CN1550224A - 用于设计左心房附器隔离的心脏ct系统和方法 - Google Patents

用于设计左心房附器隔离的心脏ct系统和方法 Download PDF

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CN1550224A
CN1550224A CNA2004100386484A CN200410038648A CN1550224A CN 1550224 A CN1550224 A CN 1550224A CN A2004100386484 A CNA2004100386484 A CN A2004100386484A CN 200410038648 A CN200410038648 A CN 200410038648A CN 1550224 A CN1550224 A CN 1550224A
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D��R���¿��׵�
D·R·奥克伦德
J·S·斯拉
M·L·瓦斯
S·B·雷迪
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Abstract

用于为病人设计左心房附器闭塞的方法(200)，包括从医学成像系统获得探测数据(202)，以及产生病人左心房的3D模型(130) (206)。在所述3D模型(130)上确定一个或多个左心房的解剖标记(210)，以及在介入系统上登记所保存的所述3D模型(130)(216)。用所述介入系统显示一个或多个所述已登记的所保存的视图(218)。

Description

用于设计左心房附器隔离的心脏CT系统和方法
技术领域
目前的公开内容一般涉及心脏植入系统，尤其是涉及用于设计心脏左心房附器的隔离的心脏成像系统和方法。
背景技术
心房颤动(AF)是一种心率失常，其中当心房(心脏的上腔)颤动时，心房停止正常地收缩，并且心房颤动是最常见的心率不规则。据估计超过2.2百万的美国人已被诊断为有AF，每年还有超过140,000的新病例被诊断出。有AF的病人具有高度的中风的危险，并且大约15％的中风发生在有房颤的人中。每年约600,000美国人中风或中风复发。在1991年，Framingham的研究表明：AF的诊断使中风的危险增高了3至5倍，从在生命中的第五个十年的1.5％上升到在第八个十年的超过23％。
更准确地说，以前的研究表明多于90％的与非风湿性AF有关的中风由在左心房附器(LAA)、即在心脏左上腔中的小的拇指形状的袋中形成的血块而产生。这些血块可能阻塞通向脑部的血管，因而引起中风。几个大的随机试验已表明warfarin、一种抗凝血剂在降低中风的危险方面的功效。可是，在临床实践中，在超过40％的病人中该药由于例如出血的副作用而被显示不当或不能被使用。另一种治疗AF的方法是手术干预、例如迷宫手术，在该手术中切口在两个心房中战略上的布置阻止了错误电脉冲的形成和传导。迷宫手术通过产生永久地阻塞引起AF的电脉冲的传播路径的伤疤组织来引导正常的电脉冲在从心脏的顶部到底部的一个方向上传播，因此根除了心率失常。在这样的手术中，如在美国心脏病学院-美国心脏协会的指导方针中所推荐的，常规上LAA被切除。
最近，为了提供另一种可选的用于预防中风的方案，正在实现涉及考虑闭塞LAA的最低限度侵入式技术。特别是使用导管将一个闭塞装置放在LAA的入口处。该闭塞装置是一个自膨胀的镍钛诺金属盒，当金属在体内变热时，该装置爆裂开。所述金属盒被覆盖了一层阻塞心房附器并允许正常的组织生长到所述装置中的隔膜。在一个对这个被称为PLAATO(经皮左心房附器经导管闭塞术)的手术的研究中，病人的植入物的直径范围为18-32毫米，平均手术时间为92.7分钟。然而，在25％的病人中，最初的装置被移去并用一个不同尺寸的装置来代替。同样地，改进的、用于为LAA解剖确定有效的路线图以及适当的时候为有效的LAA隔离和/或闭塞确定路线图的系统和方法是必需的。
发明内容
通过一种用于为病人设计左心房附器(LAA)闭塞的方法来克服或缓和以前技术的上述的和其他的缺点和不足。在一个示例性的实施方案中，所述方法包括从医学成像系统得到非侵入式的探测数据，以及产生病人左心房的3D模型。在该3D模型上确定一个或多个左心房的解剖标志，并将被保存的3D模型的视图在介入系统上登记。使用该介入系统来显示一个或多个已登记的被保存的视图。
在另一个方案中，用于为病人设计左心房附器(LAA)闭塞的方法包括从使用以左心房为目标的协议的医学成像系统得到探测数据。使用3D协议将该探测数据分段以显示包括LAA的左心房。产生病人左心房的3D模型，并在该3D模型上确定一个或多个左心房的解剖标志。将被保存的3D模型的视图在介入系统上登记，并在该介入系统上显示一个或多个已登记的被保存的视图。从所述的3D模型来确定LAA的方位和大小以及此外任何有关的异常。
在另一个方案中，用于为病人设计左心房附器(LAA)闭塞的方法包括从使用以左心房为目标的协议的、例如计算机X线断层造影(CT)扫描仪的医学成像系统得到探测数据。使用3D协议将该探测数据分段，使得包括LAA的左心房可见。产生病人左心房的3D模型，并在该3D模型上确定一个或多个左心房的解剖标志。将被保存的3D模型的视图在荧光透视检查系统上登记，并用该荧光透视检查系统来显示一个或多个已登记的被保存的视图。从所述的3D模型来确定LAA的方位和大小以及此外任何有关的异常。
在另一个方案中，用于为病人设计左心房附器(LAA)闭塞的系统包括用于产生非侵入式探测数据的医学成像系统，以及用于接收探测数据并产生一个或多个病人左心房的图像的图像产生子系统。操作控制台或后处理装置被设计用于在一个或多个图像上确定一个或多个左心房解剖标志。工作站包括用于保存3D模型的视图的后处理软件。所述3D模型的视图可以在一个介入系统上登记。该接入系统被设计用于显示一个或多个在此已登记的被保存的视图以及确定LAA的方位和大小。
在另一个方案中，用于为病人设计左心房附器(LAA)闭塞的系统包括用于产生探测数据的心脏计算机X线断层造影(CT)成像系统，该CT成像系统使用以左心房为目标的协议。图像产生子系统接收探测数据并产生一个或多个病人左心房的图像。图像产生子系统还被设计用于使用3D协议将探测数据分段，使得包括LAA的左心房可见。操作控制台被设计用于在一个或多个图像上确定一个或多个左心房解剖标志，以及工作站包括用于在荧光透视检查系统上登记被保存的3D模型的视图的后处理软件。该荧光透视检查系统被设计用于显示一个或多个在此已登记的被保存的视图以及确定LAA的方位和大小。
附图说明
参考示例性的附图，其中在几个附图中以相同的方式将相似元件编号：
图1是根据本发明的一个实施方案的、适合设计左心房附器(LAA)隔离的例如计算机X线断层造影(CT)系统的医学成像系统的示意图；以及
图2是根据本发明的另一个实施方案的、用于设计左心房附器(LAA)隔离的方法的流程图。
具体实施方式
在这里公开的是用于LAA隔离/闭塞的心脏计算机X线断层造影(CT)系统和方法，该系统和方法提供用于设计介入手术的信息，该信息使电生理学家、心脏病专家和/或外科医生能够预先设计一个理想的手术方法。另外，专业人员可以利用如可从例如CT、磁共振(MR)和超声的成像方式得到的更详细的LAA的三维(3D)几何图像来确定LAA的方位、大小和任何异常。因此，在设计的时候可以选择正确尺寸的装置或植入物，以避免错误尺寸的植入物与这个手术冲突的问题。得到的3D图像也可以被用于设计从外侧隔离LAA(即从心外膜)。
虽然在CT成像系统的上下文中描述了在下文中说明的示例性的实施方案，但是应理解，关于LAA隔离/闭塞的设计也可考虑在本领域中已知的其他成像系统。
首先参考图1，示出了示例性的支持心脏成像的心脏计算机X线断层造影(CT)系统100的概观。此外，应理解心脏CT系统100只是作为例子而介绍，因为在本领域中已知的其他成像系统(例如磁共振、超声)也可用于本发明的实施方案。系统100的扫描仪部分102包括心电图(EKG)监控器104，其将R峰事件经扫描仪接口板108输出到扫描仪106。扫描仪接口板108的一个适当的例子是可用于将EKG系统连接到扫描仪的Gantry接口板。由扫描仪部分102定义的心脏CT子系统利用EKG门控探测或图像重建的能力以使心脏在其舒张的阶段以及在多个收缩和舒张的早期阶段无运动地成像。
数据从扫描仪部分102输出到包括用于实现数据探测、数据控制和图像产生的软件的子系统110。此外，从扫描仪106输出的、包括R峰时间标志的数据被存储在探测数据库112中。根据一个或多个对于心脏成像以及尤其是对于左心房成像为最优化的探测协议来实现探测。使用一个或多个最优化的、用于对LAA的内表面的CT图像数据组自动地进行图像分割的3D协议来实现图像产生。
图像数据流114被发送到操作控制台116。由在用于检查命令和显像的操作控制台114上的软件使用的数据连同来自图像数据流114的数据一起被存储在图像数据库118中。显示屏120被提供用于检查命令和显像过程的操作。图像数据可以被存档，放在胶片上或经网络122发送到用于进行包括3D后处理的分析和观察的工作站124。在工作站124中描述的后处理软件提供可从内部观察的LAA口和LAA体的“可浸入的”视图，这些特殊的视图可由专业人员保存和观察。
后处理软件的3D协议使软件能够在提供LAA的确定的定量的特征、例如在离心房附器的末端不同距离的以及在心门、LAA和肺静脉之间的心房的轮廓、位置方位和尺寸(例如周长)。可以为这些特征自动地或半自动地提供用户输入和交互作用，并且将这些特征存入3D透视图文件126中以便为专业人员的介入设计和手术而使用。后处理软件还提供输出左心房和LAA的详细的3D模型128。该3D模型128(可以在由与工作站124联合的显示屏132上观察)被设计用于包括在感兴趣的标志处插入体积的几何标识符，使得以具有不透明的几何标志的透明方式来显示左心房和LAA。
此外，该3D模型128可以用下列几种格式的任何一种来输出，这几种格式包括但不局限于：线网几何模型、一组表面轮廓、二进制图像的分段的量、以及使用放射治疗(RT)DICOM(数字图像和医学通信)对象标准的DICOM对象或相似的对象。也可以使用本领域中已知的其他格式来存储和输出3D模型128。
现在参考图2，根据本发明的另一个实施方案示出了说明设计LAA隔离的方法的流程图。在方框202开始，使用优选地对于心脏的左心房(LA)区域为最优化的协议开始在心脏CT系统上获得大量的数据。在方框204，以使用优选地对于LA为最优化的3D协议的后处理软件将图像数据组分段，并且设计该图像数据组以提取包括LA的心脏房室的表面。适当的时候可以使用具有或不具有操作队列(例如前后、左前斜肌的、后外侧斜肌和右前斜肌的视图位置)的自动手术。
然后，如方框206所示，使用3D表面和/或体积透视图来显示LAA以产生LAA的3D模型，该模型也优选地包括可浸入的视图(即来自房室内部的视图)。如方框208所示，用这种方式可以测量LAA的心门大小和轮廓。如方框210所示，明确的几何标识符被插入在感兴趣的标志处的体积内，其中随后可以用透明的方式显示该标识符。然后，如方框212所示，作为所期望的用于随后的在介入设计期间的视觉参考以及为在介入手术期间的使用而保存特定的3D透视图和轴向图(例如DICOM图像、视频剪辑、电影、多媒体格式等)。然后，如方框214所示，被保存的视图被输出，并且用投影图像在荧光透视检查系统上或可选地用3D荧光透视检测系统的层析X射线照相组合图像来显示所保存的视图。
如方框216所示，访问介入系统并且由专业人员来显示与此输入的显示模型。最后，在方框218，专业人员确定LAA的方位。大小和任何异常，使得可以选择适当尺寸的装置或植入物并在LAA内植入。需理解通过利用几个有效的计算机辅助的检测、定位和显示方法中的一个或多个而使用自动技术以实现任何上述步骤。此外，当手术或感兴趣的器官是指定的或是部分地与用户的输入交互时，这些方法可以为全自动的。
此外，需理解通过使用上述的方法和系统实施方案，LAA闭塞设计在以下方面有改进，即产生和显示的图像信息允许适当修改介入手术的方法。在选择适当的方法时，手术本身的持续时间被降低并且去除了任何不必要的步骤。更特别地是，通过提供在离心房附器的末端不同距离的以及在心门、LAA和肺静脉之间的心房的轮廓、位置方位和尺寸(例如周长)，LAA壁详细的3D几何图像增加了隔离/闭塞手术的精度。此外，可以用输入和交互作用自动地或半自动地提供这些特征。
当参考优选实施方案描述本发明时，需理解那些本领域中的技术人员可以不离开本发明的范围而做出各种修改以及用等价物来替换其中的元件。此外，可以做出许多修改以使特殊的情况或材料适合于本发明的学说而不离开它的基本范围。因此，这意味者本发明不应局限于特殊的、作为考虑用于实现本发明的最佳方式而公开的实施方案，但是本发明将包括所有在从属权利要求范围内的实施方案。
附图标记列表
100  心脏计算机X线断层造影(CT)系统
102  扫描仪部分
104  心电图(EKG)监控器
106  扫描仪
108  扫描仪接口板
110  子系统
112  探测数据库
114  图像数据流
116  操作控制台
118  图像数据库
120  显示屏
122  网络
124  工作站
126  3D透视图
128  详细的3D模型
132  显示屏
200  方法
202  方框
204  方框
206  方框
208  方框
210  方框
212  方框
214  方框
216  方框
218  方框
220  方框

Claims (10)

1.用于为病人设计左心房附器(LAA)闭塞的方法(200)，所述方法(200)包括：
从医学成像系统获得探测数据(202)；
产生病人左心房的3D模型(206)；
在所述3D模型上确定一个或多个左心房的解剖标记(210)；
在介入系统上登记所保存的所述3D模型(130)(216)；
用所述介入系统显示一个或多个所述已登记的所保存的视图(218)。
2.如权利要求1所述的方法(200)，还包括从所述3D模型确定LAA的方位和大小(220)。
3.如权利要求1所述的方法(200)，其中获得所述探测数据(202)用被控制用于左心房成像的协议来实现(204)。
4.如权利要求3所述的方法(200)，还包括利用后处理软件来处理所述探测数据以便产生LAA口的可浸入的视图。
5.如权利要求4所述的方法(200)，其中通过与所述介入系统相连的显示屏来显示所述的3D模型和所述可浸入的视图。
6.如权利要求1所述的方法(200)，还包括测量LAA门的大小和轮廓(208)。
7.如权利要求1所述的方法(200)，其中所述获得的探测数据是EKG门控的。
8.用于为病人设计左心房附器(LAA)闭塞的系统，包括：
用于产生探测数据的医学成像系统(102)；
用于接收所述探测数据并产生一个或多个病人左心房的图像的图像产生子系统(110)；
用于在所述一个或多个图像上确定一个或多个左心房解剖标记的操作控制台(116)；
工作站(124)，其包括用于在介入系统上登记保存的所述3D模型(128)视图的后处理软件；以及
其中所述介入系统被设计用于显示一个或多个所述在此已登记的保存的视图并确定LAA的方位和大小。
9.如权利要求8所述的系统，其中用被控制用于左心房成像的协议来设计所述图像产生子系统(110)。
10.如权利要求9所述的系统，其中所述后处理软件还被设计用于处理所述探测数据以产生LAA口的可浸入的视图。
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