CN115553818B - Myocardial biopsy system based on fusion positioning - Google Patents
Myocardial biopsy system based on fusion positioning Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
- A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/46—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with special arrangements for interfacing with the operator or the patient
- A61B6/461—Displaying means of special interest
- A61B6/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
- A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
- A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
- A61B6/5288—Devices using data or image processing specially adapted for radiation diagnosis involving retrospective matching to a physiological signal
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
- A61B8/461—Displaying means of special interest
- A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5284—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving retrospective matching to a physiological signal
Abstract
The invention provides a myocardial biopsy system based on fusion positioning, and relates to the field of surgical diagnosis and treatment instruments. A myocardial biopsy system comprising: an ultrasound image acquisition unit, an image processing unit, an image fusion device, a fusion display device, and a myocardial biopsy device. The image processing unit is used for dividing a plurality of preoperative ultrasonic images according to the cardiac cycle of the target patient, respectively receiving an image set of each cardiac state in the cardiac cycle, extracting contour features to obtain a ventricular contour image, and the ultrasonic image acquisition unit is also used for acquiring a real-time image in real time.
Description
Technical Field
The invention relates to the technical field of surgical diagnosis and treatment instruments, in particular to a myocardial biopsy system based on fusion positioning.
Background
Myocardial biopsy is mainly used for the diagnosis of invasive or inflammatory diseases of the myocardium, such as myocardial rejection, diagnosis of cardiac sarcoidosis, cardiac hemochromatosis, cardiac fibroelastosis, and cardiac glycogen accumulation. Some diseases affecting the myocardium by infectivity can be diagnosed unequivocally by biopsy of the myocardium. Taking myocarditis as an example, myocardial biopsy is the most direct and accurate means of determining the cause of inflammation.
The cardiac muscle biopsy can adopt a method of myocardial biopsy through a radial artery, a left ventricle and an endocardium, ultrasonic image acquisition or ventricular radiography is required before the biopsy, and the graph of the ventricle is determined; or right ventricular biopsy may be performed by placement of a venous cannula into a myocardial biopsy forceps via the jugular vein, the subclavian vein, and the veins of the femoral vein.
During biopsy, the end hole of the biopsy forceps catheter is placed in the ventricular cavity through the guide catheter, but not against the ventricular wall, and the distance between the catheter head and the ventricular wall is preferably 2-3 cm. Perforation is likely to occur if the distance is too close and the risk of damage to the mitral chordae tendineae increases if the distance is too far. The endocardium myocardial biopsy forceps are wiped by using heparin saline gauze, a guide tube is fed into the biopsy forceps under the guidance of X rays or ultrasonic waves, the biopsy forceps are fed to the ventricular apex or the ventricular lateral wall, the position of the biopsy forceps is adjusted under fluoroscopy, the biopsy forceps are withdrawn by about 1cm, the jaws are opened, the biopsy forceps are fed forward again, once resistance is sensed, the jaws are closed quickly, and the biopsy forceps are withdrawn stably to be separated from the ventricular wall.
However, in the case of ultrasound guidance or X-ray guidance during surgery, since the cardiac region is involved, biopsy sampling must be completed as soon as possible, otherwise problems such as myocardial damage and infection are easily caused, and if the operation is mishandled, intracardiac septal puncture is easily caused, so effective image guidance is very important. The existing guidance methods all adopt a direct image guidance method, and the guidance process completely depends on real-time ultrasonic images or X-ray images. Such images are extremely dependent on the physician's immediate view of the ultrasound, and the borders of ultrasound images are often not clear enough to cause errors in highly stressful situations.
Disclosure of Invention
In view of the above problems, the present invention is directed to a fusion localization-based myocardial biopsy system, comprising: the system comprises an ultrasonic image acquisition device, an image processing unit, an image fusion device, a fusion display device and a myocardial biopsy device, wherein the ultrasonic image acquisition device is used for acquiring or receiving a preoperative ultrasonic image of a target patient and correlating the preoperative ultrasonic image with cardiac cycle data of the target patient acquired by an external ECG detection device; the image processing unit is used for dividing a plurality of preoperative ultrasonic images into image sets in different heartbeat states according to the cardiac cycle of a target patient, and the image processing unit is used for selecting images at the end of the cycle from the image sets in each cardiac state in the cardiac cycle respectively to extract contour features so as to obtain contour images of the left ventricle or the right ventricle at the end of the corresponding cycle; the real-time image acquisition device is also used for intraoperatively acquiring a real-time image of a heart part, and the image fusion device is used for projecting the extracted contour information at the end of the corresponding period to the corresponding contour position in the real-time image in the form of a weak contour line according to the cardiac cycle of the current patient.
Further, an X-ray image acquisition device is also included.
Further, the image fusion device extracts a contour based on the acquired real-time ultrasound image, matches the extracted real-time contour with a pre-extracted contour image, and further determines a mapping relationship between the current ultrasound image and the contour image.
Further, when the image of the patient is acquired, the ECG detection device is adopted to synchronously acquire the electrocardio data of the patient so as to determine the cardiac cycle of the patient.
Furthermore, the image processing device is used for intercepting the real-time contour map, matching the contour of the intercepted intracardiac interval part with the intracardiac interval part of the pre-extracted contour image, projecting the pre-extracted contour image to the real-time ultrasonic image by taking the matching result of the intracardiac interval part as a reference, and fusing the real-time ultrasonic image and the pre-extracted contour image.
Further, when the image of the patient is acquired, the ECG detection device is adopted to synchronously acquire the electrocardio data of the patient so as to determine the cardiac cycle of the patient.
Further, the cardiac cycle is divided into two cardiac states, systolic and diastolic.
Contour extraction is based on biopsy forceps insertion location determination, e.g., biopsy of the jugular, subclavian and femoral veins, then right ventricle contour extraction can be performed preoperatively.
The myocardial biopsy system can project the ventricular wall limit positions of different cardiac states, which are accurately acquired in advance, onto a real-time ultrasonic image or an X-ray image, so that a clearer ventricular boundary concept is provided for medical staff, more clear guidance is provided for the medical staff with less skilled service, and the operation risk is effectively controlled.
Drawings
FIG. 1 is a schematic diagram of the architecture of a myocardial biopsy system according to the present invention.
Fig. 2 is a schematic flow chart of the image fusion process performed by the myocardial biopsy system of the present invention.
Fig. 3-6 are schematic diagrams of image fusion performed with the right ventricle as an example, where fig. 3 is a pre-operative ultrasound image at the end of the diastole, fig. 4 is a view of a selected region of interest, where the region of interest is assumed to be the ventricular septum and the right sidewall, fig. 5 is a masked region of interest, and fig. 6 is an end-of-diastole contour line displayed in the form of a weak outline on a real-time image.
Detailed Description
Example 1
The present embodiments provide a fusion localization based myocardial biopsy system. As shown in fig. 1, the myocardial biopsy system based on fusion localization of the present embodiment includes: the image fusion system comprises an image acquisition unit 101, an image processing unit 102, an image fusion device 103, a fusion display device 104 and a myocardial biopsy device, wherein the image acquisition unit 101 is used for acquiring or receiving preoperative ultrasonic images of a target patient. During preoperative examination of a patient, ECG monitoring equipment is also used to synchronously acquire the electrocardiographic data of the patient so as to determine the cardiac cycle of the patient. The preoperative ultrasound image processing unit is used for dividing a plurality of preoperative ultrasound images into image sets in different cardiac states according to the cardiac cycle of the target patient. In this embodiment, the description of the cardiac cycle is performed by taking two cardiac states of systolic phase and diastolic phase as an example.
The image processing unit 102 receives the image sets of each cardiac state in the cardiac cycle, and selects the ultrasound images with clear contours at the end of the cardiac cycle to perform contour feature extraction to obtain the contour image of the right ventricle. Of course, the method of the present invention may also be applied to myocardial biopsy procedures of the left ventricle.
In a preferred implementation, the process of contour extraction is as follows:
several, e.g., 3 or 5, images of the end of diastole and several, e.g., 3 or 5, images of the end of systole are called up from the pre-operative ultrasound image set. In one implementation, contours extracted from the end-of-cycle images are averaged to obtain a homogenized contour map of the end-systolic and diastolic phases.
Then, filtering and denoising the image, and smoothing the high-order noise, for example, denoising may be performed by using a P-M model or filtering by using a median filtering denoising algorithm or gaussian filtering.
The Canny operator or the Sobel operator is used for edge detection, the Canny operator can detect more exquisite edge contour information, but the calculation is more complicated, and in the invention, a plurality of detail contours in an image are not important, and the important is the determination of the extreme positions of different cardiac states of the heart wall before the cardiac muscle biopsy, so that the injury and puncture to the cardiac muscle of a patient in the operation are avoided. Therefore, the region of interest in the myocardial contour map can be manually delineated on the basis of manual selection by a physician, and an image of the delineated region is captured. Then, the edge profile is determined based on the image gradient by means of a Sobel operator.
The Sobel operator includes a horizontal operator G x And vertical operator G y ：
That is, after the end-of-term image is acquired, the physician performs a rough confirmation of the manual contour, extracts pixels at the corresponding positions based on the positions of the contour defined by the physician, and zeros out the pixel values at the remaining positions using a mask, as shown in fig. 4 and 5.
For each pixel in the non-zero area, extracting the pixel value in 3*3 sub-area with the pixel as the center, forming 3*3 matrix, and respectively connecting with G x And G y Convolution to obtain corresponding convolution result value
And &>
: the gradient value G and gradient direction at each pixel are calculated based on:
and calculating corresponding gradient values and gradient directions of all pixel points in the selected contour region according to the method, eliminating the condition that the difference between the gradient direction angle and the gradient direction angles of a plurality of adjacent pixels is greater than a threshold value, such as 45 degrees, and replacing the gradient direction angle and the gradient direction angles of the plurality of adjacent pixels by using the average value of the adjacent pixels so as to remove the abrupt burr points.
And fitting the gradient values of the pixels in the profile by using a least square method, determining a maximum gradient curve as the ventricular wall profile of the current cardiac cycle, wherein the line width of the maximum gradient curve is as narrow as possible so as to avoid interference on a subsequent real-time image.
In the same manner, the contour map at the end of systole is extracted again.
In performing a myocardial biopsy, the image acquisition unit 101 acquires ultrasound images of the patient in real time or at intervals, and the ECG device acquires heartbeat data of the patient in real time and synchronizes the cardiac cycle to the image fusion device 103.
As shown in fig. 6, the image fusion device 103 projects the contour data extracted in the above steps into the real-time image data according to the cardiac cycle, i.e., projects the end-systolic contour into the real-time image data in the systole, projects the end-diastolic contour into the real-time image data in the diastole, and projects the contour in the form of a weak contour line in the projection, thereby providing a position reference and avoiding causing large interference to the real-time image.
When contour projection is carried out, anchor points or anchor segments need to be extracted from a real-time ultrasonic image, and a segment or feature points with clear enough contour on the myocardial wall can be used as the anchor points to carry out alignment of the real-time image and the projection contour. For example, a segment having a gradient value at a ventricular interval that exceeds the average gradient value by 110% is used as an anchor segment, and the projection contour is projected into the real-time image based on the position of the anchor segment.
Taking biopsy through the right internal jugular vein as an example, when in biopsy, the patient takes a puncture from the right jugular vein and inserts a guide wire in the positions of low head and high shoulder. During the insertion of the guide wire, ultrasound image acquisition is performed in real time (or oblique 60-degree X-ray detection is used as an auxiliary), when the guide wire is in place, a biopsy forceps is inserted, ultrasound image and patient ECG cardiac data are acquired in real time at this time, the extracted patient contour data is projected into the real-time image data according to the cardiac cycle, that is, the end-systolic contour is projected into the real-time image data in the systole, and the end-diastolic contour is projected into the real-time image data in the diastole, so as to perform fusion display, as shown in fig. 6. At the end of each cardiac cycle, the position of the projected contour is matched to the real-time image and recalibrated (rotating the contour based on the matched angular difference if necessary) to avoid misalignment of the projected contour due to movement of the ultrasound device. By adopting the mode, clearer boundary warning can be provided for an operator, and myocardial damage or puncture caused by overlarge force is avoided.
It should be noted that although the right ventricle is described above as an example, the method of the present invention may be applied to other ventricles. Moreover, the method can adjust the brightness ratio of the contour display and the real-time ultrasonic display according to the requirement. In addition, the diastolic and systolic contours can be displayed in a suitably extended manner, i.e., both end-diastolic and end-systolic contours are displayed, as required by the application, but this is likely to cause more disturbance to the medical staff.
While the principles of the invention have been described in detail in connection with the preferred embodiments thereof, it will be understood by those skilled in the art that the foregoing embodiments are merely illustrative of exemplary implementations of the invention and are not limiting of the scope of the invention.
Claims (4)
1. A fusion localization-based myocardial biopsy system, comprising: the system comprises an ultrasonic image acquisition device, an image processing unit, an image fusion device and a fusion display device, wherein the ultrasonic image acquisition device is used for acquiring or receiving a preoperative ultrasonic image of a target patient and correlating the preoperative ultrasonic image with cardiac cycle data of the target patient acquired by an external ECG detection device; the image processing unit is used for dividing a plurality of preoperative ultrasonic images into image sets in different cardiac states according to the cardiac cycle of a target patient, and the image processing unit is used for selecting images at the end of the cycle from the image sets in each cardiac state in the cardiac cycle respectively to extract contour features so as to obtain contour images of the left ventricle or the right ventricle at the end of the corresponding cycle; the ultrasound image acquisition device is further used for intraoperatively acquiring a real-time image of a heart part, the image fusion device is used for projecting extracted contour information at the end of a corresponding period to a corresponding contour position in the real-time image in the form of a weak contour line according to the cardiac cycle of a current patient, the image processing device is used for intercepting the real-time contour map, the contour of the intercepted intracardiac interval part is matched with the pre-extracted central interval part of the contour image, and the pre-extracted contour image is projected to the real-time ultrasound image and fused with the real-time ultrasound image by taking the matching result of the intracardiac interval part as a reference, wherein the contour extraction process comprises the following steps: after the end-of-term image is acquired, the manual contour is confirmed, the pixels at the corresponding positions are extracted, the pixel values at the rest positions are reset to zero by utilizing a mask,
for each pixel of the non-zero region,extracting pixel value in 3*3 sub-region with the pixel as center to form 3*3 matrix, and comparing with G x And G y Convolution to obtain corresponding convolution result value
And &>
：/>
Calculating a gradient value G and a gradient direction at each pixel based on>
：/>
And calculating corresponding gradient values and gradient directions of all pixel points in the selected contour region according to the formula, fitting the gradient values of the pixel points in the contour by using a least square method, and determining a maximum gradient curve as the contour of the ventricular wall of the current cardiac cycle.
2. The fusion localization-based myocardial biopsy system of claim 1, further comprising an X-ray image acquisition device.
3. The fusion localization-based myocardial biopsy system of claim 1, wherein the ECG detection device is used to synchronously acquire the cardiac electrical data of the patient to determine the cardiac cycle of the patient during image acquisition of the patient.
4. The fusion localization-based myocardial biopsy system of claim 1, wherein the cardiac cycle is divided into two cardiac states, a systolic phase and a diastolic phase.
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