JP2016511016A - 身体構造イメージング - Google Patents
身体構造イメージング Download PDFInfo
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- JP2016511016A JP2016511016A JP2015554305A JP2015554305A JP2016511016A JP 2016511016 A JP2016511016 A JP 2016511016A JP 2015554305 A JP2015554305 A JP 2015554305A JP 2015554305 A JP2015554305 A JP 2015554305A JP 2016511016 A JP2016511016 A JP 2016511016A
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Abstract
Description
本願は、以下の出願:
2013年1月24日に出願された米国仮特許出願第61/756,112号明細書、
2013年3月11日に出願された米国仮特許出願第61/776,599号明細書、
2013年3月20日に出願された米国仮特許出願第61/803,611号明細書、
2013年6月6日に出願された米国仮特許出願第61/831,664号明細書、
2013年9月8日に出願された米国仮特許出願第61/875,069号明細書、
2013年9月8日に出願された米国仮特許出願第61/875,070号明細書、
2013年9月8日に出願された米国仮特許出願第61/875,074号明細書
からの優先権を主張し、これらの内容は全体として参照により本明細書に援用される。
「BODY STRUCTURE IMAGING」(代理人整理番号第58457号);
「BODY STRUCTURE IMAGING」(代理人整理番号第58459号);
「NERVE IMAGING AND TREATMENT」(代理人整理番号第58463号);
「BODY STRUCTURE IMAGING」(代理人整理番号第58465号);
これらは全て本願と同日に同時出願される。
それに代えて又は加えて、GPは、画像マスク内の計算された活性(例えば、画像強度)を別の画像マスクの活性と比較することにより同定され得る。例えば、EGPは、EGPの総活性が標準偏差(SD1及び/又はSD2)の所定の倍数だけ平均活性(A1及び/又はA2)を上回る、及び/又はその周囲の隣接する活性が(例えば、容積について相関付けられる)EGP活性の半分未満であるという規則を満たすものとして同定され得る。任意選択で、使用者は所定の倍数を選択及び/又は変更し得る。例えば、MGPは、MGPの総活性が標準偏差(SD1及び/又はSD2)の別の所定の倍数だけ平均活性(A1及び/又はA2)を上回る、及び/又はその周囲の隣接する活性が(例えば、容積について相関付けられる)MGP活性の半分未満であるという規則を満たすものとして同定され得る。任意選択で、使用者は所定の倍数を選択及び/又は変更し得る。
図14は右心室1704及び左心室1302の画像を示し、ここでは右心室が本発明の例示的実施形態に係るmIBG活性に従い色付けされており、心室中隔1706において最大活性レベルを示し、これは中隔内ホットスポットである。1706におけるアブレーションにより肥大型心筋症(HCM)及び/又は閉塞性肥大型心筋症(HOCM)が治療され得る;及び
図15は、本発明の例示的実施形態に係る、mIBG活性に従い色付けされた1906左心房1304の画像を示す。特に、心室中隔(inter−ventricular speta)近傍の活性のホットスポットは興味深く、これは当該技術分野において一見したところ知られておらず、治療及び/又は診断の計画に用いられていない。本発明の一部の実施形態では、活性化エリアの分解能は、カウントにより測定したときの、mIBG活性のヒストグラムにおける種々の数十のパーセンタイルの位置間を分けるため、直線分解能が1〜10mm(例えば3mm、5mm、7mm又は中間の分解能)である。
Claims (46)
- 機能的イメージングモダリティを使用して心臓治療をガイドする方法において、
心臓を含む患者の生体内ボリュームをイメージングする機能的イメージングモダリティから機能的イメージングモダリティデータを提供するステップであって、前記患者は、前記心臓の自律神経系(ANS)による神経組織内取込みを有する造影剤を注入されており、前記ANSは少なくとも1つのGPを含む、ステップと、
前記機能的イメージングモダリティデータに基づき、前記心臓を神経支配する前記少なくとも1つのGPの位置を決定するステップと、
前記位置が決定された少なくとも1つのGPを提供するステップと、
を含むことを特徴とする方法。 - 請求項1に記載の方法において、前記ANSが、左上GP(SLGP)、左下GP(ILGP)、右前GP(ARGP)、右下GP(IRGP)、及びマーシャルGPのうちの1つ以上を含む少なくとも1つのGPを含むことを特徴とする方法。
- 請求項2に記載の方法において、前記ANSが、左上GP(SLGP)、左下GP(ILGP)、右前GP(ARGP)、右下GP(IRGP)、及びマーシャルGPのうちの2つ又は3つ又はそれ以上からの2つ、3つ又はそれ以上のGPを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記位置決定された少なくとも1つのGPの不適切な活性に基づき心疾患を治療するため、前記位置決定された少なくとも1つのGPのアブレーション用システムをセットアップするステップをさらに含むことを特徴とする方法。
- 請求項1に記載の方法において、前記心疾患が心房細動を含むことを特徴とする方法。
- 請求項1に記載の方法において、治療用又は他の診断用EPカテーテルに対する前記GPの位置を表示するため、前記位置が決定されたGPの座標が生体内ナビゲーションシステムにロードされることを特徴とする方法。
- 請求項1に記載の方法において、CARTO(登録商標)システムの治療用カテーテルに対する前記GPの位置を表示するため、前記位置が決定されたGPの座標が前記CARTO(登録商標)システムにロードされることを特徴とする方法。
- 請求項7に記載の方法において、前記CARTO(登録商標)システムに基づき前記患者体内でカテーテルをナビゲートするステップをさらに含むことを特徴とする方法。
- 請求項7に記載の方法において、前記CARTO(登録商標)システムに基づきGPアブレーションの治療ポイントを機能的に検証するステップをさらに含むことを特徴とする方法。
- 請求項7に記載の方法において、前記位置が決定されたGPを前記CARTO(登録商標)システムでアブレーションするステップをさらに含むことを特徴とする方法。
- 請求項7に記載の方法において、前記GPのアブレーションを前記CARTO(登録商標)システムで確認するステップをさらに含むことを特徴とする方法。
- 請求項1に記載の方法において、位置を決定するステップが、前記機能的イメージングモダリティデータに基づき前記心臓の脂肪パッド又は他の周囲組織において前記少なくとも1つのGPの位置を決定するステップを含むことを特徴とする方法。
- 請求項12に記載の方法において、前記システムをセットアップするステップが、前記周囲の脂肪パッドの大部分をアブレーションすることなしに前記脂肪パッド内の前記少なくとも1つのGPをアブレーションするため前記システムをセットアップするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記心臓を含む前記患者の生体内ボリュームをイメージングする解剖学的画像モダリティから解剖学的イメージングモダリティデータを取得するステップをさらに含み、位置を決定するステップが、前記機能的イメージングモダリティデータ及び前記解剖学的イメージングモダリティデータのレジストレーションに基づき前記心臓の前記生体内ボリュームにおける又は前記生体内ボリュームに隣接する前記少なくとも1つのGPの位置を決定するステップを含むことを特徴とする方法。
- 請求項14に記載の方法において、前記位置が決定された少なくとも1つのGPを前記解剖学的イメージングモダリティデータ上にマーキングするステップをさらに含むことを特徴とする方法。
- 請求項15に記載の方法において、前記解剖学的イメージングモダリティデータが蛍光透視による治療手技中にリアルタイムで取得され、前記位置を決定するステップが、CTによる前記治療手技の前に及び/又はその最中にリアルタイムで実施され、及び前記少なくとも1つのGPの前記位置が、前記治療手技を実施している操作者に提示されることを特徴とする方法。
- 請求項1に記載の方法において、ANSシナプス及びGPの一方又は両方の分布及び/又は活性を含むANSマップを生成するステップと、表示のため前記ANSマップを提供するステップとをさらに含むことを特徴とする方法。
- 請求項17に記載の方法において、前記ANSマップが、前記心臓内の治療プローブ又はイメージングプローブを含む前記心臓の再構成された解剖学的画像上に、前記再構成された解剖学的画像及びCARTO(登録商標)マッピング画像と同じスペース内においてオーバーレイされることを特徴とする方法。
- 請求項1に記載の方法において、前記位置を決定するステップが、連続性分裂心房電位(CFAE)部位と収縮力(CF)部位との間の共通部分を同定するステップを含み、前記ガイドするステップが、前記共通部分のアブレーションをガイドするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記位置を決定するステップが、連続性分裂心房電位(CFAE)部位とドミナント周波数(DF)部位との間の共通部分を同定するステップを含み、前記ガイドするステップが、前記共通部分のアブレーションをガイドするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記位置を決定するステップが、連続性分裂心房電位(CFAE)部位と少なくとも1つのGPとの間の共通部分を同定するステップを含み、前記ガイドするステップが、前記共通部分のアブレーションをガイドするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記位置を決定するステップが、連続性分裂心房電位(CFAE)部位とドミナント周波数(DF)と少なくとも1つのGPとの間の共通部分を同定するステップを含み、前記ガイドするステップが、前記共通部分のアブレーションをガイドするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記位置を決定するステップが、連続性分裂心房電位(CFAE)部位と収縮力(CF)部位と少なくとも1つのGPとの間の共通部分を同定するステップを含み、前記ガイドするステップが、前記共通部分のアブレーションをガイドするステップを含むことを特徴とする方法。
- 請求項1に記載の方法において、位置を決定するステップが、少なくとも1つのGPをイメージングするステップと、前記位置が決定されたGPの周りをマッピングして前記GPの位置を確かめるステップとを含むことを特徴とする方法。
- 請求項1に記載の方法において、患者が前記心臓ANSの不適切な活性を受けているという仮説に基づき前記患者を選択するステップをさらに含むことを特徴とする方法。
- 請求項1に記載の方法において、取得するステップが、少なくとも1つの心周期の間にデータ複数フレームを含むように取得するステップと、単一画像を再構成するステップとを含むことを特徴とする方法。
- 請求項1に記載の方法において、前記心臓に対するアブレーションの効果をモニタするステップをさらに含むことを特徴とする方法。
- 請求項1に記載の方法において、生成されたANSモデルに基づきアブレーションの効果を確認するステップをさらに含むことを特徴とする方法。
- 患者の心臓の画像内でANS組織を同定するシステムにおいて、
心臓を含む患者の生体内ボリュームをイメージングする機能的イメージングモダリティから機能的イメージングモダリティデータを受け取るモジュールであって、前記患者は、前記心臓の自律神経系(ANS)による神経組織内取込みを有する造影剤を注入されており、前記ANSは少なくとも1つのGPを含む、モジュールと、
前記心臓を含む患者の生体内ボリュームをイメージングする解剖学的イメージングモダリティから解剖学的イメージングモダリティデータを受け取るモジュールと、
前記機能的イメージングモダリティデータに基づき、前記心臓を神経支配する前記少なくとも1つのGPの位置を決定するモジュールと、
前記位置が決定された少なくとも1つのGPを前記解剖学的イメージングデータ上に位置付けるモジュールと、
を含むことを特徴とするシステム。 - 請求項29に記載のシステムにおいて、前記ANSが、左上GP(SLGP)、左下GP(ILGP)、右前GP(ARGP)、右下GP(IRGP)、及びマーシャルGPのうちの1つ以上を含む少なくとも1つのGPを含むことを特徴とするシステム。
- 請求項30に記載のシステムにおいて、前記ANSが、左上GP(SLGP)、左下GP(ILGP)、右前GP(ARGP)、右下GP(IRGP)、及びマーシャルGPのうちの2つ又は3つ又はそれ以上からの2つ、3つ又はそれ以上のGPを含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記解剖学的イメージングモダリティデータが治療手技の前及び/又はその最中に受け取られることを特徴とするシステム。
- 請求項29に記載のシステムにおいて、カテーテル心臓ナビゲーションシステムをさらに含み、前記カテーテル心臓ナビゲーションシステムが、前記位置決定された神経組織を受け取り表示することにより、前記神経組織のアブレーションのため前記心臓内で生体内治療プローブをガイドすることを特徴とするシステム。
- 請求項33に記載のシステムにおいて、前記カテーテル心臓ナビゲーションシステムがCARTO(登録商標)であることを特徴とするシステム。
- 請求項33に記載のシステムにおいて、前記カテーテル心臓ナビゲーションシステムが3D電気生理学的(EP)システムであることを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記心臓内での前記神経組織のアブレーション用生体内治療プローブをさらに含むことを特徴とするシステム。
- 請求項36に記載のシステムにおいて、前記生体内治療プローブが、高周波(RF)治療プローブ、冷凍外科手術治療プローブ、及び毒素又は薬物を注入するプローブのうちの少なくとも1つであることを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記イメージングされた神経組織の分布を1つ以上の予想分布セットと比較し、且つ前記比較に基づき異常なシナプス分布及び/又は活性を検出するための診断モジュールをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記イメージングされた神経組織の分布の経時的変化をトラッキングするトラッキングモジュールをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、生成されたANSモデル及び診断のうちの少なくとも一方を保存するリポジトリをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記機能的画像の測定された取込みに基づきアブレーション手技の成功の予測を推定するモジュールをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、使用者から手動入力を受け取るユーザ入力要素と、前記受け取った手動入力に基づき、前記位置決定された神経組織に注釈を付ける治療計画モジュールとをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、特定の生体内エリアにおける神経組織を刺激すること、及び前記刺激に応答した1つ以上の神経応答を同定することのうちの少なくとも一方のための機能検証モジュールをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、生成されたANSモデルに基づき治療後の神経組織の刺激の効果を治療前の神経組織の刺激の効果と比較して前記治療を確認するモジュールをさらに含むことを特徴とするシステム。
- 請求項29に記載のシステムにおいて、前記システムの前記モジュールが分散していることを特徴とするシステム。
- 患者の心臓の画像内においてANS成分を同定するためのシステムにおいて、
心臓を含む患者であって、前記患者は前記心臓の自律神経系(ANS)による神経組織内取込みを有する造影剤を注入されており、前記ANSは、左上GP(SLGP)、左下GP(ILGP)、右前GP(ARGP)、右下GP(IRGP)、及びマーシャルGPのうちの1つ以上を含む少なくとも1つのGPを含む、患者の生体内ボリュームをイメージングする機能的イメージングモダリティから機能的イメージングモダリティデータを受け取るため;
前記心臓を含む患者の生体内ボリュームをイメージングする解剖学的イメージングモダリティから解剖学的イメージングモダリティデータを受け取るため;及び
前記機能的イメージングモダリティデータ及び解剖学的イメージングモダリティデータに基づき前記心臓の前記生体内ボリュームにおいて前記少なくとも1つのGPの位置を決定するため
の少なくとも1つのモジュールを含むことを特徴とするシステム。
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JP2016509508A (ja) | 2016-03-31 |
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AU2014208379A1 (en) | 2015-07-23 |
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CN104936511A (zh) | 2015-09-23 |
CN104936511B (zh) | 2018-01-16 |
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US20150359430A1 (en) | 2015-12-17 |
CN105025779A (zh) | 2015-11-04 |
AU2014208381A1 (en) | 2015-07-23 |
JP6389193B2 (ja) | 2018-09-12 |
CN105025779B (zh) | 2017-06-23 |
EP2948044A4 (en) | 2016-03-09 |
EP2948045B1 (en) | 2022-04-13 |
JP6470185B2 (ja) | 2019-02-13 |
EP2948045A1 (en) | 2015-12-02 |
US20150351834A1 (en) | 2015-12-10 |
CN104936512A (zh) | 2015-09-23 |
US20220133151A1 (en) | 2022-05-05 |
WO2014115148A1 (en) | 2014-07-31 |
US10292588B2 (en) | 2019-05-21 |
JP6334566B2 (ja) | 2018-05-30 |
EP2948047B1 (en) | 2021-03-03 |
US20150327805A1 (en) | 2015-11-19 |
WO2014115151A1 (en) | 2014-07-31 |
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