CN115619750A - Method for calculating contrast projection angle in TAVR (percutaneous transluminal coronary angiography) operation by taking coronary sinus as reference - Google Patents

Method for calculating contrast projection angle in TAVR (percutaneous transluminal coronary angiography) operation by taking coronary sinus as reference Download PDF

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CN115619750A
CN115619750A CN202211329996.1A CN202211329996A CN115619750A CN 115619750 A CN115619750 A CN 115619750A CN 202211329996 A CN202211329996 A CN 202211329996A CN 115619750 A CN115619750 A CN 115619750A
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王墨扬
牛冠男
吴永健
方桧铭
曾智敏
马琛明
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Abstract

The invention discloses a method for calculating a contrast projection angle in a TAVR (percutaneous transluminal coronary angioplasty) operation by taking a non-coronary sinus as a reference, which comprises the following steps of: acquiring three-dimensional medical image data of an aortic valve; extracting aortic root annulus plane: extracting three sinus floor coordinates of the aortic root; extracting a tile-shaped sinus region plane parallel to the valve annulus plane, wherein the connection points among the sinus regions can be clearly seen on the tile-shaped sinus region plane; identifying an avascular sinus within the sinus zone plane; identifying left and right connection points of the non-coronary sinus; acquiring a projection vector, wherein the projection vector is a vector in the direction of a connecting line of a left side connecting point and a right side connecting point of the non-coronary sinus; automatically calculating left/right front based on the projection vectorAngle of inclination
Figure DDA0003913148170000011
And a head/foot angle theta. The method can effectively reduce the operation difficulty of a doctor, shorten the operation time, improve the accuracy of the projection angle and improve the contrast effect, thereby helping the doctor to better perform transcatheter aortic valve replacement.

Description

Method for calculating contrast projection angle in TAVR (percutaneous transluminal coronary angiography) operation by taking coronary sinus as reference
Technical Field
The invention belongs to the technical field of medical image processing, and relates to a method for calculating a contrast projection angle in a TAVR (percutaneous transluminal coronary angiography) operation by taking a coronary sinus as a reference.
Background
Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive Valve Replacement, and is used for conveying a prosthetic heart Valve to the position of an Aortic Valve through an interventional catheter technology, so that implantation of the prosthetic Valve is completed, and the function of the Valve is recovered.
In transcatheter aortic valve replacement procedures, a physician uses a catheter to deliver a prosthetic valve through a blood vessel to the site of a diseased valve. Accurate release of the prosthetic valve in place has a significant effect on the outcome of the procedure, and poor release may lead to complications such as valve migration, paravalvular leakage, valve regurgitation and coronary occlusion. Thus, in transcatheter aortic valve replacement, it must be ensured that the valve is released in the proper position and depth.
In order to implant the valve at the proper location and depth, positioning by angiography is required during the procedure. For accurate positioning, it is crucial that the imaging apparatus adopts a proper projection angle. Currently, there are two commonly used projection positions in TAVR surgery: right coronary sinus medialization and left and right coronary sinus Overlap (Cusp overlay). The right coronary sinus centering method projects the coronary sinus to the center of the left coronary sinus and the center of the non-coronary sinus from the coronary sinus, the three sinus bottoms are in a straight line, and under the projected body position, the three sinus bottoms and the surrounding structure are clear, but because the conveying system and the valve ring plane are not parallel under the body position, the implantation depth of the valve is difficult to accurately control. The left and right coronary sinus overlapping method means that the right coronary Dou Doude and the left coronary Dou Doude are overlapped, the valve ring is parallel to the conveying system in the body position, and the positioning can be accurately released, but the method depends on the accurate positioning of the left and right crowns Dou Doude, the prediction result is influenced when the sinus floor is seriously calcified, the left and right crowns Dou Chang are different in size, different analysts judge whether the overlapping exists a deviation, and therefore the prediction angle also has a deviation.
Considering that the two methods for determining the projection angle commonly used in the TAVR operation have certain limitations. Researches show that the angle of the projection intersection point of the tangent line of two non-coronary sinus coaptation edges (namely the non-coronary sinus coaptation edge and the left coronary sinus coaptation edge) and the valve ring plane can obtain double parallel angles of the plane of the conveying system and the valve ring plane of the self-body in most cases, so a new optimal release projection angle prediction method is proposed by scholars: and (3) a calculation method taking the non-coronary sinus as a reference.
Currently, in the usual case, the positioning of the valve requires the determination of the projection angle of the contrast device by the interventionalist by means of 3D medical image software through complex manual interaction. This requires both a high degree of experience for the software operation by the physician and considerable time for the physician. At the same time, manual interaction is difficult to guarantee and accurate, which also results in the fact that the projection angle of the imaging device may need to be adjusted several times. Therefore, a method capable of automatically calculating the projection angle is needed, and a doctor only needs to directly set parameters in the radiography equipment according to the calculated angle, so that the operation time in the operation is greatly reduced, the precision of the projection angle can be ensured, and the radiography effect is ensured.
Disclosure of Invention
The invention aims to provide a method for calculating a contrast projection angle in a TAVR (percutaneous transluminal coronary angioplasty) operation by taking a coronary sinus as a reference, aiming at the defects in the prior art, and comprising the following steps:
step 1: acquiring three-dimensional medical image data of an aortic valve;
and 2, step: extracting the aortic root annulus plane: extracting three sinobasal coordinates of the aortic root, which are respectively P1 (x,y,z) 、P2 (x,y,z) And P3 (x,y,z) Forming an annulus plane based on the three sinus soles, and obtaining an annulus plane normal vector annulus normal by a calculation or manual extraction method (x,y,z) ；
And 3, step 3: along the vector annulus normal (x,y,z) The method comprises the following steps of (1) extracting a tile-shaped sinus region plane parallel to an annulus plane, wherein a connection point between sinus regions can be clearly seen on the tile-shaped sinus region plane;
and 4, step 4: identifying a non-coronary sinus in the plane of the tiled sinus region in step 3;
and 5: identifying the left connecting point and the right connecting point of the coronary sinus in the step 4 respectively, and expressing the coordinates of the connecting points as follows: left side connection point coordinates LHinge (x,y,z) And right connection point coordinates RHinge (x,y,z) ；
Step 6, obtaining a projection vector, wherein the projection vector is a connecting direction vector ProDirection of a left side connecting point and a right side connecting point of the non-coronary sinus (x,y,z) ；
And 7: automatically calculating left/right front oblique angles based on the projection vectors acquired in step 6
Figure BDA0003913148150000036
And a head/foot position angle theta.
Further, the three-dimensional medical image data is medical image data containing information of the aortic valve of the human body.
Further, the extraction of the aortic root annular plane in step 2 may be obtained by an automatic extraction algorithm, or by manual extraction, and the normal vector calculation method of the annular plane is as follows: setting a plane equation as Ax + By + Cz + D =0, then respectively substituting the three sinofloor coordinates into the equation to obtain parameters A, B, C and D, and obtaining a plane normal vector ann nulus normal (x,y,z) Is (A, B, C).
Furthermore, the plane of the tiled sinus region parallel to the plane of the valve annulus in step 3 can be identified by an automatic identification algorithm, and also can be identified by a manual positioning mode,
further, the non-coronary sinus in the identification plane in the step 4 can be identified by an automatic identification algorithm, and can also be identified by a manual positioning mode.
Further, the left side connection point and the right side connection point of the non-coronary sinus in the plane extracted in the step 5 can be identified through an automatic identification algorithm.
Further, the projection vector ProDirection in the step 6 (x,y,z) The calculation method comprises the following steps:
ProDirection＝RHinge-LHinge
ProDirection x ＝RHinge z -LHinge z
ProDirection y ＝RHinge y -LHinge y
ProDirection z ＝RHinge z -LHinge z
further, in the step 7, the left/right front lean angle is calculated
Figure BDA0003913148150000031
And the head/foot position angle θ is:
a. left/right front oblique angle for calculating suggested projection angle
Figure BDA0003913148150000032
Figure BDA0003913148150000033
When in use
Figure BDA0003913148150000034
When it is inclined to the right, when
Figure BDA0003913148150000035
When the utility model is used, the left front is inclined,
b. calculating a head/foot position angle θ of the proposed projection angle:
θ＝arctan2(ProDirection z ,ProDirection y )
when θ >0, it is the head bit, and when θ <0, it is the foot bit.
The invention has the technical effects that:
by applying the technical scheme of the invention, the operation difficulty of a doctor can be effectively reduced, the operation time is shortened, the accuracy of a projection angle can be improved, and the contrast effect is improved, so that the doctor is helped to better perform transcatheter aortic valve replacement.
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FIG. 1 is a schematic flow chart of the calculation method of the contrast projection angle in TAVR surgery based on coronary sinus absence according to the present invention;
FIG. 2 is a schematic representation of the three sinus floor locations of the aortic root at step 2 of the method of the present invention;
FIG. 3 is a schematic view of the plane of the tile sinus region parallel to the annulus plane, and the corresponding non-coronary sinus region and the left and right side junction points of the non-coronary sinus in steps 3, 4 and 5 of the method of the present invention;
fig. 4 is a schematic view of the projection direction in step 6 of the method of the present invention.
Detailed Description
The invention will be further illustrated with reference to the following specific examples. It should be understood that the examples are only for illustrating the present invention and are not intended to limit the scope of the present invention. In addition, it should be understood that various changes or modifications can be made by those skilled in the art after reading the disclosure of the present invention, and such equivalents also fall within the scope of the invention.
As shown in fig. 1, the method for calculating the contrast projection angle in TAVR surgery based on the coronary sinus of the present invention includes the following 7 steps:
step 1: three-dimensional medical image data of an aortic valve is acquired. In particular, the three-dimensional medical image data should contain information about the aortic valve of the body, and may be of any medical image data type, such as a CT/MRI/US modality.
Step 2: extracting three sino-fundus coordinates of the aortic root, which are respectively P1 (x,y,z) 、P2 (x,y,z) And P3 (x,y,z) Forming an annular plane based on the three sinus floors to obtain an annular plane normal vector (x,y,z) . Specifically, the above three aorta roots are extractedThe sinus floor coordinates can be obtained by an automatic extraction algorithm or manually. The automatic extraction algorithm can be a machine learning method and can also be a traditional image processing algorithm; the manual extraction method can select three sinus floor coordinates by a three-dimensional image browsing tool and by using a multi-planar reconstruction (MPR) function.
And step 3: along the vector annulus normal (x,y,z) In the orientation, the plane of the tegular sinus region is taken parallel to the plane of the annulus where the junction between the individual sinus regions is clearly visible. Specifically, the extraction of the plane of the tegular sinus region parallel to the plane of the annulus may be obtained by an automatic extraction algorithm or may be performed by manually selecting the location. The automatic extraction algorithm can be a machine learning method or a traditional image processing algorithm, for example, after the annulus plane is determined, translation is carried out along the normal vector of the annulus plane towards the ascending aorta direction, the sinus structure characteristics are obtained through polar coordinate expansion in the translation process, and one layer which can clearly see each sinus connection point is selected. The manual extraction method can be realized by a three-dimensional image browsing tool, utilizing a multi-planar reconstruction (MPR) function, after the annulus plane is determined, selecting a parallel moving layer and selecting a layer on which each sinus connection point can be clearly seen.
And 4, step 4: identifying a plane of the tiled sinus region in step 3 without a coronary sinus; specifically, the above-mentioned coronary sinus can be obtained by an automatic extraction algorithm or manually. The automatic extraction algorithm may be a machine learning method, or may be based on sinus and coronary structures using traditional image processing algorithms; the manual extraction method may determine the coronary sinus by using a multi-planar reconstruction (MPR) function through a three-dimensional image browsing tool.
And 5: identifying the left side connection point and the right side connection point of the non-coronary sinus in the step 4, and expressing the coordinates of the connection points as follows: left side connection point coordinates LHinge (x,y,z) And right connection point coordinates RHinge (x,y,z) And obtaining the connecting line direction vector LRHingeDirection of the left and right connecting points (x,y,z) Specifically, the left and right connection points without coronary sinus in the above identification step 4 can be obtained by an automatic extraction algorithm or manually. The automatic extraction algorithm may beThe machine learning method can also be a traditional image processing algorithm, for example, through polar coordinate expansion, extreme points are searched near the area without the coronary sinus, and then left and right side connection points can be found; the manual extraction method can determine the left and right connection points of the coronary sinus by using a multi-planar reconstruction (MPR) function through a three-dimensional image browsing tool.
Step 6, obtaining a projection vector, namely a ProDirection vector of a connecting line of the left and right connecting points of the non-coronary sinus (x,y,z) 。
Specifically, the ProDirection acquisition (x,y,z) Solving by the following method:
ProDirection＝RHinge-LHinge
ProDirection x ＝RHinge z -LHinge z
ProDirection y ＝RHinge y -LHinge y
ProDirection z ＝RHinge z -LHinge z
and 7: based on the projection vector obtained in step 6, the left/right front oblique angle is automatically calculated
Figure BDA0003913148150000061
And a head/foot position angle θ; specifically, the solving method comprises the following steps:
a. left/right front oblique angle for calculating suggested projection angle
Figure BDA0003913148150000062
Figure BDA0003913148150000063
When in use
Figure BDA0003913148150000064
When it is inclined to the right, when
Figure BDA0003913148150000065
When the utility model is used, the left front is inclined,
b. calculating a head/foot angle θ of the proposed projection angle:
θ＝arctan2(ProDirection z ,ProDirection y )
when θ >0, it is the head bit, and when θ <0, it is the foot bit.

Claims (8)

1. A method for calculating an imaging projection angle in TAVR (percutaneous transluminal coronary angiography) operation by taking an arteria coronaria as a reference comprises the following steps:
step 1: acquiring three-dimensional medical image data of an aortic valve;
step 2: extracting aortic root annulus plane: extracting three sinobasal coordinates of the aortic root, which are respectively P1 (x，y，z) 、P2 (x，y，z) And P3 (x，y，z) Forming an annular plane based on the three sinus floors, and obtaining an annular plane normal vector by a calculation or manual extraction method (x，y，z) ；
And step 3: along the vector annulus normal (x，y，z) The direction is that a tile-shaped sinus region plane parallel to the valve annulus plane is extracted, and the connection points between the sinus regions can be clearly seen on the tile-shaped sinus region plane;
and 4, step 4: identifying a non-coronary sinus in the plane of the tiled sinus region in step 3;
and 5: identifying the left connecting point and the right connecting point of the coronary sinus in the step 4 respectively, and expressing the coordinates of the connecting points as follows: left side connection point coordinates LHinge (x，y，z) And right connection point coordinates RHinge (x，y，z) ；
Step 6: obtaining a projection vector which is a vector ProDirection in the direction of the connecting line of the left side connecting point and the right side connecting point of the non-coronary sinus (x，y，z) ；
And 7: automatically calculating left/right front oblique angles based on the projection vectors acquired in step 6
Figure FDA0003913148140000011
And a head/foot angle theta.
2. The method of claim 1The method for calculating the contrast projection angle is characterized in that the extraction of the aortic root annulus plane in the step 2 can be obtained by an automatic extraction algorithm or by manual extraction, and the normal vector calculation method of the aortic root annulus plane comprises the following steps: setting a plane equation as Ax + By + Cz + D =0, then respectively substituting the three sinofloor coordinates into the equation to obtain parameters A, B, C and D, and thus obtaining a plane normal vector ann nulus normal (x，y，z) Is (A, B, C).
3. The method for calculating the projection angle of the radiography according to claim 2, wherein the projection vector ProDirection in the step 6 (x，y，z) The calculating method comprises the following steps:
ProDirection＝RHinge-LHinge
ProDirection x ＝RHinge z -LHinge z
ProDirection y ＝RHinge y -LHinge y
ProDirection z ＝RHinge z -LHinge z 。
4. the method for calculating an angle of projection of an angiogram according to claim 3, wherein in step 7, the left/right oblique angle is calculated
Figure FDA0003913148140000021
And the head/foot position angle θ is:
a. left/right front oblique angle for calculating suggested projection angle
Figure FDA0003913148140000022
Figure FDA0003913148140000023
When the temperature is higher than the set temperature
Figure FDA0003913148140000024
When it is right frontOblique when
Figure FDA0003913148140000025
When the utility model is used, the left front is inclined,
b. calculating a head/foot position angle θ of the proposed projection angle:
θ＝arctan2(ProDirection z ，ProDirection y )
when theta is greater than 0, it is the head position, and when theta is less than 0, it is the foot position.
5. The method of calculating an angle of contrast projection according to any one of claims 1 to 4, wherein the three-dimensional medical image data is medical image data containing information on an aortic valve of a human body.
6. The method for calculating an angle of contrast projection according to any one of claims 1 to 5, wherein the plane of the sinus region parallel to the plane of the annulus in step 3 can be identified by an automatic identification algorithm or by manual positioning.
7. The method for calculating an angiography projection angle according to any one of claims 1 to 6, wherein the identification plane of step 4 is identified as the non-coronary sinus by an automatic identification algorithm or by manual positioning.
8. The method for calculating an angiography projection angle according to any one of claims 1 to 7, wherein the left and right connection points of the non-coronary sinus in the plane extracted in step 5 are identified by an automatic identification algorithm.
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