding material properties, storing a tissue material property list and using a fitting function or a simulation energy diffusion model; the monitoring module monitors and ablates and evaluates the ablation process in real time; the evaluation module carries out three-dimensional modeling on the real-time evaluation ablation area, automatically fits into an approximate ablation area, or carries out registration and contrast analysis on the same sequence images of the preoperative structure phase and the postoperative, uses a contrast difference method to carry out highlighting identification on the changed area, uses a three-dimensional rapid sketching method to reconstruct the postoperative ablation area, and compares the postoperative ablation area with the preoperative estimated ablation area.
The function of the laser ablation evaluation system based on magnetic resonance guidance is realized through corresponding hardware equipment, and evaluation system software is generally loaded in the hardware, so that medical workers can be assisted in making accurate operation planning and postoperative evaluation by using the evaluation system software, and real-time monitoring of a process can be realized. The following will explain in detail an example in which the hardware device is a laser interstitial thermotherapy device.
In the second embodiment, the laser ablation evaluation system based on magnetic resonance guidance is loaded in the laser interstitial thermotherapy device, and at least comprises an estimation module, a monitoring module and an evaluation module, and the pre-operation ablation area estimation, parameter estimation, intra-operation real-time ablation monitoring and postoperative ablation image evaluation are realized through the estimation module, the monitoring module and the evaluation module, so that a pre-operation, intra-operation and postoperative three-in-one ablation evaluation scheme is obtained. Compared with the prior art, the laser ablation evaluation system combines the evaluation modes of three stages of preoperative, intraoperative and postoperative into a whole set of complete ablation evaluation mode, so that the whole operation process is penetrated, the relevant workers are more accurately assisted to perform preoperative planning and timely monitoring, and the ablation result is effectively judged; the whole ablation process is parameterized and planned, so that risks caused by accidents are reduced. Specifically, the following is described.
Stage one: preoperative ablation area prediction and parameter prediction
At this stage, the predictive module will be used to perform at least one of the following processes: creating a planned ablation area, completing the estimation of the planned ablation area and planned ablation parameters, obtaining a surgical scheme and the like. More specifically, at least the following processing will be performed: (1) acquiring medical images of focal tissue including, but not limited to, CT images, magnetic resonance images, PET images; (2) the tissue type and tissue attributes of the focal tissue are analyzed and validated, for example, the tissue type may include one or more than two, each of the tissue types having its particular tissue attributes. The organization type and the organization attribute list can be extracted and preset in the pre-estimation module, and the organization attribute comprises at least one of the following components: anisotropy of tissue, absorptivity of tissue, reflectivity of tissue, refractive index of tissue, blood flow perfusion rate of tissue, thermal conductivity of tissue, specific heat of tissue, thermal transfer of tissue. (3) And acquiring a three-dimensional model of the focus tissue by adopting a multi-mode fusion technology according to the medical image, namely automatically creating a planned ablation area, wherein the three-dimensional model is attached with the tissue type and the tissue attribute. (4) According to the three-dimensional model, different tissue types of the focus tissue are segmented, and finally, a plurality of segmented areas capable of three-dimensional display are segmented; and meanwhile, the focal tissue and normal tissues around the focal tissue can be segmented. (5) Simulating an actual ablation process based on the tissue attribute of each segmented region to obtain a dynamic temperature distribution and/or an ablation damage percentage distribution map, and acquiring an operation scheme of the whole three-dimensional model by combining preoperative software; the surgical protocol includes at least one of: the optical fiber insertion path, the planned ablation times, the planned ablation region, the planned ablation area, and the planned ablation parameters.
In the first stage, the tissue type and the tissue attribute of the focus tissue are confirmed, and then the graph segmentation is carried out according to different tissue types, so that the tissue condition of the focus tissue is clear at a glance, the focus condition is more accurately and integrally grasped by related workers, and the obtained operation scheme on the basis has higher accuracy and higher reliability; the inaccuracy caused by manually sketching the focus area or the ablation area in the prior art is avoided.
Further, the estimation module at least adopts a biological heat transfer model and/or an energy simulation model containing blood flow perfusion influence to simulate the actual ablation process to obtain dynamic temperature distribution and/or an ablation damage condition percentage distribution map; and/or, the thermal ablation calculation model is an Arrhenius equation or a CEM43 model.
Further, the energy simulation model includes at least one of: a Monte Carlo simulation model and a Maxwell simulation model.
Further, in the present invention, the prediction module completes the prediction of the planned ablation parameter through a fitting function based on the planned ablation area and the surgical scheme, where the fitting function is expressed as a function of the ablation time and the ablation area under the predetermined laser power and the laser wavelength, and the formula is as follows:
Wherein Area (t) is a piecewise function to represent the ablation Area at ablation time t; c (C) 0 Is a first constant, C 1 Is a second constant, C 2 Is a third constant, C 3 Is a fourth constant, wherein C 0 、C 1 、C 2 、C 3 Is a constant obtained in advance; t is the ablation time; c (C) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached.
More specifically, the pre-estimation module acquires a large amount of actual ablation experimental data, wherein the actual ablation experimental data comprises laser light emitting power, ablation time, ablation area, laser wavelength and total energy; under the conditions of different laser light output powers and laser wavelengths, fitting the ablation time and the ablation area to obtain a fitting function, and calculating a planned ablation parameter containing at least one of the following by using the fitting function: the laser beam output power, the laser beam output time, the laser beam output mode, the circulation rate of the cooling medium, the wavelength of the laser beam and the total energy.
For example, in the second embodiment, based on a large amount of actual ablation experimental data, under a certain light output power, a fitting function of an ablation area of a normal center section of an optical fiber and time is linear in the early stage, then under the combined action of factors such as blood flow perfusion and a cooling system, the fitting function tends to converge, and due to the physical characteristic limitation of 980nm or 1064nm laser, there is a limitation of a maximum ablation area, and the limitation of the maximum ablation area forms a boundary of the fitting function, so the fitting function is represented as a three-stage piecewise function, the 1 st stage is a linear growth stage of the ablation area, the 2 nd stage is a temperature convergence stage under the same power, and the 3 rd stage is a maximum ablation area under the physical characteristic limitation, as shown in the following (first expression method):
Wherein Area (t) is a piecewise function to represent the ablation Area at ablation time t; c (C) 0 Is a first constant, C 1 Is a second constant, C 2 Is a third constant, C 3 Is a fourth constant, wherein C 0 、C 1 、C 2 、C 3 Is a constant obtained in advance; t is the ablation time; c (C) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached.
As described above, the formulation of the Area (t) piecewise function is based on a large number of actual ablation experimental data, and the experimental apparatus may use a laser hyperthermia apparatus. Specifically, the relevant workers can use annular optical fibers or diffuse optical fibers with different lengths of emergent light to perform ablation experiments under a selected laser power, for example, the laser power is 3W, or the laser power is any one of 5W to 20W, or 23W, 25W and the like. In the experimental process, experimental data are recorded, wherein the experimental data mainly comprise tissue types, tissue characteristics, laser light emitting power, ablation time, ablation area, laser wavelength, light emitting mode and total energy. Wherein the ablation area is preferentially expressed as a cross-section perpendicular to the ablation center area of the optical fiber (i.e. the ablation area on a cross-section of the normal plane of the center of the light exit of the optical fiber).
That is, if a ring-shaped optical fiber is used, the ablation area means an ablation area on a cross section of a normal plane on a center point of a light-emitting portion of the ring-shaped optical fiber; if a dispersive optical fiber is used, the ablation area is the ablation area in cross-section of the normal plane at the center point of the exit of the dispersive optical fiber. Furthermore, if the optical fiber is side-emitting optical fiber, the equivalent radius can be used to express the dynamic change of the transmission depth achieved by the side-emitting optical fiber under the condition that the laser wavelength and the light emitting mode are consistent. Therefore, the Area (t) piecewise function of the invention is more suitable for annular optical fibers and dispersive optical fibers. Furthermore, the applicability of the Area (t) piecewise function also comprises the application of the medical ablation optical fiber assembly with a cooling system or the application of the medical ablation optical fiber assembly without the cooling system.
Further, as shown in fig. 3A, a schematic view of the ring-shaped optical fiber of the present invention is shown. The annular optical fiber is a laser transmission optical fiber, and the front end light-emitting mode of the annular optical fiber is output along the whole circumference in the radial direction. FIG. 3B is a schematic illustration of a dispersion fiber according to the present invention. The dispersion fiber is a laser transmission fiber whose front end light-emitting mode is to be output all around along the radial direction and along the axial direction by a predetermined length. Fig. 3C is a schematic diagram of a side-emitting fiber according to the present invention. The side-emitting optical fiber is a laser transmission optical fiber, and the front end light-emitting mode of the side-emitting optical fiber is radial side-emitting. The laser hyperthermia device, the annular optical fiber, the dispersion optical fiber, the side-emitting optical fiber, the medical ablation optical fiber component and the like are all existing devices or technologies, and are not described in detail herein.
Furthermore, on the basis of a large number of ablation experiments, the ablation experiment data are subjected to inductive verification, and finally the formula of the Area (t) piecewise function is obtained through fitting. The formula of the Area (t) piecewise function can also be expressed as follows (second expression):
wherein Area (t) is a piecewise function to represent the ablation Area at ablation time t; d (D) 0 Is a first constant, D 1 Is a second constant, wherein D 0 、D 1 Is a constant obtained in advance; t is the ablation time; d (D) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached. The second expression is a variation of the first expression, which has the advantage that the reduction of the pre-constants to be obtained can simplify the fitting function calculation.
Based on the second expression method, the creator of the invention uses the dispersion optical fiber, and carries out a large amount of ablation experiments on the pig liver under the conditions of laser power of 6W, laser wavelength of 980nm and continuous light emission, and records experimental data such as tissue type, tissue characteristics, ablation time, ablation area and the like in real time, and generalizes the data into the following:
wherein Area (t) is a piecewise function representing the ablation Area/mm at ablation time t 2 (square millimeters); t is ablation time/s (seconds).
Similarly, based on a large number of actual ablation experiments, fitting functions of other types of tissues under a certain preset laser power and laser wavelength can be obtained, and more accurate ablation parameters can be further obtained through the fitting functions. Therefore, the prediction module provided by the invention can give corresponding ablation parameters based on different tissue types, and compared with the prior art, the prediction module provided by the invention realizes more differentiated and accurate ablation prediction, enhances the reliability of prediction information and has guiding significance.
Stage two, real-time ablation monitoring
Further, the real-time monitoring process of the monitoring module comprises: inserting an ablation probe to a respective location according to the surgical plan and the three-dimensional model; setting scanning parameters of magnetic resonance temperature imaging, wherein the monitoring module automatically identifies the size of pixel points by reading information in a DICOM image, and calculates by using each pixel point as an ablation unit; ablation monitoring is performed using the Arrhenius' equation or the CEM43 model in combination with segmentation of the planned ablation region and the tissue properties under magnetic resonance non-invasive thermometry.
Further, the Arrhenius model reflects an empirical formula of a relationship between a chemical reaction rate and a temperature change, and specifically comprises the following steps:
wherein, the Arrhenius model is used for real-time ablation feedback in operation, R is a universal gas constant, T: is the temperature (k), A is the Arrhenius constant, and the unit is s -1 ，E a Is the activation energy, c (0) is the initial concentration of cells, and c (t) is the concentration of cells at time t.
When the arrhenius equation is used for carrying out ablation monitoring, an ablation threshold value can be displayed on the ablation condition of the ablation unit; and selecting different colors to mark and display different ablation conditions of the ablation unit.
For example, in a preferred embodiment of the present invention, the ablation threshold display includes at least one of the following when the ablation monitoring is performed using the arrhenius equation: when Ω=1, the cell damage rate is 63.2%, and the tissue within the ablation threshold range shows a first color, for example, the first color is yellow; when Ω=4.6, the cell damage rate is 99%, and the tissue within the ablation threshold range shows a second color, for example, red. Further, the worker may set a first range in advance (the setting of the first range may be freely set according to the actual operation condition), when the tissue temperature exceeds the first range, for example, the first range is 43 ℃ to 50 ℃, the ablation condition of the tissue located in the first range is between the condition that the damage may be caused and the condition that the damage is not completely caused, and at this time, the ablation threshold of the tissue is displayed as a third color, for example, the third color is green.
Further, the first color, the second color and the third color can be set and selected freely according to the preference of the related worker or the ablation condition. Preferably, the third color may be preferentially displayed on the bottom surface of the ablation region with other color marks, or may be partially covered by the other ablation threshold display region.
For another example, in the ablation monitoring using the CEM43 model, the ablation region is displayed with different colors at different equivalent ablation durations of 43 ℃. For example: the color distinguishing display is respectively carried out under different conditions of 2 minutes equivalent, 10 minutes equivalent and 60 minutes equivalent, and the color distinguishing display enables a doctor to better judge the ablation effect. Additionally, in the monitoring of the ablation using the CEM43 model, the ablation zone is a MASK (MASK) display or a semi-transparent display, and the planned ablation zone and the actual ablation zone can be seen simultaneously after the tissue structure phases are displayed superimposed on the ablation zone. Namely which are the ablation areas planned before the operation and which are the actual ablation areas in the operation, the ablation coverage area and the like are clear at a glance, the accurate and controllable operation process is realized, and then related workers are guided to perform more accurate ablation operation, so that the influence caused by incomplete ablation or excessive ablation is reduced.
Further, if the actual ablation area is larger than the planned ablation area, the monitoring module automatically presents a bullet frame to prompt whether to stop ablation; if the actual ablation area exceeds a first percentage, for example, the first percentage is set to 110%, the monitoring module will automatically shut off the energy output. The first percentage is preset by the related workers, and the value of the first percentage can be flexibly set according to actual conditions without limitation.
Stage three: postoperative ablation image evaluation
The evaluation module evaluating the degree of ablation includes: carrying out highlighting identification on the changed ablation area by using a contrast difference method, and reconstructing an actual ablation area after operation by using a three-dimensional rapid sketching method, wherein the actual ablation area is compared with the planned ablation area in percentage and calculated; if the ablation area percentage exceeds a first percentage, for example, the first percentage is set to 110%, then it is considered as overerased; if below a second percentage, for example 90%, the second percentage is considered to be under-ablated. Preferably, the first percentage is greater than the second percentage. The first percentage and the second percentage are not unique, and the worker can freely set according to the operation condition, for example, the first percentage is set to be 85%, and the second percentage is set to be 54%.
Wherein the calculation of the percentage of ablation area takes into account at least one of the following factors: the planned ablation region is an overlapping ablation range, an ablation range outside the planned ablation region, and a non-ablated range within the planned ablation region. Preferably, for example, the calculation method of the ablation percentage adopts boolean operation, which is the prior art and will not be described herein.
The evaluation module reconstructs an actual ablation area, registers and compares images of the planned ablation area and the actual ablation area, analyzes the images to obtain image evaluation information, and the image evaluation information is displayed on the man-machine interaction module; the image evaluation information at least comprises one of the following: percentage of ablation area, tissue shrinkage, tissue expansion, and tissue edema. Preferably, the tissue shrinkage condition, the tissue expansion condition and the tissue edema condition can be marked correspondingly according to the requirement and displayed on a human-computer interaction module. Therefore, in the evaluation module, not only can very accurate ablation area evaluation be obtained, but also the shrinkage condition of the tissues, the expansion condition of the tissues and the edema condition of the tissues can be displayed, so that related workers can more comprehensively know the current ablation operation and the state of an ablation area.
Furthermore, the related workers can judge whether the tissue suction or other operations are needed according to the shrinkage condition of the tissue, the expansion condition of the tissue and the edema condition of the tissue. Furthermore, the ablation area in the invention can also be an ablation volume calculated according to the ablation area, that is, the invention can use the ablation area to judge when evaluating or use the ablation volume to judge. Therefore, the ablation area or the ablation volume according to the present invention may be expressed as an ablation area, for example, "if the actual ablation area is larger than the planned ablation area, the monitoring module automatically proposes a frame to prompt whether to stop ablation" or "if the actual ablation volume is larger than the planned ablation volume, the monitoring module automatically proposes a frame to prompt whether to stop ablation", or "if the actual ablation area is larger than the planned ablation area, the monitoring module automatically proposes a frame to prompt whether to stop ablation". Similarly, when the ablation area percentage is calculated, the ablation volume percentage and the ablation area percentage can be expressed. The calculation of the ablation area and the ablation volume are all available to the person skilled in the art according to the prior art and will not be described in detail here.
The laser ablation evaluation system based on the magnetic resonance guidance disclosed in the embodiment shown in the specification can be applied to a processor or implemented by the processor. The processor is an integrated circuit chip with signal processing capabilities. In the implementation process, each step of the above method may be implemented by an integrated logic circuit of hardware in a processor or, of course, an electronic device in this embodiment of the present disclosure does not exclude other implementations, such as a logic device or a combination of software and hardware, etc., that is, an execution body of the following processing flow is not limited to each logic unit, but may also be hardware or a logic device.
In summary, the foregoing description is only a preferred embodiment of the present invention and is not intended to limit the scope of the present invention. Any modification, equivalent replacement, improvement, etc. made within the spirit and principle of the present specification should be included in the protection scope of the present specification.
The system, apparatus, module or unit set forth in the above embodiments may be implemented in particular by a computer chip or entity, or by a product having a certain function. One typical implementation is a computer. In particular, the computer may be, for example, a personal computer, a notebook computer, a mobile phone, a smart phone, a personal digital assistant, a media player, a navigation device, an email device, a game console, a tablet computer, a wearable device, or a combination of any of these devices.
Computer readable media, including both non-transitory and non-transitory, removable and non-removable media, may implement information storage by any method or technology. The information may be computer readable instructions, data structures, modules of a program, or other data. Examples of storage media for a computer include, but are not limited to, phase change memory (PRAM), static Random Access Memory (SRAM), dynamic Random Access Memory (DRAM), other types of Random Access Memory (RAM), read Only Memory (ROM), electrically Erasable Programmable Read Only Memory (EEPROM), flash memory or other memory technology, compact disc read only memory (CD-ROM), digital Versatile Discs (DVD) or other optical storage, magnetic cassettes, magnetic tape magnetic disk storage or other magnetic storage devices, or any other non-transmission medium, which can be used to store information that can be accessed by a computing device. Computer-readable media, as defined herein, does not include transitory computer-readable media (transmission media), such as modulated data signals and carrier waves.
It should also be noted that the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. Without further limitation, an element defined by the phrase "comprising one … …" does not exclude the presence of other like elements in a process, method, article or apparatus that comprises the element.
In this specification, each embodiment is described in a progressive manner, and identical and similar parts of each embodiment are all referred to each other, and each embodiment mainly describes differences from other embodiments. In particular, for system embodiments, since they are substantially similar to method embodiments, the description is relatively simple, as relevant to see a section of the description of method embodiments.
Claims (13)
1. The laser ablation evaluation system based on magnetic resonance guidance is characterized by comprising an estimation module, a monitoring module and an evaluation module, wherein:
the estimating module is used for carrying out at least one of the following processes: creating a planned ablation region, completing the prediction of the planned ablation area and the planned ablation parameters, generating a surgical plan, and the process includes:
acquiring a medical image of focus tissue;
confirming a tissue type and a tissue attribute of the focal tissue;
generating a three-dimensional model of the focal tissue from the medical image, the three-dimensional model being accompanied by the tissue type and the tissue attribute;
dividing the lesion tissue into a plurality of dividing areas capable of three-dimensional display according to the three-dimensional model and aiming at different tissue types of the lesion tissue;
Simulating a dynamic temperature distribution and/or an ablation damage percentage distribution map of an actual ablation process based on the tissue attribute of each segmented region to determine a surgical plan of the whole three-dimensional model;
the monitoring module monitors the digestion process in real time;
the evaluation module rebuilds an actual ablation area, and performs contrast analysis on the images of the planned ablation area and the actual ablation area to obtain image evaluation information, wherein the image evaluation information is displayed on the human-computer interaction module; the image evaluation information at least comprises one of the following: percentage of ablation area, tissue shrinkage, tissue expansion, and tissue edema.
2. The magnetic resonance guidance-based laser ablation evaluation system according to claim 1, wherein the prediction module performs the prediction of the planned ablation parameters based on the planned ablation area and the surgical plan by a fitting function expressed as a function of the ablation time and the ablation area at a predetermined laser power and laser wavelength, and the formula is:
wherein Area (t) is a piecewise function representing the ablation timeAblation area at interval t; c (C) 0 Is a first constant, C 1 Is a second constant, C 2 Is a third constant, C 3 Is a fourth constant, wherein C 0 、C 1 、C 2 、C 3 Is a constant obtained in advance; t is the ablation time; c (C) max Is the maximum ablation area; y is the time of the end point of the linear increase of the fitting function; z is the time the maximum ablation area is reached.
3. A magnetic resonance guidance based laser ablation evaluation system according to claim 2, wherein the fitting function is obtained by:
acquiring a plurality of groups of actual ablation experimental data, wherein the actual ablation experimental data comprise laser light output power, ablation time, ablation area, laser wavelength and total energy;
and fitting the actual ablation experimental data to obtain the fitting function.
4. The magnetic resonance guidance-based laser ablation evaluation system of claim 1, wherein the pre-estimation module simulates a dynamic temperature distribution and/or an ablation damage percentage distribution map of an actual ablation process in consideration of at least a biological heat transfer model and/or an energy simulation model containing blood flow perfusion effects; and/or the thermal ablation calculation model is an Arrhenius equation or a CEM43 model.
5. The magnetic resonance-guided laser ablation evaluation system of claim 1, wherein the surgical procedure comprises at least one of: the optical fiber insertion path, the planned ablation times, the planned ablation area and the planned ablation parameters; and/or
The ablation parameters include at least one of: the laser beam irradiation method comprises the steps of laser beam irradiation power, laser beam irradiation time, laser beam irradiation mode, cooling medium circulation rate, laser beam wavelength and total energy; and/or
The tissue attributes include at least one of: anisotropy of tissue, absorptivity of tissue, reflectivity of tissue, refractive index of tissue, blood flow perfusion rate of tissue, thermal conductivity of tissue, specific heat of tissue, thermal transfer of tissue.
6. The magnetic resonance guidance-based laser ablation evaluation system of claim 4, wherein the arrhenius equation reflects an empirical formula of a chemical reaction rate versus temperature, specifically:
wherein the Arrhenius equation is used for real-time ablation feedback in surgery, R is a universal gas constant, T: for the temperature k, A is the Arrhenius constant in s -1 ，E a Is the activation energy, c (0) is the initial concentration of cells, and c (t) is the concentration of cells at time t.
7. A magnetic resonance guidance based laser ablation evaluation system according to any of claims 1-6, wherein the real time monitoring process of the monitoring module comprises: inserting an ablation probe to a respective location according to the surgical plan and the three-dimensional model; setting scanning parameters of magnetic resonance temperature imaging, wherein the monitoring module identifies the size of pixel points by reading information in a DICOM image, and uses each pixel point as an ablation unit for calculation; and under the magnetic resonance thermometry, combining the segmentation of the planned ablation region and the tissue attribute, and performing ablation monitoring.
8. The magnetic resonance guidance-based laser ablation evaluation system of claim 7, wherein an ablation threshold display is performed for an ablation condition of the ablation unit when the ablation monitoring is performed using an arrhenius equation; selecting different colors to mark and display the ablation condition of the ablation unit;
alternatively, in the ablation monitoring using the CEM43 model, the ablation threshold display is performed on the ablation region using a different color.
9. The magnetic resonance guidance-based laser ablation evaluation system of claim 8, wherein when the ablation monitoring is performed using the arrhenius model, the tissue temperature is outside a first range, wherein the tissue in the first range is ablated between a condition that may cause damage but is not completely damaged, and wherein an ablation threshold is displayed for the tissue in the first range.
10. The magnetic resonance guidance-based laser ablation evaluation system of claim 8, wherein the ablation zone is a masked or semi-transparent display when the CEM43 model is used for the ablation monitoring, and the planned ablation zone and the actual ablation zone are simultaneously seen after the ablation zone superimposes the displayed tissue structures.
11. The magnetic resonance guidance-based laser ablation evaluation system of claim 7, wherein the monitoring module automatically presents a bullet box to indicate whether ablation is stopped if the actual ablation area is greater than the planned ablation area; if the actual ablation area exceeds a first percentage, the monitoring module will automatically shut off the energy output.
12. The magnetic resonance guidance-based laser ablation evaluation system of claim 7, wherein the evaluation module evaluates the extent of ablation comprising: carrying out highlighting identification on the changed ablation area by using a contrast difference method, and reconstructing an actual ablation area after operation by using a three-dimensional rapid sketching method, wherein the actual ablation area is compared with the planned ablation area in percentage and calculated; if the ablation area percentage exceeds a first percentage, over-ablating; insufficient ablation if below a second percentage, wherein the first percentage is greater than the second percentage.
13. The magnetic resonance-guided laser ablation evaluation system of claim 12, wherein the calculation of the percentage of ablation area simultaneously takes into account at least one of the following factors: the planned ablation region is an overlapping ablation range, an ablation range outside the planned ablation region, and a non-ablated range within the planned ablation region.
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| CN116805308A (en) | 2023-09-26 |
| WO2023274219A1 (en) | 2023-01-05 |
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