CN118476860A - Left auricle plugging simulation method, system and application - Google Patents

Left auricle plugging simulation method, system and application Download PDF

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CN118476860A
CN118476860A CN202410702311.6A CN202410702311A CN118476860A CN 118476860 A CN118476860 A CN 118476860A CN 202410702311 A CN202410702311 A CN 202410702311A CN 118476860 A CN118476860 A CN 118476860A
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atrial appendage
image
left auricle
left atrial
simulation
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郁怡
杨杰
李毅刚
顾运
王婷
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XinHua Hospital Affiliated To Shanghai JiaoTong University School of Medicine
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Abstract

The invention relates to a left auricle plugging simulation method, a left auricle plugging simulation system and application, and belongs to the technical field of medical appliances. The invention respectively collects the image data of the two imaging methods through the combined application of the two imaging methods, designs software to realize fusion imaging, simultaneously displays the internal structure, the function and the external form of the left auricle and adjacency, then simulates to match the occluder, so that an operator can select an operation strategy by using the left auricle occlusion simulation device before operation, and selects the optimal and most suitable occluder device. The image fusion simulation system provided by the invention can realize the fusion of the transesophageal real-time four-dimensional echocardiogram and the CT multi-mode image of the left auricle, and can fuse the internal structure and the function of the left auricle, the external integral form and the adjacent left auricle, thereby providing a practical imaging method for improving the success rate of left auricle plugging operation and reducing complications.

Description

一种左心耳封堵模拟方法、系统及应用A left atrial appendage occlusion simulation method, system and application

技术领域Technical Field

本发明涉及一种左心耳封堵模拟方法、系统及应用，属于医疗器械技术领域。The present invention relates to a left atrial appendage occlusion simulation method, system and application, and belongs to the technical field of medical devices.

背景技术Background Art

目前，在左心耳封堵手术中，临床应用多是在经食管超声心动图或CT单一模态影像学方法引导的基础上，结合术中心血管造影来实现观察左心耳封堵的效果。At present, in left atrial appendage occlusion surgery, clinical applications are mostly based on the guidance of transesophageal echocardiography or CT single-modality imaging methods, combined with intraoperative cardiovascular angiography to achieve observation of the effect of left atrial appendage occlusion.

然而，随着左心耳封堵术特别是极简式手术方式的广泛开展，一方面左心耳封堵术后残余分流率较高，仍是心血管科医生面临的重要难题之一，残余分流量多的患者封堵器表面血栓形成的风险增加，除了需要长期抗凝治疗外，还需要对残腔进行再次封堵；另一方面由于左心耳的解剖形态多样，常规的方法对左心耳解剖形态及其毗邻形态的评价有限，左心耳封堵术中进行左心耳造影时也可以测量锚定区直径、左心耳深度等，但在术中对左心耳的评价有限，即刻选择封堵策略相对比较仓促、不够精准。上述情况可能造成左心耳封堵失败，或封堵术后残余分流量较多、封堵器移位甚至脱落等情况的发生，同样手术医生在选择封堵器装置时也存在困难，影响手术效果。所以，本技术领域亟需解决如何在术前模拟左心耳封堵效果，减少左心耳封堵术后残余分流等并发症，提高手术成功率的技术问题。However, with the widespread development of left atrial appendage occlusion, especially the minimalist surgical method, on the one hand, the high residual shunt rate after left atrial appendage occlusion is still one of the important problems faced by cardiovascular doctors. The risk of thrombosis on the surface of the occluder increases in patients with a large amount of residual shunt. In addition to long-term anticoagulation treatment, the residual cavity needs to be re-occluded; on the other hand, due to the diverse anatomical morphology of the left atrial appendage, conventional methods have limited evaluation of the anatomical morphology of the left atrial appendage and its adjacent morphology. During the left atrial appendage occlusion, the diameter of the anchoring area and the depth of the left atrial appendage can also be measured during left atrial appendage angiography, but the evaluation of the left atrial appendage during the operation is limited, and the immediate selection of the occlusion strategy is relatively hasty and not accurate enough. The above situation may cause the failure of left atrial appendage occlusion, or the occurrence of more residual shunt after occlusion, displacement of the occluder or even falling off. Similarly, the surgeon also has difficulties in selecting the occluder device, which affects the effect of the operation. Therefore, this technical field urgently needs to solve the technical problem of how to simulate the effect of left atrial appendage occlusion before surgery, reduce complications such as residual shunt after left atrial appendage occlusion, and improve the success rate of the operation.

发明内容Summary of the invention

本发明的目的是为解决如何在术前模拟左心耳封堵效果，减少左心耳封堵术后封堵器周围残余分流、移位甚至脱落等并发症，提高手术成功率的技术问题。The purpose of the present invention is to solve the technical problem of how to simulate the left atrial appendage occlusion effect before surgery, reduce complications such as residual shunting, displacement and even detachment around the occluder after left atrial appendage occlusion surgery, and improve the success rate of the surgery.

为达到解决上述问题的目的，本发明所采取的技术方案是提供一种经食管实时四维超声心动图和CT多模态图像融合预测左心耳封堵效果的方法，包括以下步骤：In order to achieve the purpose of solving the above problems, the technical solution adopted by the present invention is to provide a method for predicting the effect of left atrial appendage occlusion by fusion of real-time four-dimensional transesophageal echocardiography and CT multimodal images, comprising the following steps:

步骤1：获取人体心脏左心耳经食管实时四维超声心动图和CT的DICOM(DigitalImaging and Communications in Medicine，医学数字成像和通信)格式图像数据；Step 1: Acquire DICOM (Digital Imaging and Communications in Medicine) format image data of human left atrial appendage transesophageal real-time four-dimensional echocardiography and CT;

步骤2：对人体心脏的CT图像进行阈值分割；对于典型的心脏分割任务，通过全卷积神经网络FCN(Fully-Convolutional Neural Networks)将输入的CT图像生成右室/左室/右房/左房与基本血管结构；FCN基于公开的全心脏分割数据集，通过U结构网络与监督学习框架进行模型训练；采用心脏结构中的所有网格点进行主方向提取；对于给定的DSCT(Dual Source CT，双源CT)图像其中，C为通道数目，D，H，W分别为输入图像的厚度，高度和宽度。Step 2: Perform threshold segmentation on the CT image of the human heart; for typical heart segmentation tasks, generate right ventricle/left ventricle/right atrium/left atrium and basic vascular structures from the input CT image through the fully convolutional neural network (FCN); FCN is based on a public whole heart segmentation dataset, and the model is trained through the U structure network and supervised learning framework; all grid points in the heart structure are used to extract the main direction; for a given DSCT (Dual Source CT) image Where C is the number of channels, D, H, and W are the thickness, height, and width of the input image, respectively.

步骤3：对人体左心耳经食管实时四维超声图像，基于极大化-期望EM(Expectation-Maximization，EM)算法进行预处理与分割；分割过程首先通过四腔平面选取基本位置，基于Sobel算子进行局部区域膨胀，并引入时序权重用于CT与TEE(经食管超声心动图，transesophageal echocardiography，TEE)之间的相似性度量；给定RT4D-TEE超声图像序列，共包含NE张3D-TEE图像，模型将得到NE个点集合Yl用于表征超声图像中的四腔轮廓。Step 3: The real-time four-dimensional transesophageal ultrasound image of the human left atrial appendage is preprocessed and segmented based on the expectation-maximization (EM) algorithm. The segmentation process first selects the basic position through the four-chamber plane, performs local area expansion based on the Sobel operator, and introduces temporal weights for the similarity measurement between CT and TEE (transesophageal echocardiography, TEE). Given a RT4D-TEE ultrasound image sequence containing N E 3D-TEE images, the model will obtain N E point sets Y l to characterize the four-chamber contours in the ultrasound image.

步骤4：基于处理完毕的CT图像与超声图像，通过与现有方法类似的穷举离散搜索方法执行初始粗超声帧与CT层位匹配；对于每个时间点t，带有最小均方误差的截面将作为刚性变换为最优匹配；Step 4: Based on the processed CT image and ultrasound image, the initial coarse ultrasound frame and CT layer matching is performed by an exhaustive discrete search method similar to the existing method; for each time point t, the section with the minimum mean square error will be used as a rigid transformation to obtain the optimal match;

步骤5：对心脏腔室、左心耳的CT三维模型和左心耳的超声四维模型进行空间配准，得到基于超声/CT图像的左心耳图像的融合模型，通过可视化的方式实现两种图像模态的联合显示，得到超声/CT图像的左心耳图像的融合模型；Step 5: spatially registering the CT three-dimensional model of the cardiac chamber and the left atrial appendage and the ultrasound four-dimensional model of the left atrial appendage to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image, and realizing joint display of the two image modalities by visualization to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image;

步骤6：基于左心耳图像的融合模型，模拟将左心耳封堵装置放入左心耳融合模型，用于辅助临床医生对于病灶等级判别，并指导手术规划与术后效果评估。Step 6: Based on the fusion model of the left atrial appendage image, simulate placing the left atrial appendage occlusion device into the left atrial appendage fusion model to assist clinicians in determining the grade of lesions and guide surgical planning and postoperative effect evaluation.

优选地，上述步骤5中空间配准包括配准算法，配准算法将两种异构的图像模态通过特征变换映射到同一个坐标空间之下，并且能够对于运动造成的局部非刚性形变具备较好的鲁棒性。Preferably, the spatial registration in the above step 5 includes a registration algorithm, which maps two heterogeneous image modalities into the same coordinate space through feature transformation and has good robustness to local non-rigid deformation caused by motion.

优选地，上述步骤5中融合模型显示的左心耳内表面设有定位锚定区，底部有左心耳深度的标志点；上述步骤6中模拟将左心耳封堵装置放入左心耳融合模型，是将左心耳封堵装置放置于锚定区。Preferably, the inner surface of the left atrial appendage displayed by the fusion model in the above step 5 is provided with a positioning anchoring area, and a marking point of the left atrial appendage depth is provided at the bottom; the simulation of placing the left atrial appendage occlusion device into the left atrial appendage fusion model in the above step 6 is to place the left atrial appendage occlusion device in the anchoring area.

本发明提供一种左心耳封堵模拟系统，包括：The present invention provides a left atrial appendage occlusion simulation system, comprising:

数据采集模块，用于获取人体心脏左心耳经食管实时四维超声心动图和CT的DICOM格式图像数据；A data acquisition module, used to obtain DICOM format image data of the left atrial appendage of the human heart through the esophagus in real-time four-dimensional echocardiography and CT;

数据处理模块，用于处理人体心脏的CT图像和人体左心耳经食管实时四维超声图像，并建模；对心脏腔室、左心耳的CT三维模型和左心耳的超声四维模型进行空间配准，得到基于超声/CT图像的左心耳图像的融合模型；The data processing module is used to process the CT image of the human heart and the real-time four-dimensional ultrasound image of the human left atrial appendage through the esophagus, and to build models; to spatially align the CT three-dimensional model of the heart chamber and the left atrial appendage and the ultrasound four-dimensional model of the left atrial appendage, and to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image;

模拟手术模块，用于模拟将左心耳封堵装置放入左心耳融合模型；A simulated surgery module is used to simulate the placement of a left atrial appendage occlusion device into a left atrial appendage fusion model;

风险评估模块，用于辅助临床医生对于病灶进行判别，并指导手术规划与术后效果评估；根据模拟效果选择合适的左心耳封堵装置和手术方案。The risk assessment module is used to assist clinicians in identifying lesions and guiding surgical planning and postoperative effect evaluation; and to select appropriate left atrial appendage occlusion devices and surgical plans based on simulation results.

优选地，所述模拟手术模块中设有用于模拟不同类型左心耳封堵装置的匹配装置。Preferably, the simulated surgery module is provided with a matching device for simulating different types of left atrial appendage occlusion devices.

优选地，所述匹配装置上设有用于与左心耳锚定区锚定的结构。Preferably, the matching device is provided with a structure for anchoring with the left atrial appendage anchoring area.

本发明提供一种存储装置，所述存储装置存储有多条指令，所述指令适于执行上述的一种经食管实时四维超声心动图和CT多模态图像融合预测左心耳封堵效果的方法中的步骤。The present invention provides a storage device storing a plurality of instructions suitable for executing the steps in the above-mentioned method for predicting the effect of left atrial appendage occlusion by fusion of real-time four-dimensional transesophageal echocardiography and CT multimodal images.

本发明提供上述一种左心耳封堵模拟系统在非诊断方法和非治疗方法上的应用。The present invention provides application of the above-mentioned left atrial appendage occlusion simulation system in non-diagnostic methods and non-therapeutic methods.

本发明提供上述一种经食管实时四维超声心动图和CT多模态图像融合预测左心耳封堵效果的方法在非诊断方法和非治疗方法上的应用。The present invention provides the application of the above-mentioned method for predicting the left atrial appendage occlusion effect by fusion of real-time four-dimensional transesophageal echocardiography and CT multimodal images in non-diagnostic methods and non-therapeutic methods.

相比现有技术，本发明具有如下有益效果：Compared with the prior art, the present invention has the following beneficial effects:

本发明涉及一种经食管实时四维超声心动图和CT多模态图像融合系统和左心耳封堵模拟装置。通过两种影像学方法的联合运用，分别采集两者的DICOM图像数据，设计软件实现融合成像，将左心耳内部结构和功能以及外部形态和毗邻同时显现，然后模拟进行封堵器的匹配，使手术医师在术前就可以运用左心耳封堵模拟装置选择手术策略，选择最佳、最合适的封堵器装置，通过本发明提高手术成功率。本发明提供的左心耳多模态融合-预测系统可实现左心耳的经食管实时四维超声心动图和CT多模态图像的融合，对左心耳进行内部结构和功能以及外部整体形态和左心耳毗邻的融合，从而为提高左心耳封堵术的成功率，减少并发症提供切实可行的影像学方法。The present invention relates to a transesophageal real-time four-dimensional echocardiogram and CT multimodal image fusion system and a left atrial appendage occlusion simulation device. Through the combined use of two imaging methods, the DICOM image data of the two are collected respectively, and the software is designed to realize fusion imaging, so that the internal structure and function of the left atrial appendage as well as the external morphology and adjacent parts are simultaneously displayed, and then the matching of the occluder is simulated, so that the surgeon can use the left atrial appendage occlusion simulation device to select the surgical strategy before the operation, and select the best and most suitable occluder device, and the success rate of the operation is improved by the present invention. The left atrial appendage multimodal fusion-prediction system provided by the present invention can realize the fusion of the transesophageal real-time four-dimensional echocardiogram and CT multimodal images of the left atrial appendage, and the fusion of the internal structure and function of the left atrial appendage as well as the external overall morphology and adjacent parts of the left atrial appendage, thereby providing a practical imaging method for improving the success rate of left atrial appendage occlusion and reducing complications.

本发明提供的左心耳封堵模拟系统可实现左心耳封堵器装置和左心耳的匹配，帮助临床医生选择最合适的封堵器装置；本发明对常规左心耳封堵器选择的可行性、准确性及可推广性，为提高左心耳封堵术的成功率，减少并发症提供切实可行的影像学方法。The left atrial appendage occlusion simulation system provided by the present invention can achieve the matching of the left atrial appendage occluder device and the left atrial appendage, helping clinicians to select the most suitable occluder device; the present invention improves the feasibility, accuracy and scalability of conventional left atrial appendage occluder selection, and provides a practical imaging method for improving the success rate of left atrial appendage occlusion and reducing complications.

本发明有助于选择最合适的封堵器装置，对特殊形态的左心耳有助于判断是否适合封堵以及封堵器的选择；本发明有助于设计特殊形态的封堵器装置，指导装置的设计以及在现有装置的基础上进行改进，为左心耳封堵器装置改良奠定基础。The present invention helps to select the most suitable occluder device, and helps to judge whether a left atrial appendage with a special form is suitable for occlusion and the selection of an occluder; the present invention helps to design an occluder device with a special form, guides the design of the device and improves the existing device, laying a foundation for the improvement of the left atrial appendage occluder device.

附图说明BRIEF DESCRIPTION OF THE DRAWINGS

图1为基于融合图像的封堵器选择与残余分流等并发症的分析过程图。Figure 1 is a diagram showing the selection of occluders and the analysis of complications such as residual shunt based on fusion images.

图2为模拟左心耳放置左心耳封堵装置示意图一。FIG. 2 is a schematic diagram 1 of simulating the placement of a left atrial appendage occlusion device in the left atrial appendage.

图3为模拟左心耳放置左心耳封堵装置示意图二。FIG. 3 is a second schematic diagram of simulating the placement of a left atrial appendage occlusion device in the left atrial appendage.

具体实施方式DETAILED DESCRIPTION

为使本发明更明显易懂，兹以优选实施例，并配合附图作详细说明如下：In order to make the present invention more clearly understood, a preferred embodiment is described in detail with reference to the accompanying drawings as follows:

如图1-3所示，为减少左心耳封堵术后残余分流率，提高手术成功率，本发明提供一种经食管实时四维超声心动图和CT多模态图像融合预测左心耳封堵效果的方法，包括以下步骤：As shown in Figures 1-3, in order to reduce the residual shunt rate after left atrial appendage closure surgery and improve the success rate of the surgery, the present invention provides a method for predicting the effect of left atrial appendage closure by fusion of real-time four-dimensional transesophageal echocardiography and CT multimodal images, comprising the following steps:

步骤1：获取人体心脏左心耳经食管实时四维超声心动图和CT的DICOM格式图像数据；Step 1: Acquire DICOM format image data of human left atrial appendage transesophageal real-time four-dimensional echocardiography and CT;

步骤2：对人体心脏的CT图像进行阈值分割；对于典型的心脏分割任务，通过全卷积神经网络FCN将输入的CT图像生成右室/左室/右房/左房与基本血管结构；FCN基于公开的全心脏分割数据集，通过U结构网络与监督学习框架进行模型训练；采用心脏结构中的所有网格点进行主方向提取；对于给定的DSCT图像其中，C为通道数目，D，H，W分别为输入图像的厚度，高度和宽度。Step 2: Perform threshold segmentation on the CT image of the human heart; for typical heart segmentation tasks, generate right ventricle/left ventricle/right atrium/left atrium and basic vascular structures from the input CT image through the fully convolutional neural network FCN; FCN is based on a public whole heart segmentation dataset and trained through the U structure network and supervised learning framework; all grid points in the heart structure are used to extract the main direction; for a given DSCT image Where C is the number of channels, D, H, and W are the thickness, height, and width of the input image, respectively.

步骤3：对人体左心耳经食管实时四维超声图像，基于极大化-期望EM算法进行预处理与分割；分割过程首先通过四腔平面选取基本位置，基于Sobel算子进行局部区域膨胀，并引入时序权重用于CT与TEE之间的相似性度量；给定RT4D-TEE超声图像序列，共包含NE张3D-TEE图像，模型将得到NE个点集合Yl用于表征超声图像中的四腔轮廓。Step 3: The real-time four-dimensional ultrasound images of the left atrial appendage of the human body are preprocessed and segmented based on the maximization-expectation EM algorithm. The segmentation process first selects the basic position through the four-chamber plane, performs local area expansion based on the Sobel operator, and introduces temporal weights for the similarity measurement between CT and TEE. Given a RT4D-TEE ultrasound image sequence containing N E 3D-TEE images, the model will obtain N E point sets Y l to characterize the four-chamber contours in the ultrasound image.

步骤4：基于处理完毕的CT图像与超声图像，通过与现有方法类似的穷举离散搜索方法执行初始粗超声帧与CT层位匹配；对于每个时间点t，带有最小均方误差的截面将作为刚性变换为最优匹配；Step 4: Based on the processed CT image and ultrasound image, the initial coarse ultrasound frame and CT layer matching is performed by an exhaustive discrete search method similar to the existing method; for each time point t, the section with the minimum mean square error will be used as a rigid transformation to obtain the optimal match;

步骤5：对心脏腔室、左心耳的CT三维模型和左心耳的超声四维模型进行空间配准，得到基于超声/CT图像的左心耳图像的融合模型，通过可视化的方式实现两种图像模态的联合显示，得到超声/CT图像的左心耳图像的融合模型；Step 5: spatially registering the CT three-dimensional model of the cardiac chamber and the left atrial appendage and the ultrasound four-dimensional model of the left atrial appendage to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image, and realizing joint display of the two image modalities by visualization to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image;

步骤6：基于左心耳图像的融合模型，模拟将左心耳封堵装置放入左心耳融合模型，用于辅助临床医生对于病灶等级判别，并指导手术规划与术后效果评估。Step 6: Based on the fusion model of the left atrial appendage image, simulate placing the left atrial appendage occlusion device into the left atrial appendage fusion model to assist clinicians in determining the grade of lesions and guide surgical planning and postoperative effect evaluation.

上述步骤5中空间配准包括配准算法，配准算法将两种异构的图像模态通过特征变换映射到同一个坐标空间之下，并且能够对于运动造成的局部非刚性形变具备较好的鲁棒性。The spatial registration in the above step 5 includes a registration algorithm, which maps two heterogeneous image modalities into the same coordinate space through feature transformation and has good robustness to local non-rigid deformation caused by motion.

上述步骤5中融合模型显示的左心耳内表面设有定位锚定区，底部有左心耳深度的标志点；上述步骤6中模拟将左心耳封堵装置放入左心耳融合模型，是将左心耳封堵装置放置于锚定区。The inner surface of the left atrial appendage displayed on the fusion model in the above step 5 is provided with a positioning anchoring area, and there is a marking point of the left atrial appendage depth at the bottom; the above step 6 simulates placing the left atrial appendage occlusion device into the left atrial appendage fusion model, which is to place the left atrial appendage occlusion device in the anchoring area.

本发明提供一种超声心动图和CT多模态图像融合的左心耳封堵模拟系统，包括：The present invention provides a left atrial appendage occlusion simulation system for fusion of echocardiography and CT multimodal images, comprising:

数据采集模块，用于获取人体心脏左心耳经食管实时四维超声心动图和CT的DICOM格式图像数据；A data acquisition module, used to obtain DICOM format image data of the left atrial appendage of the human heart through the esophagus in real-time four-dimensional echocardiography and CT;

数据处理模块，用于处理人体心脏的CT图像和人体左心耳经食管实时四维超声图像，并建模；对心脏腔室、左心耳的CT三维模型和左心耳的超声四维模型进行空间配准，得到基于超声/CT图像的左心耳图像的融合模型；The data processing module is used to process the CT image of the human heart and the real-time four-dimensional ultrasound image of the human left atrial appendage through the esophagus, and to build models; to spatially align the CT three-dimensional model of the heart chamber and the left atrial appendage and the ultrasound four-dimensional model of the left atrial appendage, and to obtain a fusion model of the left atrial appendage image based on the ultrasound/CT image;

模拟手术模块，用于模拟将左心耳封堵装置放入左心耳融合模型；A simulated surgery module is used to simulate the placement of a left atrial appendage occlusion device into a left atrial appendage fusion model;

风险评估模块，用于辅助临床医生对于病灶进行判别，并指导手术规划与术后效果评估；根据模拟效果选择合适的左心耳封堵装置和手术方案。The risk assessment module is used to assist clinicians in identifying lesions and guiding surgical planning and postoperative effect evaluation; and to select appropriate left atrial appendage occlusion devices and surgical plans based on simulation results.

上述模拟手术模块中设有用于模拟不同类型左心耳封堵装置的匹配装置。The above-mentioned simulated surgery module is provided with a matching device for simulating different types of left atrial appendage occlusion devices.

上述匹配装置上设有用于与左心耳锚定区锚定的结构。The matching device is provided with a structure for anchoring with the left atrial appendage anchoring area.

本发明提供一种存储装置，存储装置存储有多条指令，这些指令适于执行根据上述一种经食管实时四维超声心动图和CT多模态图像融合预测左心耳封堵效果的方法中的步骤。The present invention provides a storage device storing a plurality of instructions suitable for executing the steps in the method for predicting the left atrial appendage occlusion effect based on the above-mentioned real-time four-dimensional transesophageal echocardiography and CT multimodal image fusion.

本发明提供的一种超声心动图和CT多模态图像融合的左心耳封堵模拟系统可实现左心耳的经食管实时四维超声心动图和CT多模态图像的融合，应用于集成了左心耳影像建模及其融合系统的嵌入式设备，The left atrial appendage occlusion simulation system for fusion of echocardiography and CT multimodal images provided by the present invention can realize the fusion of transesophageal real-time four-dimensional echocardiography and CT multimodal images of the left atrial appendage, and is applied to an embedded device integrating left atrial appendage image modeling and its fusion system.

图像融合包括如下步骤：获取人体心脏左心耳经食管实时四维超声心动图和CT的DICOM格式图像数据；对人体心脏的CT图像进行阈值分割；对于典型的心脏分割任务，全卷积神经网络FCN将输入CT图像生成右室/左室/右房/左房(RV/LV/RA/LA)与基本血管结构如主动脉(Aorta)等。FCN基于公开的全心脏分割数据集，通过U结构网络与监督学习框架进行模型训练。在此基础上，进一步采用心脏结构中的所有网格点进行主方向提取。对于给定的DSCT图像其中，C为通道数目，D，H，W分别为输入图像的厚度，高度和宽度。对人体左心耳的经食管实时四维超声图像，首先基于极大化-期望(Expectation-Maximization，EM)算法进行预处理与分割。分割过程首先通过四腔平面选取基本位置，基于Sobel算子进行局部区域膨胀，并引入时序权重用于CT与TEE(经食管超声心动图transesophageal echocardiography,TEE)之间的相似性度量。给定RT4D-TEE超声图像序列，共包含NE张3D-TEE图像，模型将得到NE个点集合Yl用于表征超声图像中的四腔轮廓。Image fusion includes the following steps: obtaining real-time four-dimensional transesophageal echocardiography and CT DICOM format image data of the left atrial appendage of the human heart; performing threshold segmentation on the CT image of the human heart; for typical heart segmentation tasks, the fully convolutional neural network FCN will input the CT image to generate the right ventricle/left ventricle/right atrium/left atrium (RV/LV/RA/LA) and basic vascular structures such as the aorta (Aorta). FCN is based on a public full heart segmentation dataset and uses a U-structured network and a supervised learning framework for model training. On this basis, all grid points in the heart structure are further used to extract the main direction. For a given DSCT image Where C is the number of channels, and D, H, and W are the thickness, height, and width of the input image, respectively. The real-time four-dimensional transesophageal ultrasound image of the human left atrial appendage is first preprocessed and segmented based on the Expectation-Maximization (EM) algorithm. The segmentation process first selects the basic position through the four-chamber plane, performs local area expansion based on the Sobel operator, and introduces the time series weight for the similarity measurement between CT and TEE (transesophageal echocardiography, TEE). Given a RT4D-TEE ultrasound image sequence containing N E 3D-TEE images, the model will obtain N E point sets Y l to characterize the four-chamber contours in the ultrasound image.

本发明提供的一种经食管实时四维超声心动图和CT多模态图像融合左心耳封堵模拟系统，包括经食管实时四维超声心动图和CT多模态图像融合系统和匹配装置；The present invention provides a transesophageal real-time four-dimensional echocardiography and CT multimodal image fusion left atrial appendage occlusion simulation system, comprising a transesophageal real-time four-dimensional echocardiography and CT multimodal image fusion system and a matching device;

其中，图像融合系统，包括经食管超声心动图和CT图像；经食管超声心动图图像包括二维和四维图像；CT图像，包括二维和三维图像；匹配装置，为模拟不同类型的左心耳封堵器装置；匹配装置上具有不同封堵器装置的锚定区。Among them, the image fusion system includes transesophageal echocardiography and CT images; the transesophageal echocardiography images include two-dimensional and four-dimensional images; the CT images include two-dimensional and three-dimensional images; the matching device is used to simulate different types of left atrial appendage occluder devices; the matching device has anchoring areas for different occluder devices.

一种超声心动图和CT多模态图像融合的左心耳封堵模拟系统的左心耳影像建模方法包括：A left atrial appendage image modeling method of a left atrial appendage occlusion simulation system fused with echocardiography and CT multimodal images comprises:

1.获取人体左心耳的超声图像及CT数据，运用医疗检测仪器采集患者的左心耳DICOM格式的超声影像数据及CT数据。1. Obtain ultrasound images and CT data of the human left atrial appendage, and use medical testing equipment to collect ultrasound image data and CT data of the patient's left atrial appendage in DICOM format.

2.在患者左心耳超声图像中，首先基于极大化-期望EM算法进行预处理与分割。分割过程首先通过四腔平面选取基本位置，基于Sobel算子进行局部区域膨胀，并引入时序权重用于CT与TEE之间的相似性度量。2. In the left atrial appendage ultrasound image of the patient, preprocessing and segmentation are first performed based on the maximization-expectation EM algorithm. The segmentation process first selects the basic position through the four-chamber plane, performs local area expansion based on the Sobel operator, and introduces the time series weight for the similarity measurement between CT and TEE.

3.在人体心脏的CT图像中，首先采用FCN进行心脏基本结构的分割。对于典型的心脏分割任务，FCN将输入CT图像生成左右心室/房(RV/LV/RA/LA)与基本血管结构(Aorta等)。FCN基于公开的全心脏分割数据集，通过U结构网络与监督学习框架进行模型训练。在此基础上，进一步采用心脏结构中的所有网格点进行主方向提取。3. In the CT image of the human heart, FCN is first used to segment the basic structure of the heart. For typical heart segmentation tasks, FCN generates left and right ventricles/atria (RV/LV/RA/LA) and basic vascular structures (Aorta, etc.) from the input CT image. FCN is based on a public full heart segmentation dataset and uses the U structure network and supervised learning framework for model training. On this basis, all grid points in the heart structure are further used to extract the main direction.

4.基于处理完毕的CT图像与超声图像，通过与现有方法类似的穷举离散搜索方法执行初始粗超声帧与CT层位匹配。对于每个时间点t，带有最小均方误差的截面将作为刚性变换为最优匹配。4. Based on the processed CT image and ultrasound image, the initial rough ultrasound frame and CT slice matching is performed by an exhaustive discrete search method similar to the existing method. For each time point t, the section with the minimum mean square error will be used as a rigid transformation to obtain the optimal match.

5.对心脏腔室、左心耳的CT三维模型和左心耳的超声四维模型进行空间配准，得到基于超声-CT图像的左心耳图像的融合模型，其中包括：设计一个配准算法，将两种异构的图像模态通过特征变换映射到同一个坐标空间之下，并且能够对于运动造成的局部非刚性形变具备较好的鲁棒性。最终通过可视化的方式实现两种图像模态的联合显示，得到超声-CT图像的左心耳图像的融合模型，用于临床诊断。5. Perform spatial registration on the CT 3D model of the cardiac chamber and the left atrial appendage and the ultrasound 4D model of the left atrial appendage to obtain a fusion model of the left atrial appendage image based on ultrasound-CT images, including: designing a registration algorithm to map the two heterogeneous image modalities to the same coordinate space through feature transformation, and having good robustness to the local non-rigid deformation caused by movement. Finally, the two image modalities are jointly displayed through visualization to obtain a fusion model of the left atrial appendage image of ultrasound-CT images for clinical diagnosis.

6.进行基于多模态特征融合的计算机辅助诊断框架研究：在完成多模态配准工作后，需要基于可视化图像数据设计相应的计算机辅助诊断算法，用于辅助临床医生对于病灶等级判别，并指导手术规划与术后效果评估。6. Conduct research on computer-aided diagnosis framework based on multimodal feature fusion: After completing the multimodal registration work, it is necessary to design a corresponding computer-aided diagnosis algorithm based on the visual image data to assist clinicians in determining the grade of lesions and guide surgical planning and postoperative effect evaluation.

左心耳图像的融合模型的内表面上具有定位锚定区结构；左心耳图像的融合模型的底部具有左心耳深度的标志点；左心耳封堵器装置放置于锚定区结构上。The inner surface of the fusion model of the left atrial appendage image has a positioning anchoring area structure; the bottom of the fusion model of the left atrial appendage image has a marking point of the left atrial appendage depth; and the left atrial appendage occluder device is placed on the anchoring area structure.

左心耳图像的融合模型的内表面，向可移动部的本体内部位置延伸的方向上，设有定位锚定区结构；通过将左心耳封堵器装置放置于锚定区结构上，实现对左心耳的封堵。The inner surface of the fusion model of the left atrial appendage image is provided with a positioning anchoring area structure in a direction extending toward the inner position of the movable part; the left atrial appendage occluder device is placed on the anchoring area structure to achieve occlusion of the left atrial appendage.

匹配装置，为模拟不同类型的左心耳封堵器装置；匹配装置上具有不同封堵器装置对应的不同锚定区。The matching device is used to simulate different types of left atrial appendage occluder devices; the matching device has different anchoring areas corresponding to different occluder devices.

左心耳图像的融合模型中位于左心耳内口和回旋支的位置，分别设有锚定区。锚定区的位置，针对不同形态的左心耳为可调节的结构。左心耳外口的位置，位于华法林嵴和二尖瓣环之间，该连线与锚定区连线的区域设有覆盖区，针对不同形态的左心耳为可调节的结构。覆盖区和锚定区可针对不同类型的封堵器装置。In the fusion model of the left atrial appendage image, anchoring areas are provided at the positions of the inner opening of the left atrial appendage and the circumflex branch. The position of the anchoring area is an adjustable structure for left atrial appendages of different forms. The position of the outer opening of the left atrial appendage is located between the warfarin ridge and the mitral valve ring. The area between the line connecting the warfarin ridge and the anchoring area is provided with a coverage area, which is an adjustable structure for left atrial appendages of different forms. The coverage area and the anchoring area can be used for different types of occluder devices.

本发明提供一种左心耳封堵模拟系统可实现左心耳封堵器装置和左心耳的匹配，有助于选择最合适的封堵器装置；设置匹配装置，匹配装置上具有不同封堵器装置对应的不同锚定区；左心耳图像的融合模型中锚定区的位置为可调节的结构，还设有覆盖区，针对不同形态的左心耳为可调节的结构。覆盖区和锚定区可针对不同规格、型号的封堵器装置。The present invention provides a left atrial appendage occlusion simulation system that can achieve the matching of a left atrial appendage occluder device and a left atrial appendage, which is helpful for selecting the most suitable occluder device; a matching device is provided, and different anchoring areas corresponding to different occluder devices are provided on the matching device; the position of the anchoring area in the fusion model of the left atrial appendage image is an adjustable structure, and a coverage area is also provided, which is an adjustable structure for left atrial appendages of different forms. The coverage area and the anchoring area can be for occluder devices of different specifications and models.

以上所述，仅为本发明的较佳实施例，并非对本发明任何形式上和实质上的限制，应当指出，对于本技术领域的普通技术人员，在不脱离本发明的前提下，还将可以做出若干改进和补充，这些改进和补充也应视为本发明的保护范围。凡熟悉本专业的技术人员，在不脱离本发明的精神和范围的情况下，当可利用以上所揭示的技术内容而做出的些许更动、修饰与演变的等同变化，均为本发明的等效实施例；同时，凡依据本发明的实质技术对上述实施例所作的任何等同变化的更动、修饰与演变，均仍属于本发明的技术方案的范围内。The above is only a preferred embodiment of the present invention, and is not any formal or substantial limitation of the present invention. It should be pointed out that ordinary technicians in this technical field can make several improvements and supplements without departing from the present invention, and these improvements and supplements should also be regarded as the protection scope of the present invention. Any technician familiar with this profession, without departing from the spirit and scope of the present invention, can make some changes, modifications and evolutions of the technical content disclosed above, which are equivalent embodiments of the present invention; at the same time, any changes, modifications and evolutions of any equivalent changes made to the above embodiments based on the essential technology of the present invention are still within the scope of the technical solution of the present invention.

Claims (10)

1. The left auricle plugging simulation method is characterized by comprising the steps of performing fusion modeling on a left auricle ultrasonic image and a human heart CT image to simulate a left auricle plugging effect; the method comprises the steps of processing four-dimensional echocardiography of left auricle of a human heart and DICOM format image data of CT of the human heart; modeling based on the processed CT image and the ultrasonic image, and performing spatial registration on a heart chamber, a CT three-dimensional model of the left auricle and an ultrasonic four-dimensional model of the left auricle to obtain a fusion model of the left auricle image based on the ultrasonic/CT image; based on a fusion model of the left auricle image, a plurality of left auricle plugging devices are simulated to be put into the left auricle fusion model; and selecting a proper left auricle plugging device according to the simulation effect.
2. The method according to claim 1, wherein the processing of the CT image of the human heart comprises thresholding the CT image of the human heart, and generating the input CT image into a right/left and basic vascular structures through a full convolutional neural network FCN for a typical heart segmentation task; the FCN performs model training through a U-structure network and a supervised learning framework based on the disclosed full heart segmentation data set; all grid points in the heart structure are used for main direction extraction.
3. The left atrial appendage occlusion simulation method of claim 1, wherein the processing of the human left atrial appendage four-dimensional ultrasound image comprises preprocessing and segmentation based on a maximization-expectation EM algorithm; the segmentation process comprises the steps of selecting basic positions through four cavity planes, carrying out local region expansion based on a Sobel operator, and introducing time sequence weights for similarity measurement between CT and TEE.
4. The left atrial appendage occlusion simulation method of claim 1, wherein the modeling comprises performing initial coarse ultrasound frame-to-CT horizon matching by an exhaustive discrete search method similar to existing methods based on processed CT images and ultrasound images; for each time point t, the cross section with the least mean square error will be transformed as a rigid to the best match.
5. The left atrial appendage occlusion simulation method of claim 1, wherein a positioning anchoring zone is provided on an inner surface of a left atrial appendage of the left atrial appendage fusion model; the simulation is that the left auricle plugging device is placed into the left auricle fusion model to simulate the placement of the left auricle plugging device in the anchoring area.
6. A left atrial appendage occlusion simulation system, comprising:
The data acquisition module is used for inputting the data of the left auricle four-dimensional echocardiogram of the human heart and the DICOM format image of the CT of the human heart;
The data processing module is used for processing the CT image and the left auricle four-dimensional ultrasonic image and modeling; carrying out spatial registration on the three-dimensional model of the heart chamber and the four-dimensional model of the left auricle to obtain a fusion model of the left auricle image based on the ultrasonic/CT image;
the simulation operation module is used for simulating the placement of the left auricle plugging device into the left auricle fusion model;
the risk assessment module is used for assisting a clinician in distinguishing the focus and guiding operation planning and postoperative effect assessment; and selecting a proper left auricle plugging device and a proper operation scheme according to the simulation effect.
7. The left atrial appendage occlusion simulation system of claim 6, wherein: the simulation operation module is internally provided with a matching device for simulating different types of left auricle plugging devices; the matching device is provided with an anchoring structure for anchoring with the left auricle anchoring area.
8. Use of a left atrial appendage occlusion simulation method of any one of claims 1 to 5 for the manufacture of a left atrial appendage occlusion device.
9. Use of a left atrial appendage occlusion simulation system of any of claims 6 to 7 for the manufacture of a left atrial appendage occlusion device.
10. Use of the method or system according to any one of claims 1 to 7 in non-diagnostic and non-therapeutic methods.
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