JP2018057835A - Medical information processing apparatus, x-ray ct apparatus, and medical information processing program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical information processing apparatus which can improve efficiency of diagnosis related to a blood stream, and an X-ray CT apparatus and a medical information processing program.SOLUTION: A medical information processing apparatus includes an acquisition unit, a calculation unit, a representative value extraction unit and a display control unit. The acquisition unit acquires image data including a blood vessel of a subject. The calculation unit applies fluid analysis to the image data acquired by the acquisition unit and obtains index values related to a blood stream in the blood vessel for a plurality of positions of the blood vessel. The representative value extraction unit selects a position for obtaining a first value from the plurality of positions or selects a value to be the first value from the index values at the respective positions for the index values calculated by the calculation unit. The display control unit displays the first value in a prescribed display region for displaying the first value in a display unit.SELECTED DRAWING: Figure 2

Description

  Embodiments described herein relate generally to a medical information processing apparatus, an X-ray CT apparatus, and a medical information processing program.

  Conventionally, it is known that the causes of an ischemic disease of an organ are roughly classified into a blood circulation disorder and an organ dysfunction. For example, stenosis, which is an example of coronary artery circulation disorder, is a serious lesion that leads to ischemic heart disease. In such ischemic heart disease, whether drug treatment or stent treatment should be performed, etc. It is necessary to judge. In recent years, as a diagnosis for evaluating ischemic ischemia of coronary arteries, there is a method of measuring a myocardial blood flow reserve (FFR) using a pressure wire in a coronary angiography (CAG) using a catheter. It is being recommended.

  On the other hand, for example, coronary artery ischemic ischemia using medical images of the heart collected by a medical image diagnostic apparatus such as an X-ray CT (Computed Tomography) apparatus, an MRI (Magnetic Resonance Imaging) apparatus, or an ultrasonic diagnostic apparatus. A technique for non-invasive evaluation is also known. As described above, hematogenous ischemia is evaluated by various methods, and treatment according to the evaluation is performed. In recent years, it has been desired to determine an actual therapeutic effect before treatment.

Special table 2013-534154 gazette

  The problem to be solved by the present invention is to provide a medical information processing apparatus, an X-ray CT apparatus, and a medical information processing program that can improve the efficiency of diagnosis related to blood flow.

  The medical information processing apparatus according to the embodiment includes an acquisition unit, a calculation unit, a representative value extraction unit, and a display control unit. The acquisition unit acquires image data including a blood vessel of the subject. The calculation unit performs fluid analysis on the image data acquired by the acquisition unit, and obtains index values related to blood flow in the blood vessel at a plurality of positions of the blood vessel. The representative value extraction unit selects a position for obtaining the first value from the plurality of positions for the index value calculated by the calculation unit, or selects a value to be the first value from the index value at each position. The display control unit displays the first value in a predetermined display area for displaying the first value on the display unit.

FIG. 1 is a diagram illustrating an example of a configuration of a medical information processing system according to the first embodiment. FIG. 2 is a diagram illustrating an example of the configuration of the medical information processing apparatus according to the first embodiment. FIG. 3 is a diagram for explaining an example of processing by the calculation function according to the first embodiment. FIG. 4 is a diagram for explaining a time phase used in the fluid analysis according to the first embodiment. FIG. 5A is a diagram illustrating a display example of FFR by the display control function according to the first embodiment. FIG. 5B is a diagram illustrating a display example of FFR by the display control function according to the first embodiment. FIG. 5C is a diagram illustrating a display example of FFR by the display control function according to the first embodiment. FIG. 5D is a diagram illustrating a display example of FFR by the display control function according to the first embodiment. FIG. 6 is a diagram for explaining display control by the display control function according to the first embodiment. FIG. 7 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus according to the first embodiment. FIG. 8A is a diagram illustrating an example of display switching by the display control function according to the second embodiment. FIG. 8B is a diagram illustrating an example of display switching by the display control function according to the second embodiment. FIG. 9 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus according to the second embodiment. FIG. 10A is a diagram for explaining a calculation example of ΔFFR by the calculation function according to the third embodiment. FIG. 10B is a diagram for explaining a calculation example of ΔFFR by the calculation function according to the third embodiment. FIG. 10C is a diagram for describing a calculation example of ΔFFR by the calculation function according to the third embodiment. FIG. 11A is a diagram illustrating a display example of auxiliary information by the display control function according to the third embodiment. FIG. 11B is a diagram illustrating a display example of auxiliary information by the display control function according to the third embodiment. FIG. 11C is a diagram illustrating a display example of auxiliary information by the display control function according to the third embodiment. FIG. 12 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus according to the third embodiment. FIG. 13 is a diagram illustrating a display example of a clinical image by the display control function according to the fourth embodiment. FIG. 14 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus according to the fourth embodiment. FIG. 15A is a diagram for explaining an example of representative values according to the fifth embodiment. FIG. 15B is a diagram for describing an example of representative values according to the fifth embodiment. FIG. 15C is a diagram for explaining an example of representative values according to the fifth embodiment. FIG. 16A is a diagram illustrating an example of a display image according to the fifth embodiment. FIG. 16B is a diagram illustrating an example of a display image according to the fifth embodiment. FIG. 17 is a diagram illustrating a display example according to the fifth embodiment. FIG. 18A is a diagram for explaining an example of representative values according to the fifth embodiment. FIG. 18B is a diagram for describing an example of representative values according to the fifth embodiment. FIG. 19 is a diagram illustrating an example of the configuration of an X-ray CT apparatus according to the fifth embodiment.

  Exemplary embodiments of a medical information processing apparatus, an X-ray CT apparatus, and a medical information processing program according to the present application will be described below in detail with reference to the accompanying drawings. The medical information processing apparatus, the X-ray CT apparatus, and the medical information processing program according to the present application are not limited to the embodiments described below.

(First embodiment)
First, the first embodiment will be described. In the first embodiment, an example in which the technology according to the present application is applied to a medical information processing apparatus will be described. Hereinafter, a medical information processing system including a medical information processing apparatus will be described as an example. In the following, an example in which a cardiac blood vessel is an analysis target will be described as an example.

  FIG. 1 is a diagram illustrating an example of a configuration of a medical information processing system according to the first embodiment. As illustrated in FIG. 1, the medical information processing system according to the first embodiment includes an X-ray CT (Computed Tomography) apparatus 100, an image storage apparatus 200, and a medical information processing apparatus 300.

  For example, the medical information processing apparatus 300 according to the first embodiment is connected to the X-ray CT apparatus 100 and the image storage apparatus 200 via a network 400 as shown in FIG. The medical information processing system may be further connected via the network 400 to another medical image diagnostic apparatus such as an MRI apparatus, an ultrasonic diagnostic apparatus, or a PET (Positron Emission Tomography) apparatus.

  The X-ray CT apparatus 100 collects CT image data (volume data) of a subject. Specifically, the X-ray CT apparatus 100 collects projection data by detecting the X-rays transmitted through the subject by rotating the X-ray tube and the X-ray detector around the subject. Then, the X-ray CT apparatus 100 generates time-series three-dimensional CT image data based on the collected projection data.

  The image storage device 200 stores image data collected by various medical image diagnostic apparatuses. For example, the image storage device 200 is realized by a computer device such as a server device. In this embodiment, the image storage apparatus 200 acquires CT image data (volume data) from the X-ray CT apparatus 100 via the network 400, and the acquired CT image data is stored in the apparatus or outside the apparatus. Remember me.

  The medical information processing apparatus 300 acquires image data from various medical image diagnostic apparatuses via the network 400, and processes the acquired image data. For example, the medical information processing apparatus 300 is realized by a computer device such as a workstation. In the present embodiment, the medical information processing apparatus 300 acquires CT image data from the X-ray CT apparatus 100 or the image storage apparatus 200 via the network 400, and performs various image processes on the acquired CT image data. The medical information processing apparatus 300 displays CT image data before or after performing image processing on a display or the like.

  FIG. 2 is a diagram illustrating an example of the configuration of the medical information processing apparatus 300 according to the first embodiment. For example, as illustrated in FIG. 2, the medical information processing apparatus 300 includes an I / F (interface) circuit 310, a storage circuit 320, an input circuit 330, a display 340, and a processing circuit 350.

  The I / F circuit 310 is connected to the processing circuit 350 and controls transmission and communication of various data performed with various medical image diagnostic apparatuses or image storage apparatuses 200 connected via the network 400. For example, the I / F circuit 310 is realized by a network card, a network adapter, a NIC (Network Interface Controller), or the like. In the present embodiment, the I / F circuit 310 receives CT image data from the X-ray CT apparatus 100 or the image storage apparatus 200 and outputs the received CT image data to the processing circuit 350.

  The storage circuit 320 is connected to the processing circuit 350 and stores various data. For example, the storage circuit 320 is realized by a semiconductor memory device such as a RAM (Random Access Memory) or a flash memory, a hard disk, an optical disk, or the like. In the present embodiment, the storage circuit 320 stores CT image data received from the X-ray CT apparatus 100 or the image storage apparatus 200. In addition, the storage circuit 320 stores a processing result by the processing circuit 350.

  The input circuit 330 is connected to the processing circuit 350, converts an input operation received from the operator into an electrical signal, and outputs the electrical signal to the processing circuit 350. For example, the input circuit 330 is realized by a trackball, a switch button, a mouse, a keyboard, a touch panel, or the like. The input circuit 330 is an example of an input unit in the claims.

  The display 340 is connected to the processing circuit 350 and displays various information and various image data output from the processing circuit 350. For example, the display 340 is realized by a liquid crystal monitor, a CRT (Cathode Ray Tube) monitor, a touch panel, or the like.

  The processing circuit 350 controls each component included in the medical information processing apparatus 300 in accordance with an input operation received from the operator via the input circuit 330. For example, the processing circuit 350 is realized by a processor. In the present embodiment, the processing circuit 350 causes the storage circuit 320 to store CT image data output from the I / F circuit 310. Further, the processing circuit 350 reads out CT image data from the storage circuit 320 and displays it on the display 340.

  Under such a configuration, the medical information processing apparatus 300 according to the present embodiment can improve the efficiency of diagnosis related to blood flow. Specifically, the medical information processing apparatus 300 improves the efficiency of diagnosis by displaying a representative value of an index related to blood flow, thereby enabling appropriate diagnosis to be performed quickly.

  In order to execute the processing described above, the processing circuit 350 in the medical information processing apparatus 300 according to the first embodiment executes a control function 351, a calculation function 352, and a display control function 353 as shown in FIG. To do. Here, the control function 351 is an example of an acquisition unit and an image generation unit in the claims. The calculation function 352 is an example of a calculation unit and a representative value extraction unit in the claims. The display control function 353 is an example of a display control unit in the claims.

  The control function 351 executes overall control of the medical information processing apparatus 300. For example, the control function 351 controls various processes according to the electrical signal received from the input circuit 330. For example, the control function 351 controls acquisition of CT image data via the I / F circuit 310, storage of the acquired CT image data in the storage circuit 320, and the like. For example, the control function 351 acquires CT image data including the blood vessel of the subject and stores it in the storage circuit 320. Further, for example, the control function 351 reads the CT image data stored by the storage circuit 320 and controls the generation of a display image from the read CT image data. For example, the control function 351 generates a blood vessel image by performing various image processes on the CT image data. For example, the control function 351 performs image processing on CT image data, thereby performing volume rendering images, CPR (Curved Multi Planer Reconstruction) images, MPR (Multi Planer Reconstruction) images, SPR (Stretched Multi Planer Reconstruction) images. And so on.

  The calculation function 352 performs fluid analysis based on the CT image data. Specifically, the calculation function 352 performs fluid analysis on the CT image data acquired by the control function 351 to obtain an index value related to blood flow in the blood vessel. Here, the calculation function 352 has a representative value extraction function for extracting various representative values (first values) from the calculated index value. Specifically, for the calculated index value, the calculation function 352 selects a position on the blood vessel for obtaining a representative value from a plurality of positions, or selects a value to be a representative value from the index value at each position. For example, the calculation function 352 analyzes the shape of the blood vessel of the subject and sets a position on the blood vessel where the representative value is obtained based on the shape of the blood vessel. In addition, the calculation function 352 analyzes the shape of the blood vessel of the subject, and sets a position on the blood vessel that obtains a representative value as a position that is separated from the blood vessel deletion position by a predetermined distance. In addition, the calculation function 352 analyzes the shape of the blood vessel of the subject, and sets the position on the blood vessel where the diameter of the blood vessel becomes a predetermined diameter and is closest to the extinction to obtain the representative value. In the following embodiment, a case where the representative value extraction function is included in the calculation function 352 and a representative value is extracted will be described. However, the embodiment is not limited to this, and the processing circuit 350 has a calculation function. In addition to 352, the representative value extraction function may be executed. Details of the calculation function will be described below. For example, the calculation function 352 extracts time-series blood vessel shape data representing a blood vessel shape from three-dimensional CT image data. For example, the calculation function 352 reads CT image data of a plurality of time phases collected from the storage circuit 320 over time, and performs image processing on the read CT image data of the plurality of time phases to thereby obtain a time-series blood vessel. Extract shape data.

  Here, the calculation function 352 sets a target region for calculating a blood flow index in a blood vessel region included in the CT image data. Specifically, the calculation function 352 sets a target region in the blood vessel region by an instruction from the operator via the input circuit 330 or image processing. The calculation function 352 uses, for example, a blood vessel core line (coordinate information of the core line), a cross-sectional area of blood vessels and lumens in a cross section perpendicular to the core line, and a cross section perpendicular to the core line as blood vessel shape data of the set target region. The distance from the core line in the cylindrical direction to the inner wall and the distance from the core line to the outer wall are extracted from the CT image data. The calculation function 352 can extract other various blood vessel shape data depending on the analysis method.

  Furthermore, the calculation function 352 sets analysis conditions for fluid analysis. Specifically, the calculation function 352 sets a physical property value of blood, an iterative calculation condition, an initial value of analysis, and the like as analysis conditions. For example, the calculation function 352 sets blood viscosity, density, and the like as the physical property values of blood. In addition, the calculation function 352 sets the maximum number of iterations in the iterative calculation, a relaxation coefficient, an allowable value of the residual, and the like as conditions for the iterative calculation. In addition, the calculation function 352 sets a flow rate, a pressure, a fluid resistance, an initial value of a pressure boundary, and the like as initial values for analysis. Various values used by the calculation function 352 may be incorporated in the system in advance, or may be defined interactively by the operator.

  Then, the calculation function 352 calculates an index relating to blood flow of the blood vessel by fluid analysis using image data including blood vessels (for example, coronary arteries). Specifically, the calculation function 352 performs fluid analysis using the blood vessel shape data and analysis conditions, and calculates an index related to blood flow in the target region of the blood vessel. For example, the calculation function 352 is based on the blood vessel shape data such as the contour of the blood vessel lumen and the outer wall, the cross-sectional area of the blood vessel, and the core wire, and the setting conditions such as the physical property value of blood, the condition for repeated calculation, and the initial value of analysis For each predetermined position of the blood vessel, indices such as pressure, blood flow rate, blood flow rate, vector, and shear stress are calculated. Further, the calculation function 352 uses pressure, blood flow rate, blood flow rate, vector, shear stress, etc. by using temporal variation of blood vessel shape data such as the contour of the blood vessel and the outer wall, the cross-sectional area of the blood vessel, and the core wire. The time fluctuation of the index of is calculated.

  FIG. 3 is a diagram for explaining an example of processing by the calculation function 352 according to the first embodiment. As illustrated in FIG. 3, for example, the calculation function 352 extracts blood vessel shape data including the coordinates of the core line and cross-sectional information for the LAD that is the target region from the three-dimensional CT image data including the aorta and the coronary artery. Furthermore, the calculation function 352 sets an analysis condition for analysis for the extracted LAD. Then, the calculation function 352 performs fluid analysis using the extracted LAD blood vessel shape data and the set conditions, for example, from the entrance boundary to the exit boundary of the target region LAD, along a predetermined core line. For each position, indices such as pressure, blood flow rate, blood flow rate, vector, and shear stress are calculated. That is, the calculation function 352 calculates distributions such as pressure, blood flow rate, blood flow rate, vector, and shear stress for the target region.

  As described above, the calculation function 352 extracts blood vessel shape data from CT image data of a plurality of time phases collected over time, and performs fluid analysis using the extracted blood vessel shape data and analysis conditions of the plurality of time phases. To calculate an index relating to blood flow. Here, the calculation function 352 calculates a more accurate analysis result by using CT image data of a plurality of time phases in which the cardiac phase is within a predetermined range.

  FIG. 4 is a diagram for explaining a time phase used in the fluid analysis according to the first embodiment. In FIG. 4, the heart rate is shown in the upper stage, the heart movement is shown in the middle stage, and the area of the coronary artery is shown in the lower stage. In FIG. 4, the horizontal direction indicates time, and the heartbeat, heart motion, and coronary artery area change with time are shown in association with each other. For example, the calculation function 352 performs fluid analysis using the CT image data of the cardiac phase included in the range of 70% to 99% of the cardiac phase. Here, the cardiac phases 70% to 99% are time phases in which there is not much movement of the heart and the change in the area of the coronary artery is large, as shown in FIG. The heart moves due to contraction and dilation, and as shown in the middle part of FIG. In other words, the calculation function 352 can use CT image data having a small motion associated with the pulsation by using the CT image data of the cardiac phase included in the cardiac phase 70% to 99% where the motion is stable.

  Further, as shown in the lower part of FIG. 4, the area of the coronary artery is the maximum near the cardiac phase 70% and the minimum is near 99%. This is because blood begins to flow into the coronary artery near the cardiac phase of 70% and then flows out as it reaches 99%. The calculation function 352 calculates a more accurate analysis result by using CT image data of a plurality of time phases within the range of 70% to 99% of the cardiac phase so as to include the change in the area of the coronary artery as much as possible.

  Furthermore, the calculation function 352 calculates a myocardial blood flow reserve ratio (FFR: Fractional Flow Reserve) based on the pressure distribution in the target region. In other words, the calculation function 352 determines how much blood flow is blocked by the lesion from the upstream pressure and the downstream pressure of a predetermined position in the blood vessel (for example, a lesion site such as stenosis or plaque). FFR, which is an index for estimating Here, the calculation function 352 according to the present application can calculate various pressure indexes as FFR.

  Here, first, the definition of FFR will be described. As described above, FFR is an index for estimating how much blood flow is inhibited by a lesion (for example, stenosis or plaque). The flow rate when there is no lesion and the flow rate when there is a lesion. It is defined by the ratio and is calculated by the following equation (1). In the equation (1), “Qn” indicates the flow rate when there is no lesion, and “Qs” indicates the flow rate when there is a lesion.

  The FFR is defined by an expression that divides “Qs” by “Qn”, for example, as shown in Expression (1). Here, in general, in the calculation of FFR, the relationship between the flow rate and pressure in the blood vessel is made proportional to each other by administering adenosine to the subject to obtain a maximum hyperemia state (stress state), and FFR Can be replaced by the definition of pressure. In other words, by making the relationship between the flow rate in the blood vessel and the pressure proportional, equation (1) can be expressed as equation (2) below. In Equation (2), “Pa” indicates the pressure on the upstream side of the lesion, and “Pd” indicates the pressure on the downstream side of the lesion. “Pv” indicates the pressure of the right atrium through which venous blood from the whole body flows.

  For example, by making the relationship between the flow rate in the blood vessel and the pressure proportional to each other, “Qs” is expressed as “Pd−Pv” and “Qn” is expressed as “Pa-Pv” as shown in Expression (2). It can be expressed as That is, FFR is represented by a ratio of values obtained by subtracting the baseline pressure of the blood vessel from the upstream pressure and the downstream pressure of the lesion.

  Here, in a stress state in which adenosine is administered to a subject, it can be regarded as “Pa >> Pv” and “Pd >> Pv”, and therefore Equation (2) is expressed as Equation (3) below. Can be considered.

  That is, as shown in Expression (3), FFR is calculated by an expression that divides “Pd” by “Pa”. For example, the calculation function 352 calculates the FFR value at each position of the blood vessel by substituting the upstream pressure and the downstream pressure of the calculated lesion into the above equation (3).

  In the above-described calculation of FFR, a case has been described in which the relationship between the flow rate in the blood vessel and the pressure is made proportional by replacing the FFR with the definition of pressure by administering adenosine to the subject to be in a stress state. However, in the calculation of FFR, it is also possible to replace FFR with the definition of pressure for a subject in a resting state. In this case, even in a resting state in which adenosine is not administered, the wave-free period of the cardiac cycle (a period in which vascular resistance is low and stable) is proportional to the relationship between the flow rate and pressure in the blood vessel. The FFR is calculated using the pressure in the wave-free period in the state (hereinafter, the FFR calculated in the wave-free period in the resting state is also referred to as an instantaneous FFR).

  Instantaneous FFR can reduce the load on the subject because adenosine is not administered, and can be measured even when there are multiple stenosis in a single blood vessel that reflects characteristics of the myocardium (for example, the effect of the myocardium Etc.), the index value has been attracting attention in recent years. Here, in the calculation of FFR using image data, the above-described CT image data having a cardiac phase of 70% to 99% is used as the CT image data in the Wave-Free period. That is, in the cardiac phase of 70% to 99%, the relationship between the flow rate and pressure in the blood vessel is proportional, and CT image data collected from a resting subject by using this range of CT image data. However, the FFR based on the pressure can be calculated using the above-described equation (3).

  Further, the calculation function 352 uses, as a baseline that is different from the upstream pressure and the downstream pressure of the lesion, a zero flow rate pressure “P0” that is an intravascular blood pressure when the intravascular blood flow is “0”. By using it, the proportional relationship between the flow rate and the pressure can be expressed more accurately than when the right atrial pressure “Pv” is used as the baseline. In this case, the calculation function 352 substitutes the pressure on the upstream side of the lesion site, the pressure on the downstream side of the lesion site, and the pressure at zero flow rate into the following equation (4), thereby calculating the FFR at each position of the blood vessel. Are respectively calculated. Here, “Pa” in Equation (4) indicates the pressure upstream of the lesion (eg, stenosis), and “Pd” indicates the pressure downstream of the lesion (eg, stenosis). Further, “P0” in the equation (4) indicates a zero flow rate pressure. The pressure at zero flow rate is estimated by searching for a pressure at which the flow rate / flow velocity becomes zero in the fluid analysis by the calculation function 352.

  Here, the zero flow rate pressure “P0” indicates a value higher than “Pv” in both the stress state and the rest state. This is because there is a vascular resistance, and blood does not flow even in the state of “P0> Pv”, and the flow rate becomes zero. Then, “P0” in the wave-free period in the resting state is higher than “P0” in the stress state. This is because there is a difference in myocardial resistance between the stress state and the rest state. For example, when the blood vessel is dilated in a stress state, the resistance decreases, so the value of “P0” at which the blood flow becomes zero is closer to the value of “Pv” than in the resting state. On the other hand, in the resting state, since the resistance is larger than that in the stress state, the value of “P0” at which the blood flow becomes zero is larger than the value of “Pv”. Therefore, for example, when using CT image data in a wave-free period in a resting state, the calculation function 352 calculates FFR based on an equation that considers “P0” as shown in equation (4).

  In addition, when using CT image data in a wave-free period in a resting state, the calculation function 352 may be a case where FFR is calculated using the above equation (2). In this case, the calculation function 352 substitutes the pressure on the upstream side of the lesion site, the pressure on the downstream side of the lesion site, and “Pv” into Equation (2), and calculates the FFR value at each position of the blood vessel. calculate. In the following, each of the pressure indicators described above is collectively referred to as FFR.

  As described above, the calculation function 352 calculates various indices related to blood flow by performing fluid analysis on CT image data of a plurality of time phases collected over time. Here, the calculation function 352 calculates a representative value of an index value related to blood flow. For example, the calculation function 352 calculates, as a representative value, at least one of the FFR value at the distal end of the target region for fluid analysis in the blood vessel and the minimum value of FFR in the blood vessel. Here, the calculation function 352 calculates a representative value of FFR for each blood vessel included in the CT image data, for example. In addition, the calculation function 352 calculates, for example, a representative value of FFR for each predetermined region or predetermined distance in the blood vessel.

  Returning to FIG. 2, the display control function 353 displays the representative value in a predetermined display area for displaying the representative value on the display 340. Specifically, when the fluid analysis is executed by the calculation function 352, the display control function 353 automatically displays the representative value of the FFR calculated by the fluid analysis on the display 340. Hereinafter, FFR display examples by the display control function 353 will be described with reference to FIGS. 5A to 5D. 5A to 5D are diagrams illustrating examples of FFR display by the display control function 353 according to the first embodiment.

  For example, when the fluid analysis is executed by the calculation function 352, the display control function 353, as shown in FIG. 5A, represents the FFR representative values (LAD: 0.26, LCX: 0.97, (RCA: 0.70) only is automatically extracted and displayed on the display 340. Here, when the fluid analysis is executed by the calculation function 352, the display control function 353 automatically displays only the representative value of FFR, not the display of the clinical image of the blood vessel or the three-dimensional model generated from the clinical image. Let Therefore, the doctor can immediately determine, for example, that a lesion is included in the LAD and the extent of the lesion is poor by referring to the representative value automatically displayed as shown in FIG. 5A. It is possible to save the trouble of designating a position where the FFR value in the three-dimensional model is desired.

  Here, the display control function 353 can display various representative values for each blood vessel branch. For example, the display control function 353 displays the FFR value at the distal end (tip side) of the target region of fluid analysis in each blood vessel branch of LAD, LCX, and RCA as a representative value. Further, for example, the display control function 353 displays the minimum value of FFR in each blood vessel branch as a representative value. Further, for example, the display control function 353 displays the FFR value at a position at a predetermined distance from the tip (for example, a position 20 mm from the tip) as a representative value for each blood vessel branch. In addition, for example, the display control function 353 displays, for each blood vessel branch, the value of the FFR closest to the periphery where the blood vessel diameter is a predetermined size (for example, a diameter of 2.5 mm) as a representative value. In such a case, the FFR value at each position is calculated by the calculation function 352. Note that the display example illustrated in FIG. 5A is merely an example, and the embodiment is not limited thereto. For example, the representative value may be displayed not only for the three vascular branches described above, but for all the vascular branches included in the coronary artery.

  In addition, the display of the representative value is not limited to the case where it is displayed for each vascular branch of the coronary artery, but may be the case where, for example, the representative value in all the vascular branches is displayed. For example, the display control function 353 causes the display 340 to display the minimum value of FFR in all the vascular branches of the coronary artery as a representative value. That is, the display control function 353 causes the display 340 to display the minimum value among the FFR values calculated by the calculation function 352. In this case, the display control function 353 may display information specifying a blood vessel (for example, names such as LAD and LCX) on the display 340 or display information specifying the blood vessel. It is possible to display only the value of FFR without doing so. Thereby, the doctor can confirm the minimum value of FFR in all the vascular branches immediately, and can judge the treatment content after that easily.

  The display control function 353 can also display the average value of the FFR values at a predetermined position of each blood vessel branch as a representative value. For example, the display control function 353 calculates an average value of FFR values at a position 20 mm from the distal end of each blood vessel branch, and causes the display 340 to display the calculated average value. Further, for each vascular branch, an average value of FFR values at each point at a position from 20 mm to 30 mm from the tip may be calculated, and the calculated average value may be displayed on the display 340.

  The display control function 353 can display a representative value for each predetermined region in the blood vessel. For example, as shown in FIG. 5B, the display control function 353 causes the display 340 to display the representative value of the FFR for each segment (1 to 15) of the coronary artery classified by AHA (American Heart Association). Here, the representative value for each segment is, for example, the minimum value of FFR in each segment, the value of FFR at the distal end of each segment, or the like. In such a case, the calculation function 352 classifies the region of each vascular branch of the coronary artery into AHA segments, and calculates the FFR value at each position for each classified segment. The display control function 353 extracts the FFR representative value for each segment calculated by the calculation function 352 and causes the display 340 to display it.

  The display control function 353 can display the FFR value for each predetermined distance in the blood vessel as a representative value. For example, as shown in FIG. 5C, the display control function 353 displays the FFR values at intervals of “5 mm” from the start of the LAD. Note that the example illustrated in FIG. 5C is merely an example, and the embodiment is not limited thereto. That is, the display control function 353 can display the FFR value for each predetermined distance for other blood vessel branches. The distance for displaying the FFR value can be arbitrarily set.

  Further, the display control function 353 can display the FFR value calculated by the calculation function 352 in a schematic diagram showing the anatomical characteristics of the blood vessel and display it in a predetermined display area. For example, as shown in FIG. 5D, the display control function 353 displays display information indicating a representative value of FFR on a textbook model image (for example, an anatomical atlas) indicating anatomical features on the display 340. Let For example, the display control function 353 causes the display 340 to display display information indicating respective representative values for each blood vessel branch in the schematic diagram.

  In the above, each display example of the FFR value by the display control function 353 has been described. However, the display examples described above can be used in appropriate combination. For example, the display control function 353 may display the distance from the start point of the position of the minimum value when displaying the minimum value of the FFR for each blood vessel branch or segment.

  As described above, the display control function 353 according to the first embodiment can display the representative value of the FFR without performing position designation using a display image of a blood vessel or a three-dimensional model (color map) display based on the image. Can be displayed. Here, after displaying the representative value, the medical information processing apparatus 300 accepts the designation operation by the input circuit 330, thereby changing the location where the FFR value displayed on the display 340 is obtained according to the designation operation. be able to. Specifically, the input circuit 330 receives a position designation operation for a blood vessel included in a display image that is generated using CT image data and displayed in a display area different from a predetermined display area. The calculation function 352 calculates the FFR value at the position designated by the designation operation received by the input circuit 330. The display control function 353 displays the FFR value at the position specified by the specifying operation in a predetermined display area.

  FIG. 6 is a diagram for explaining display control by the display control function 353 according to the first embodiment. For example, as shown in FIG. 6, the display control function 353 causes the display 340 to display a blood vessel cross-sectional image separately from the representative value of the FFR of each blood vessel branch. Here, the image shown in FIG. 6 is a CPR image, an SPR image, and a short-axis cross-sectional image (an image of a cross section perpendicular to the core line) generated by the control function 351 from the CT image data. For example, the control function 351 generates a CPR image, an SPR image, and a short-axis cross-sectional image of LAD using CT image data on which fluid analysis has been performed. Note that the short-axis cross-sectional image shown at the right end of FIG. 6 shows cross-sections at positions 61 to 67 shown in the CPR image and the SPR image, respectively.

  For example, as shown in FIG. 6, the display control function 353 arranges and displays the markers 50 on the LAD of the CPR image and the SPR image. The input circuit 330 accepts a movement operation for the marker 50. Then, the display control function 353 displays the FFR value corresponding to the position of the marker 50 on the upper left portion of the display 340. For example, the display control function 353 arranges the marker 50 at the distal end of the target region at the start of display, and causes the display 340 to display the FFR value at the distal end of the target region. Then, the input circuit 330 receives an operation for moving the marker 50 along the LAD. The display control function 353 displays the FFR value corresponding to the position of the marker 50 moved via the input circuit 330 in conjunction with the movement of the marker 50.

  FIG. 6 shows the case where the marker 50 is arranged on the cross-sectional image, but the embodiment is not limited to this. For example, the marker 50 is arranged on the volume rendering image. Also good. In addition, the display control function 353 can also display the short-axis cross-sectional image corresponding to the position of the marker 50 with emphasis (for example, one enlargement).

  Heretofore, the FFR display example by the display control function 353 according to the first embodiment has been described. Here, the medical information processing apparatus 300 according to the first embodiment can output the FFR representative value (text information) calculated for each blood vessel branch or each segment to the electronic medical record. For example, the display control function 353 outputs the representative value for each blood vessel branch to the electronic medical record in association with the blood vessel branch, or outputs the representative value for each segment to the electronic medical record in association with the segment. Further, for example, an image showing the FFR value at the position of the marker 50 is outputted to the electronic medical record, and further, a clinical image on which the marker 50 is arranged is outputted to the electronic medical record in a state associated with the image showing the FFR value. You can also. Further, when an FFR value is selected on the electronic medical chart, the display control function 353 displays a clinical image such as a cross-sectional image or a volume rendering image together with a marker that identifies the position where the selected FFR value is calculated. Let As a result, the doctor can first make a diagnosis with reference to the representative value of FFR and improve the diagnosis efficiency.

  Next, a processing procedure performed by the medical information processing apparatus 300 according to the first embodiment will be described. FIG. 7 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus 300 according to the first embodiment. Here, step S101 and step S102 in FIG. 7 are realized, for example, when the processing circuit 350 calls and executes a program corresponding to the calculation function 352 from the storage circuit 320. Further, step S103 to step S107 are realized, for example, when the processing circuit 350 calls and executes a program corresponding to the display control function 353 from the storage circuit 320.

  In the medical information processing apparatus 300 according to the present embodiment, first, the processing circuit 350 performs fluid analysis using the collected CT image data (step S101), and obtains an index value (eg, FFR) related to blood flow. Calculate (step S102). Then, the processing circuit 350 displays the numerical value of the index value at the default position (step S103). Here, for example, the processing circuit 350 displays the FFR value at the distal end of the target region as the index value of the default position. Thereafter, the processing circuit 350 determines whether or not a position in the blood vessel has been designated via the input circuit 330 (step S104).

  Here, when the position is designated (Yes at Step S104), the processing circuit 350 displays the numerical value of the index value at the designated position on the display 340 (Step S105), and determines whether or not the storage operation has been executed. Determination is made (step S106). On the other hand, when the position is not specified in step S104 (No in step S104), the processing circuit 350 determines whether or not a save operation has been executed (step S106).

  Here, when the storing operation is executed (Yes at Step S106), the processing circuit 350 stores the display image and the numerical value (Step S107). For example, the processing circuit 350 associates an image with a numerical value and stores it in the storage circuit 320, and outputs the numerical value to an electronic medical record. Note that the processing circuit 350 continues to determine whether or not a position is designated until a save operation is executed (No at Step S106).

  As described above, according to the first embodiment, the calculation function 352 calculates a representative value of an index related to blood flow in a blood vessel by fluid analysis using image data including the blood vessel. The display control function 353 displays the representative value in a predetermined display area for displaying the representative value on the display 340. Therefore, the medical information processing apparatus 300 according to the first embodiment can immediately present the representative value of the FFR to the doctor, and can improve the efficiency of diagnosis.

  In addition, according to the first embodiment, the calculation function 352 represents at least one of the indicator for blood flow at the distal end of the target region for fluid analysis in the blood vessel and the minimum value for the indicator for blood flow in the blood vessel as a representative value. Calculate as Therefore, the medical information processing apparatus 300 according to the first embodiment can automatically present index values suitable for diagnosis, and can further improve the efficiency of diagnosis.

  Further, according to the first embodiment, the calculation function 352 calculates a representative value for each blood vessel included in the CT image data. Therefore, the medical information processing apparatus 300 according to the first embodiment enables comprehensive diagnosis of blood vessels included in CT image data.

  Further, according to the first embodiment, the calculation function 352 calculates a representative value for each predetermined region or predetermined distance in the blood vessel. Therefore, the medical information processing apparatus 300 according to the first embodiment can present indexes according to various conditions.

  Further, according to the first embodiment, the display control function 353 shows the representative value in the schematic diagram showing the anatomical characteristics of the blood vessel and displays it in a predetermined display area. Therefore, the medical information processing apparatus 300 according to the first embodiment makes it possible to visually grasp and grasp the position where the index value is calculated.

  In addition, according to the first embodiment, the input circuit 330 performs a position designation operation on a blood vessel included in a display image that is generated using CT image data and displayed in a display area different from a predetermined display area. Accept. The calculation function 352 calculates an index relating to the blood flow at the position specified by the specifying operation received by the input circuit 330. The display control function 353 displays an index value relating to the blood flow at the position specified by the specifying operation in a predetermined display area. Therefore, the medical information processing apparatus 300 according to the first embodiment can easily display the index value at an arbitrary position.

(Second Embodiment)
In the above-described first embodiment, the case where the FFR value is automatically displayed on the display 340 has been described. In the second embodiment, a case where the FFR value and the clinical image are switched by a simple operation will be described. The configuration of the medical information processing apparatus 300 according to the second embodiment is basically the same as the configuration of the medical information processing apparatus 300 illustrated in FIG. Therefore, in the following, differences from the medical information processing apparatus 300 according to the first embodiment will be mainly described, and constituent elements that play the same role as the constituent elements illustrated in FIG. Detailed description will be omitted.

  The input circuit 330 according to the second embodiment receives a predetermined input operation on the display area of the display 340. For example, the input circuit 330 receives an operation of clicking an arbitrary position in the display area, an operation of clicking a clinical image displayed in the display area, and the like.

  The display control function 353 according to the second embodiment switches the display information in the display area of the display 340 to the representative value of the blood flow index in response to reception of a predetermined input operation by the input circuit 330. Specifically, the display control function 353 switches between the display of the clinical image and the display of the FFR value in response to the reception of the input operation by the input circuit 330.

  FIG. 8A is a diagram illustrating an example of display switching by the display control function 353 according to the second embodiment. For example, as shown in the upper diagram of FIG. 8A, the display control function 353 causes the display 340 to display clinical images (volume rendering image, CPR image, SPR image) generated from the CT image data. Here, when the input circuit 330 accepts a predetermined input operation for the display area, the display control function 353 causes the display 340 to display only “FFR: 0.73” as shown in the lower diagram of FIG. 8A. Switch.

  Here, the display control function 353 changes the FFR value after switching to the corresponding FFR value in accordance with the position of the input operation received by the input circuit 330. For example, when the input circuit 330 receives a click operation on a position not related to a blood vessel in the clinical image, the display control function 353 switches to a preset default position or a default FFR value. Here, as the default FFR value, for example, the FFR representative values described in the first embodiment such as the FFR value at the distal end of the target region and the minimum FFR value in the blood vessel are used. it can.

  On the other hand, when the input circuit 330 receives a click operation on a blood vessel in the clinical image, the display control function 353 switches to the FFR value at the position where the click operation is received. Note that the display control function 353 adds and displays an annotation or mark indicating whether the FFR value after switching is a default FFR value or an FFR value at a specified position. Can do. For example, the display control function 353 can add an annotation or mark to “FFR: 0.73” in the lower diagram of FIG. 8A.

  Further, the display control function 353 according to the second embodiment switches the display information in the display area of the display 340 to a graph of an index related to blood flow in response to reception of a predetermined input operation by the input circuit 330. Specifically, the display control function 353 switches between the display of the clinical image and the display of the FFR graph in the target blood vessel in response to reception of the input operation by the input circuit 330.

  FIG. 8B is a diagram illustrating an example of display switching by the display control function 353 according to the second embodiment. For example, as shown in the upper diagram of FIG. 8B, the display control function 353 causes the display 340 to display clinical images (volume rendering image, CPR image, SPR image) generated from the CT image data. Here, when the input circuit 330 accepts a predetermined input operation on the display area, the display control function 353 switches the display on the display 340 to the FFR graph as shown in the lower diagram of FIG. 8B. Here, in the graph shown in FIG. 8B, the vertical axis indicates FFR, and the horizontal axis indicates a position on the blood vessel.

  For example, when the input circuit 330 accepts the click operation, the display control function 353 switches the display information to the FFR graph in the blood vessel of the clinical image shown in the lower diagram of FIG. 8B. Here, the graph displayed by the display control function 353 is provided with an auxiliary line for determining the FFR value. For example, the display control function 353 displays a graph in which an auxiliary line is added to the FFR value “0.8” as shown in the lower diagram of FIG. 8B.

  Further, as shown in FIG. 8B, the display control function 353 can also display the FFR value together with the graph. Here, the value of FFR displayed together with the graph is, for example, the value of FFR at the distal end of the target region, the minimum value of FFR in the blood vessel, or the like. Although FIG. 8B shows a case where a clinical image of one blood vessel and a graph are switched, the embodiment is not limited to this. For example, it may be a case where clinical images and graphs of a plurality of blood vessels are switched.

  In the medical information processing apparatus 300 according to the second embodiment, the display screen before and after the switching can be saved as an image. In such a case, for example, the input circuit 330 further accepts an operation for saving display information displayed on the display 340. Then, when the input circuit 330 accepts a save operation, the display control function 353 outputs display information before and after switching displayed on the display 340 as image information. For example, when a storage operation is received by the input circuit 330, the display control function 353 captures the upper screen and the lower screen in FIG. 8A, and stores them in the storage circuit 320 in association with each other. Similarly, when a storage operation is accepted by the input circuit 330, the display control function 353 captures the upper screen and the lower screen in FIG. 8B and stores them in the storage circuit 320 in association with each other. Instead of capturing and saving the two images, the lower clinical image may store the captured image, while the upper FFR value may be stored as text data.

  Next, a processing procedure performed by the medical information processing apparatus 300 according to the second embodiment will be described. FIG. 9 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus 300 according to the second embodiment. Here, step S201 and step S202 in FIG. 9 are realized by, for example, the processing circuit 350 calling and executing a program corresponding to the calculation function 352 from the storage circuit 320. Steps S203 to S207 are realized, for example, when the processing circuit 350 calls and executes a program corresponding to the display control function 353 from the storage circuit 320.

  In the medical information processing apparatus 300 according to the present embodiment, first, the processing circuit 350 performs fluid analysis using the collected CT image data (step S201), and obtains an index value (eg, FFR) related to blood flow. Calculate (step S202). Then, the processing circuit 350 displays an image generated from the CT image data (step S203). Then, the processing circuit 350 determines whether or not an operation has been received via the input circuit 330 (step S204).

  Here, when the operation is accepted (Yes at Step S204), the processing circuit 350 displays only the numerical value of the index value at the position corresponding to the operation on the display 340 (Step S205), and whether or not the storage operation has been executed. Is determined (step S206). On the other hand, the processing circuit 350 continues the determination of accepting the operation until the operation is accepted in Step S204 (No in Step S204).

  Here, when the save operation is executed (Yes at Step S206), the processing circuit 350 saves the capture of the clinical image and the capture of the numerical value, respectively (Step S207). For example, the processing circuit 350 associates the capture of clinical images with the capture of numerical values and stores them in the storage circuit 320. The processing circuit 350 continues to determine whether or not the save operation is executed until the save operation is executed (No at Step S206).

  As described above, according to the second embodiment, the input circuit 330 receives a predetermined input operation on the display area of the display 340. The display control function 353 switches the display information in the display area of the display 340 to the representative value of the blood flow index in response to reception of a predetermined input operation by the input circuit 330. Further, the display control function 353 switches display information in the display area of the display 340 to a graph of an index related to blood flow in response to reception of a predetermined input operation by the input circuit 330. Therefore, the medical information processing apparatus 300 according to the second embodiment enables easy-to-see FFR values and graphs to be displayed with a simple operation.

  As described above, according to the second embodiment, the input circuit 330 further accepts an operation for storing the display information displayed on the display 340. When the input circuit 330 accepts a save operation, the display control function 353 outputs the display information before and after switching displayed on the display 340 as image information. Therefore, the medical information processing apparatus 300 according to the second embodiment makes it possible to store clinical images, FFR values, and graphs in a readable state.

(Third embodiment)
In the first and second embodiments described above, the case where the FFR value is displayed on the display 340 has been described. In the third embodiment, a case where auxiliary information is displayed in addition to the FFR value will be described. The configuration of the medical information processing apparatus 300 according to the third embodiment is basically the same as the configuration of the medical information processing apparatus 300 illustrated in FIG. Therefore, in the following, differences from the medical information processing apparatus 300 according to the first and second embodiments will be mainly described, and components having the same functions as those illustrated in FIG. Detailed description will be omitted.

  The calculation function 352 according to the third embodiment calculates the index value in the blood vessel for each position of the blood vessel, the difference in the index value obtained by subtracting the calculated index value between the positions, and the stenosis for each position of the blood vessel. At least one of the rates is further calculated. For example, the calculation function 352 calculates at least one of ΔFFR obtained by substituting the FFR value in the blood vessel between positions, and an inner diameter stenosis ratio (percentage diameter stenosis:% DS).

  10A to 10C are diagrams for explaining an example of calculating ΔFFR by the calculation function 352 according to the third embodiment. Here, FIG. 10A shows a blood vessel for calculating ΔFFR and a calculation width of ΔFFR for the blood vessel. FIG. 10B shows a graph of FFR in the blood vessel shown in FIG. 10A. FIG. 10C is a diagram illustrating an example of ΔFFR calculated by the calculation function 352.

  For example, as shown in FIG. 10A, the calculation function 352 sets a calculation width “1.0 cm” for calculating ΔFFR for a blood vessel for calculating ΔFFR. Here, the calculated width is a width for determining a position where the FFR values are different. For example, in the calculated width “1.0 cm” shown in FIG. 10A, the FFR value at the position of the arrow 81 in the blood vessel and the FFR value at the position of the arrow 82 are differentiated. That is, the calculation function 352 calculates the difference at each position while moving the calculation width shown in FIG. 10A by a predetermined distance along the blood vessel.

  For example, the calculation function 352 first calculates the difference (ΔFFR) between the FFR value at the position of the arrow 81 and the FFR value at the position of the arrow 82 at the position of the calculation width shown in FIG. 10A. Then, the calculation function 352 moves the calculation width by “1 mm” along the blood vessel (rightward in the figure), and at the position after the movement, the FFR value at the position of the arrow 81 and the FFR value at the position of the arrow 82 The difference (ΔFFR) is calculated. Similarly, the calculation function 352 moves the calculation width by “1 mm” along the blood vessel, and sequentially calculates ΔFFR at each position.

  Thereby, the calculation function 352 can calculate ΔFFR for each position on the blood vessel (distance from the start portion) as shown by a curve L2 in FIG. 10C. The calculation range used for calculating ΔFFR can be arbitrarily set. For example, the calculation function 352 can extract a stenosis or a plaque from CT image data, and set a calculation width according to the extracted size of the stenosis or plaque. As an example, the calculation function 352 sets a calculation width that is substantially the same as the width of a stenosis or plaque in the major axis direction of the blood vessel.

  As described above, ΔFFR calculated by the calculation function 352 can be used, for example, for evaluation of a plurality of stenosis as shown in FIG. 10A. For example, as shown in FIG. 10A, when a stenosis 71 and a stenosis 72 occur in a blood vessel, the FFR graph of the blood vessel shows a decrease in the FFR value at each stenosis position as shown by a curve L1 in FIG. 10B. To be. Here, when the stenosis 71 and the stenosis 72 are evaluated using only the FFR graph shown in FIG. 10B, it is difficult to determine which stenosis has a strong influence on the blood flow.

  Therefore, when the value of ΔFFR calculated by the calculation function 352 is referred to, the change in ΔFFR is larger among the change position 73 and the change position 74 where the value of ΔFFR changes greatly (the value of FFR decreases rapidly). It can be seen that the change position 73 has more influence on the blood flow. That is, it can be seen that the stenosis 71 corresponding to the change position 73 has a stronger influence on the blood flow, and it can be seen that the treatment priority is high.

  Further, the calculation function 352 according to the third embodiment calculates the inner diameter stenosis rate based on the inner diameter of the blood vessel. For example, the calculation function 352 calculates the lumen diameter of the blood vessel at each position of the blood vessel using the CT image data, and calculates the inner diameter stenosis rate (% DS) using the calculated lumen diameter of each position.

  The display control function 353 according to the third embodiment further displays at least one of ΔFFR and the stenosis rate in the display area of the display 340. 11A to 11C are diagrams illustrating examples of displaying auxiliary information by the display control function 353 according to the third embodiment. For example, when the fluid analysis is performed by the calculation function 352 and ΔFFR is calculated by the display control function 353, as shown in FIG. ΔFFR is also displayed. Here, as the representative value of the displayed FFR, various representative values can be displayed in the same manner as in the first embodiment. That is, the display control function 353 determines and displays the representative value of the FFR to be displayed, and displays the corresponding ΔFFR in association with it.

  Further, for example, as shown in FIG. 11B, the display control function 353 displays the FFR value and the ΔFFR value together on the short-axis cross-sectional image of the blood vessel. For example, as shown in FIG. 11B, the display control function 353 displays “FFR: 0.7, ΔFFR: 0.1” in the short-axis cross-sectional image corresponding to the position 61 on the blood vessel, and the short-axis cross-section corresponding to the position 62. “FFR: 0.88, ΔFFR: 0.05” is displayed on the image, and “FFR: 0.81, ΔFFR: 0.15” is displayed on the short-axis cross-sectional image corresponding to the position 63.

  Further, for example, as shown in FIG. 11C, the display control function 353 displays the FFR value and the inner diameter stenosis ratio value together on the short-axis cross-sectional image of the blood vessel. For example, as shown in FIG. 11C, the display control function 353 displays “FFR: 0.7,% DS: 20” in the short-axis cross-sectional image corresponding to the position 61 on the blood vessel, and the short-axis cross-sectional image corresponding to the position 62. “FFR: 0.88,% DS: 80” and “FFR: 0.81,% DS: 50” are displayed on the short-axis cross-sectional image corresponding to the position 63.

  The display control function 353 can also display the FFR and auxiliary information (ΔFFR, inner diameter stenosis rate) on the short-axis cross-sectional image at the position on the marker 50 together. In such a case, the display control function 353 changes the display of the short-axis cross-sectional image, the value of FFR, and the value of auxiliary information in conjunction with the movement of the marker 50 via the input circuit 330.

  Next, a processing procedure performed by the medical information processing apparatus 300 according to the third embodiment will be described. FIG. 12 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus 300 according to the third embodiment. Here, steps S301 to S303 in FIG. 12 are realized by, for example, the processing circuit 350 calling and executing a program corresponding to the calculation function 352 from the storage circuit 320. Steps S304 to S306 are realized, for example, by the processing circuit 350 calling and executing a program corresponding to the display control function 353 from the storage circuit 320.

  In the medical information processing apparatus 300 according to the present embodiment, first, the processing circuit 350 executes fluid analysis using the collected CT image data (step S301), and obtains an index value (eg, FFR) related to blood flow. Calculate (step S302). Further, the processing circuit 350 calculates a difference in index value (ΔFFR) along the blood vessel (step S303). Then, the processing circuit 350 displays the index value difference together with the index value (step S304). Then, the processing circuit 350 determines whether or not a save operation has been accepted via the input circuit 330 (step S305).

  Here, when the storing operation is executed (Yes at Step S305), the processing circuit 350 stores the difference between the index value and the index value (Step S306). The processing circuit 350 continues to determine whether or not the save operation is executed until the save operation is executed (No at Step S305).

  As described above, according to the third embodiment, the calculation function 352 calculates the FFR value in the blood vessel for each position of the blood vessel, the ΔFFR obtained by subtracting the calculated FFR value between the positions, and the blood vessel At least one of the stenosis rates for each position is further calculated. The display control function 353 further displays at least one of ΔFFR and the stenosis rate in the display area of the display 340. Therefore, the medical information processing apparatus 300 according to the third embodiment can further display auxiliary information, and can further improve the efficiency of diagnosis.

(Fourth embodiment)
In the first to third embodiments described above, the case where an arbitrary clinical image is displayed on the display 340 has been described. In the fourth embodiment, a case where a clinical image to be displayed is changed according to the result of fluid analysis will be described. Note that the configuration of the medical information processing apparatus 300 according to the fourth embodiment is basically the same as the configuration of the medical information processing apparatus 300 illustrated in FIG. Therefore, in the following, differences from the medical information processing apparatus 300 according to the first to third embodiments will be mainly described, and constituent elements that play the same role as the constituent elements illustrated in FIG. Detailed description will be omitted.

  The control function 351 according to the fourth embodiment generates a display image corresponding to the calculation result by the calculation function 352. Specifically, the control function 351 generates a clinical image in which the position where the FFR shows the minimum value or the position where the value of ΔFFR shows the maximum value is shown on the front. For example, the control function 351 generates a volume rendering image in which a blood vessel whose FFR has a minimum value or a blood vessel whose ΔFFR has a maximum value is shown in front. In addition, the control function 351 generates a volume rendering image in which the position where the FFR shows the minimum value or the position where ΔFFR shows the maximum value in the predetermined blood vessel is shown at the center of the display 340. In addition, the control function 351 generates a CPR image or an SPR image of a blood vessel in which FFR has a minimum value or a blood vessel in which ΔFFR has a maximum value.

  The display control function 353 according to the fourth embodiment displays the clinical image generated by the control function 351 in the display area of the display 340. FIG. 13 is a diagram illustrating a display example of a clinical image by the display control function 353 according to the fourth embodiment. For example, when the fluid analysis is performed by the calculation function 352, the display control function 353, as shown in FIG. 13, shows the volume LAD from the front showing the blood vessel LAD having the minimum FFR value calculated by the calculation function 352. The rendered image, the LAD CPR image, and the SPR image are displayed on the display 340. Here, as shown in FIG. 13, the display control function 353 displays the FFR value “0.26” and the ΔFFR value “0.3” in a display area different from the clinical image, together with each clinical image.

  Next, a processing procedure performed by the medical information processing apparatus 300 according to the fourth embodiment will be described. FIG. 14 is a flowchart illustrating a processing procedure performed by the medical information processing apparatus 300 according to the fourth embodiment. Here, step S401 to step S403 in FIG. 14 are realized, for example, when the processing circuit 350 calls and executes a program corresponding to the calculation function 352 from the storage circuit 320. Further, step S404 is realized, for example, when the processing circuit 350 calls and executes a program corresponding to the control function 351 from the storage circuit 320. Further, step S405 is realized by the processing circuit 350 calling and executing a program corresponding to the display control function 353 from the storage circuit 320, for example.

  In the medical information processing apparatus 300 according to the present embodiment, first, the processing circuit 350 performs fluid analysis using the collected CT image data (step S401) and obtains an index value (eg, FFR) relating to blood flow. Calculate (step S402). Further, the processing circuit 350 calculates a difference in index value (ΔFFR) along the blood vessel (step S403). Then, the processing circuit 350 generates a clinical image in which the blood vessel branch having the lowest index value or the blood vessel branch having the largest index value difference is the front (step S404). Then, the processing circuit 350 displays the clinical image, the index value, and the difference between the index values on the display 340 (step S405).

  As described above, according to the fourth embodiment, the control function 351 generates a display image corresponding to the calculation result by the calculation function 352. For example, the control function 351 has a display image in which the position where the FFR in the blood vessel shows the minimum value, or the position where ΔFFR obtained by subtracting the index value between the blood vessel positions shows the maximum value, and the FFR At least one of the display images showing the cross section of the position showing the minimum value or the position where ΔFFR shows the maximum value is generated. The display control function 353 displays the display image generated by the control function 351 in the display area of the display 340. Therefore, the medical information processing apparatus 300 according to the fourth embodiment can display clinical images appropriate for diagnosis, and can further improve the efficiency of diagnosis.

(Fifth embodiment)
The first to fourth embodiments have been described so far, but may be implemented in various different forms other than the first to fourth embodiments described above.

  In the above-described embodiment, the case where FFR is displayed as an index related to blood flow has been described. However, the embodiment is not limited to this. For example, other indicators such as a flow rate, a flow rate, and a pressure may be displayed. In such a case, a value used as a representative value is set for each index.

  Further, in the above-described embodiment, the display control function 353 includes, as representative values, an index value (for example, FFR) at the distal end of the blood vessel, a minimum value of FFR in the blood vessel, and a predetermined distance from the distal end. The case where the index value of the position (for example, the position of 20 mm from the end portion, etc.) is displayed has been described. However, the above-described example is merely an example, and the display control function 353 can display various other index values as representative values.

  For example, the display control function 353 can display an index value at a position where the index value changes rapidly as a representative value. In such a case, the calculation function 352 sets, as the position on the blood vessel where the first value is obtained, the position where the change amount of the index value in the blood vessel traveling direction exceeds the threshold value among the index values at each position of the blood vessel. That is, the calculation function 352 calculates a difference between index values between positions on the blood vessel, and sets an index value at a position where the calculated difference exceeds a threshold value as a representative value. For example, the calculation function 352 sets the FFR value at the position where the above-described ΔFFR value exceeds a predetermined threshold value as a representative value. Here, the calculation function 352 can also set two index values used for the difference as representative values. For example, the calculation function 352 can set the FFR value on the blood vessel junction side and the FFR value on the peripheral side when ΔFFR exceeds a predetermined threshold as representative values. Note that the calculation function 352 can also use either the FFR value on the blood vessel branch side or the FFR value on the peripheral side as a representative value. Further, the threshold value to be compared with the difference can be arbitrarily set and is stored in advance by the storage circuit 320.

  Further, for example, the display control function 353 can display an index value at a position where the cross-sectional area of the blood vessel changes rapidly as a representative value. In such a case, the calculation function 352 analyzes the shape of the blood vessel of the subject, and the position where the amount of change in the cross-sectional area of the blood vessel in the traveling direction of the blood vessel exceeds the threshold is determined as the position on the blood vessel where the first value is obtained. Set. That is, the calculation function 352 calculates a difference in cross-sectional area between positions on the blood vessel, and sets an index value at a position where the calculated difference exceeds a threshold value as a representative value. For example, the calculation function 352 can set the FFR value on the blood vessel bifurcation side and the FFR value on the distal side when the cross-sectional area difference exceeds a predetermined threshold as representative values. Note that the calculation function 352 can also use either the FFR value on the blood vessel branch side or the FFR value on the peripheral side as a representative value. Further, the threshold value to be compared with the difference can be arbitrarily set and is stored in advance by the storage circuit 320.

  For example, the display control function 353 can display a representative value based on a lesion site included in a blood vessel. In such a case, the calculation function 352 analyzes the blood vessel of the subject and sets a position on the distal side of the lesion site included in the blood vessel as a position on the blood vessel that obtains the first value. For example, the calculation function 352 analyzes a blood vessel to extract a stenosis region, and sets an index value at a position on the distal side of the extracted stenosis region as a representative value. For example, the calculation function 352 sets the FFR value at a position on the distal side at a predetermined distance (for example, 10 mm) from the stenosis region as a representative value. When there are a plurality of stenosis regions, the calculation function 352 sets, for example, the smallest value among the FFRs in each stenosis region as a representative value.

  For example, the calculation function 352 sets an index value at a position on the distal side of the plaque region in the blood vessel as a representative value. In such a case, the calculation function 352 first detects the position of the plaque region by analyzing the CT image data. Here, various existing methods can be applied to the detection of the plaque region. Then, for example, the calculation function 352 sets the FFR value immediately below the detected plaque region (the peripheral region on the distal side) as a representative value. In the present specification, “directly” means a position corresponding to the corresponding part (for example, a part corresponding to the plaque area), or a predetermined distance from the corresponding part (for example, the plaque area) to the distal side. It shall refer to the position.

  For example, the display control function 353 can display an index value whose reliability exceeds a threshold value as a representative value. In such a case, the calculation function 352 calculates the reliability of the index value at each position of the blood vessel in the fluid analysis on the CT image data, and obtains a representative value from the index values for which the calculated reliability exceeds a predetermined threshold value. Set. Note that the threshold value can be arbitrarily set and is stored in advance by the storage circuit 320. Moreover, you may combine reliability and another parameter | index. For example, among the index values whose calculated reliability exceeds a predetermined threshold value, a value at the distal end may be set as the representative value.

  Further, for example, the display control function 353 can display an index value at a position of interest in the blood vessel as a representative value. In such a case, the calculation function 352 sets a position of interest in the blood vessel as a position on the blood vessel where the first value is obtained. Here, the noted position is a position on the blood vessel included in the past information of the subject, a position where the shape is virtually changed by a simulation of fluid analysis on the blood vessel, a position where treatment is performed in the blood vessel, or , The location specified before treatment for blood vessels. Hereinafter, examples of representative values will be described with reference to FIGS. 15A to 15C. 15A to 15C are diagrams for explaining examples of representative values according to the fifth embodiment.

  First, an example of the representative value based on the past information of the subject will be described. For example, as shown in FIG. 15A, the calculation function 352 sets the same position as the position set in the past report as the representative value of the index value currently displayed. Here, an index value at an arbitrary position designated by the operator can be stored in a report created in the examination / diagnosis. For example, in an examination of a subject, the FFR of the coronary artery is calculated by fluid analysis using CT image data including the coronary artery. In creating the report, the operator operates the marker on the three-dimensional model to store the FFR value at the desired position in the report. As a result, as shown in the upper part of FIG. 15A, the observer's desired position on the coronary artery and the FFR value “0.76” at that position are stored in the past report.

  When the fluid analysis is performed again on the same subject as the above-described subject, the calculation function 352 reads the past report, and the desired position set in the past report is displayed on the analysis result of the currently performed fluid analysis. Identify where to correspond. This identification is performed, for example, by aligning the volume data in which a desired position is set in the past report and the volume data that is the target of the fluid analysis that is currently performed, so that the coordinate systems of both are matched. Can be completed. Then, the calculation function 352 sets the FFR value at the desired position of the observer included in the past report as a representative value. That is, the display control function 353 uses the FFR value “0.72” at the same position as the position stored in the past report as a representative value in the currently performed fluid analysis, as shown in the lower diagram of FIG. 15A. indicate. Here, the calculation function 352 can specify the same position as the desired position included in the past report in the currently collected CT image data by various methods.

  For example, the calculation function 352 specifies a desired position in the currently collected CT image data based on the distance from the beginning (or peripheral end) of the desired position stored in the past report. In other words, the calculation function 352 specifies the vascular branch where the desired position is set in the past report, and calculates the distance from the start portion (or the distal end) of the desired position in the specified vascular branch. Then, the calculation function 352 identifies the same blood vessel branch in the currently acquired CT image data, and the calculated distance-separated position in the identified blood vessel branch is the same position as the desired position included in the past report. As specified. The specific example described above is merely an example, and the calculation function 352 can specify the position by various other methods. For example, the calculation function 352 identifies a desired position stored in the past report based on anatomical features in the coronary artery, and identifies the same position as the identified position in the currently collected CT image data.

  In the above-described embodiment, the case where the same position as the position stored by the past report is set as the representative value has been described. However, the embodiment is not limited to this, and for example, the display 340 displays the current position. The same position as the position of the displayed index value may be set as the representative value. That is, the calculation function 352 sets the same position as the position of the index value on the display image currently displayed on the display 340 as the position of the representative value when setting the representative value on the new display image.

  Next, an example of representative values based on simulation will be described. For example, as shown in FIG. 15B, the calculation function 352 can set an index value at a position whose shape has been virtually changed in the simulation as a representative value. For example, the calculation function 352 can change the blood vessel shape data in the collected CT image data to virtually change the shape of the blood vessel and perform fluid analysis on the deformed blood vessel. As an example, the calculation function 352 transforms the shape of the blood vessel in the CT image data into a shape that eliminates the stenosis 75 and performs fluid analysis on the deformed blood vessel as shown in the lower diagram of FIG. 15B. Thereby, for example, the effect of treatment on the stenosis 75 can be simulated.

  When the above-described simulation is executed, the calculation function 352 sets a blood vessel position index value whose shape has been changed by the simulation as a representative value. For example, as shown in the lower diagram of FIG. 15B, the calculation function 352 is performed immediately below the value of the FFR at the position 76 immediately below the stenosis 75 (proximal region on the distal side) or the position of the blood vessel whose shape has changed. The FFR value is set as a representative value.

  Next, an example of the representative value based on the position where the treatment is performed in the blood vessel will be described. For example, as shown in FIG. 15C, the calculation function 352 sets the index value immediately below the treatment site (the peripheral region on the peripheral side) as a representative value. For example, as shown in FIG. 15C, the calculation function 352 sets the FFR value at a position 78 immediately below the position where the stent 77 is placed as a representative value. Note that the calculation function 352 can use, for example, a position designated before treatment for a blood vessel as a noted position in addition to the above-described positions. That is, the calculation function 352 sets the index value at the position designated by the operator before treatment as a representative value.

  In the above-described embodiment, the case has been described in which the control function 351 generates a display image in which the position where the FFR shows the minimum value or the position where the value of ΔFFR shows the maximum value is shown in front. However, the embodiment is not limited to this, and for example, the control function 351 may generate a display image in which a position of interest in the blood vessel is shown in front. In such a case, for example, the control function 351 performs the above-described attention position (position on the blood vessel included in the past information of the subject, position where the shape is virtually changed by simulation of fluid analysis on the blood vessel, blood vessel A display image is generated in which the position where the treatment is performed or the position designated before the treatment on the blood vessel is displayed on the front.

  FIG. 16A is a diagram illustrating an example of a display image according to the fifth embodiment. In FIG. 16A, a volume rendering image will be described as an example. However, the embodiment is not limited to this, and a case where a three-dimensional model, a surface rendering image, or the like is used as a display image. Also good. For example, as shown in FIG. 16A, the control function 351 generates a display image in which the position where the stent 79 is placed is shown in front. That is, the display control function 353 can cause the display 340 to display a display image in which the stent 79 is shown on the front surface and the index value immediately below the stent 79 is shown as a representative value. As a result, the operator can immediately observe the index value at the position of interest.

  Here, the display image as shown in FIG. 16A can be arbitrarily rotated according to the operation by the operator. In such a case, the calculation function 352 can select a position for obtaining a representative value according to the direction of the blood vessel indicated by the display image. FIG. 16B is a diagram illustrating an example of a display image according to the fifth embodiment. In FIG. 16B, a volume rendering image will be described as an example. However, the embodiment is not limited to this, and a case where a three-dimensional model, a surface rendering image, or the like is used as a display image. Also good. For example, as shown in FIG. 16B, the calculation function 352 sets the index value of the blood vessel that is the front in the display image as a representative value. That is, as shown in FIG. 16B, the calculation function 352 changes the representative value from “0.76” to “0.70”, or from “0.70” to “0.76” according to the orientation of the display image. Switch to. In addition, the representative value in the blood vessel displayed on the front is set to an arbitrary representative value among the various representative values described above.

  In the above-described embodiment, the case where the index value in the blood vessel is displayed has been described. However, the embodiment is not limited thereto, and for example, even if the index value is not displayed depending on the position in the blood vessel. Good. That is, the display control function 353 does not display the index value at a predetermined part of the blood vessel. Here, the predetermined part of the blood vessel includes a plaque region, a bypass region, a bridge region, a calcification region, and an image artifact region in the blood vessel.

  For example, the display control function 353 hides the FFR values of the plaque area, the bypass area, the bridge area, the calcification area, and the image artifact area in the CT image data. In other words, the display control function 353 hides the index value for an area where the index value cannot be calculated or an area where the reliability of the calculated index value is low. FIG. 17 is a diagram illustrating a display example according to the fifth embodiment.

  For example, as shown in FIG. 17, the display control function 353 displays the marker 50 on the display image, and accepts a position designation operation by an operation of moving the marker 50 by the operator. In this case, when the position of the marker 50 becomes the above-described predetermined part, the display control function 353 hides the index value at the position specified by the marker 50. Here, the display control function 353 can display an annotation indicating that the index value is not displayed on the display 340. For example, as shown in FIG. 17, the display control function 353 causes the display 340 to display an annotation “* because of the plaque area, the value cannot be displayed”.

  In the above-described example, the case where the index value is not displayed even when the marker 50 is arranged at a predetermined part on the display image has been described. However, the embodiment is not limited thereto, and for example, the marker It may be a case where 50 is not arranged. That is, the display control function 353 can also perform control so that the marker 50 is not displayed at a predetermined part on the display image.

  In addition, the numerical values and characters described in the above-described embodiments can be arbitrarily set in size, color, and the like. For example, when a plurality of FFR values are displayed on a display image, the size or color of a number may be changed according to the FFR value.

  In the above-described embodiment, the case where the representative value is set based on the index value calculated by the fluid analysis, the position of the index value, or the like has been described. However, the embodiment is not limited to this, and may be a case where the representative value is set by combining other conditions. For example, the representative value may be set in consideration of a range by an Invasive FFR inspection (also referred to as a Wired FFR inspection) in which a pressure change is measured with a pressure wire and an FFR value is calculated.

  In the FFR examination based on the fluid analysis described above, it is possible to measure the FFR value from the CT image data to the blood vessel end portion where the blood vessel structure information can be obtained. On the other hand, since the measurable distance of the Invasive FFR test is limited to a place where the pressure wire can be physically inserted, the blood vessel position at which the FFR value can be obtained by the fluid analysis is determined by the Invasive FFR test. In many cases, the value of is a portion closer to the periphery than the position of an obtainable blood vessel. Therefore, when the Invasive FFR inspection and the analysis result of the FFR inspection using CT image data are compared, the comparison may be complicated due to a deviation in the range in which values can be acquired. Furthermore, if the image quality of the CT image data in the portion close to erasure is low, the FFR value obtained by the FFR analysis using the CT image data tends to be low in the portion closer to the periphery, and a false positive test Results are likely to occur. Therefore, the medical information processing apparatus 300 according to the present application estimates the position of the distal end that can be measured with the pressure wire in the CT image data, and displays the result (index value) by the fluid analysis at the estimated position as a representative value. Thereby, a highly accurate test result can be presented. Details of the processing will be described below.

  In the medical information processing apparatus 300 described above, the calculation function 352 calculates the position of the distal end of the blood vessel where pressure can be measured with the pressure wire based on the blood vessel structure information and the pressure wire structure information. Specifically, the calculation function 352 calculates a measurable range based on the blood vessel structure and the structure of the pressure wire when it is assumed that the pressure is measured by inserting the pressure wire into the blood vessel included in the CT image data. To estimate.

  For example, the calculation function 352 uses the “blood vessel diameter”, “blood vessel curvature”, “blood vessel torsion”, “blood vessel wall thickness”, etc. from the blood vessel shape data extracted from the CT image data as the blood vessel structure information (parameter). To get. Further, the calculation function 352 includes, as information (parameters) on the structure of the pressure wire, “pressure wire thickness”, “maximum bending area of the pressure wire”, “pressure wire curvature-stress relationship (elastic force)”, etc. To get. Information on the structure of the pressure wire is stored in advance in the storage circuit 320 for each type of pressure wire.

  Then, the calculation function 352 estimates the range of blood vessels that can be pressure-measured with the pressure wire based on the acquired blood vessel structure information and pressure wire structure information. For example, threshold values are set in advance for the “blood vessel diameter”, “blood vessel curvature”, “blood vessel torsion”, and “blood vessel wall thickness”, which are information on the blood vessel structure, and the calculation function 352 sets the set threshold values. Based on this, it is determined whether or not measurement with a pressure wire is possible. For example, the calculation function 352 determines a position that is equal to or less than the “pressure wire thickness” in the “blood vessel diameter” as an unmeasurable position. For example, since the representative value of “the thickness of the pressure wire” is “0.014 inch”, “0.014 inch” is preset as the threshold value.

  Similarly, the calculation function 352 determines whether or not measurement with a pressure wire is possible by comparing each of “blood vessel curvature”, “blood vessel torsion”, and “blood vessel wall thickness” with a threshold value. . For example, the calculation function 352 may compare each of the above four parameters with a threshold value, and may determine a position that exceeds the threshold value for any of the parameters as an unmeasurable position on the pressure wire.

  Here, the calculation function 352 can also execute the above-described determination according to the state of the blood vessel. The FFR test by fluid analysis is often performed on a resting blood vessel, while the FFR test with a pressure wire is often performed in a stress state in which adenosine is administered to a subject. Accordingly, the shape of the blood vessel on which the FFR inspection using the pressure wire is performed is different from the shape of the blood vessel in the CT image data collected in a resting state, and for example, the blood vessel diameter may be enlarged. Therefore, the calculation function 352 performs the determination by combining these states, and converts the blood vessel structure information obtained from the CT image data into the blood vessel structure information in the stress state, and based on the pressure wire structure information. Then, the position of the distal end capable of measuring pressure with the pressure wire in the blood vessel is calculated.

  For example, information on how a resting blood vessel changes its shape in a stress state is stored in the storage circuit 320 in advance. Then, the calculation function 352 reads the information on the shape change from the storage circuit 320 and applies it to the CT image data, thereby changing the shape of the blood vessel included in the CT image data to the shape of the stress state, and the changed blood vessel. The above four parameters are acquired from the shape data. Then, the calculation function 352 determines whether or not measurement with a pressure wire is possible by comparing each of the acquired four parameters with a threshold value.

  As described above, when the position of the distal end where the pressure can be measured with the pressure wire in the blood vessel is specified, the calculation function 352 sets the result of the fluid analysis at the specified position as a representative value. FIG. 18A is a diagram for explaining an example of representative values according to the fifth embodiment. For example, as shown in FIG. 18A, the calculation function 352 specifies a distal end portion 91 that can be measured by an FFR test by fluid analysis and a distal end portion 92 that can be measured by a pressure wire. Then, the calculation function 352 sets the FFR value “0.82” at the position of the distal end portion 92 as a representative value within a range in which measurement by FFR inspection by fluid analysis is possible. The display control function 353 causes the display 340 to display the representative value “0.82” set by the calculation function 352. Thus, the operator can immediately determine which position of the fluid analysis result (for example, the FFR value) should be correct. Furthermore, by acquiring a value at the same position as the position measured by the Invasive FFR test as the measurement result of the FFR test by fluid analysis, the measurement result of the FFR test by fluid analysis can be determined at a glance. It is possible to reduce the burden on the operator when reading.

  Further, even when considering the above-described range based on the Invasive FFR inspection, the position of the index value to be displayed can be designated by the marker. FIG. 18B is a diagram for describing an example of representative values according to the fifth embodiment. In FIG. 18B, two markers 50 are shown for convenience of explanation, but one marker 50 is actually displayed. For example, as shown in FIG. 18B, the display control function 353 displays the marker 50 along the blood vessel of the three-dimensional model, and accepts an operation for designating the display position of the index value. Then, the display control function 353 displays the index value (for example, FFR value) at the position designated by the marker 50 on the three-dimensional model.

  Here, the display control function 353 can change the display form of the marker 50 and the number of the index value according to the position of the marker 50. For example, as shown in FIG. 18B, the display control function 353 determines whether the position designated by the designation operation is a position where pressure measurement with a pressure wire is possible or not, and the marker 50 that receives the designation operation and the index value. Change the display form. In other words, the display control function 353 determines the shape of the marker 50 based on the position where measurement with the pressure wire is possible and the position where measurement with the FFR inspection by fluid analysis is impossible. The color can be changed, and the FFR values “0.85” and “0.76” can be changed in size and color.

  The display control function 353 can also display the FFR value measured by the pressure wire and the measurement result by the fluid analysis in parallel. In such a case, for example, the distribution of the FFR value measured with the pressure wire is obtained because the FFR has been measured with the pressure wire in the past or is currently being measured, and the measurement is performed with the pressure wire. On the condition that the marker 50 is placed at a position where the FFR value is present, the display control function 353 displays the fluid analysis result (FFR value) at the position of the marker 50 and the FFR value measured with the pressure wire. Are displayed in parallel.

  In the foregoing, examples of various representative values, display methods, and image display methods have been described. Here, various contents described in the first to fifth embodiments can be appropriately combined. That is, the above-described setting of the representative value and the display on the display 340 can be executed in any combination.

  In the above-described embodiment, the case where the medical information processing apparatus 300 executes various processes has been described. However, the embodiment is not limited to this. For example, the X-ray CT apparatus 100 may execute various processes. FIG. 19 is a diagram illustrating an example of the configuration of the X-ray CT apparatus 100 according to the fifth embodiment.

  As shown in FIG. 19, the X-ray CT apparatus 100 according to the third embodiment includes a gantry 10, a bed apparatus 20, and a console 30. The gantry 10 is a device that irradiates the subject P with X-rays, detects the X-rays transmitted through the subject P, and outputs them to the console 30. The gantry 10 includes an X-ray irradiation control circuit 11, an X-ray generator 12, and the like. , A detector 13, a data acquisition circuit (DAS: Data Acquisition System) 14, a rotating frame 15, and a gantry drive circuit 16.

  The rotating frame 15 supports the X-ray generator 12 and the detector 13 so as to face each other with the subject P interposed therebetween, and is rotated at a high speed in a circular orbit around the subject P by a gantry driving circuit 16 described later. It is an annular frame.

  The X-ray irradiation control circuit 11 is a device that supplies a high voltage to the X-ray tube 12 a as a high voltage generator, and the X-ray tube 12 a uses the high voltage supplied from the X-ray irradiation control circuit 11 to Generate a line. The X-ray irradiation control circuit 11 adjusts the X-ray dose irradiated to the subject P by adjusting the tube voltage and tube current supplied to the X-ray tube 12a under the control of the scan control circuit 33 described later. .

  The X-ray irradiation control circuit 11 switches the wedge 12b. The X-ray irradiation control circuit 11 adjusts the X-ray irradiation range (fan angle and cone angle) by adjusting the aperture of the collimator 12c. In addition, this embodiment may be a case where the operator manually switches a plurality of types of wedges 12b.

  The X-ray generator 12 is an apparatus that generates X-rays and irradiates the subject P with the generated X-rays, and includes an X-ray tube 12a, a wedge 12b, and a collimator 12c.

  The X-ray tube 12 a is a vacuum tube that irradiates the subject P with an X-ray beam with a high voltage supplied by a high voltage generator (not shown). The X-ray beam is applied to the subject P as the rotating frame 15 rotates. Irradiate. The X-ray tube 12a generates an X-ray beam that spreads with a fan angle and a cone angle. For example, under the control of the X-ray irradiation control circuit 11, the X-ray tube 12 a continuously exposes X-rays around the subject P for full reconstruction or exposure that can be reconfigured for half reconstruction. It is possible to continuously expose X-rays in the irradiation range (180 degrees + fan angle). Further, the X-ray irradiation control circuit 11 can control the X-ray tube 12a to intermittently emit X-rays (pulse X-rays) at a preset position (tube position). The X-ray irradiation control circuit 11 can also modulate the intensity of the X-rays emitted from the X-ray tube 12a. For example, the X-ray irradiation control circuit 11 increases the intensity of X-rays emitted from the X-ray tube 12a at a specific tube position, and exposes from the X-ray tube 12a at a range other than the specific tube position. Reduce the intensity of the emitted X-rays.

  The wedge 12b is an X-ray filter for adjusting the X-ray dose of X-rays emitted from the X-ray tube 12a. Specifically, the wedge 12b transmits the X-rays exposed from the X-ray tube 12a so that the X-rays irradiated from the X-ray tube 12a to the subject P have a predetermined distribution. Attenuating filter. For example, the wedge 12b is a filter obtained by processing aluminum so as to have a predetermined target angle or a predetermined thickness. The wedge 12b is also called a wedge filter or a bow-tie filter.

  The collimator 12c is a slit for narrowing the X-ray irradiation range in which the X-ray dose is adjusted by the wedge 12b under the control of the X-ray irradiation control circuit 11 described later.

  The gantry driving circuit 16 rotates the rotary frame 15 to rotate the X-ray generator 12 and the detector 13 on a circular orbit around the subject P.

  The detector 13 is a two-dimensional array type detector (surface detector) that detects X-rays that have passed through the subject P, and a detection element array in which X-ray detection elements for a plurality of channels are arranged has a Z-axis direction. Are arranged in multiple rows. Specifically, the detector 13 has X-ray detection elements arranged in multiple rows such as 320 rows along the Z-axis direction. For example, the detector 13 covers a wide range such as a range including the lung and heart of the subject P. X-rays transmitted through the specimen P can be detected. The Z-axis indicates the direction of the rotation center axis of the rotary frame 15 when the gantry 10 is not tilted.

  The data collection circuit 14 is a DAS, and collects projection data from the X-ray detection data detected by the detector 13. For example, the data collection circuit 14 generates projection data by performing amplification processing, A / D conversion processing, inter-channel sensitivity correction processing, and the like on the X-ray intensity distribution data detected by the detector 13. The projected data is transmitted to the console 30 described later. For example, when X-rays are continuously emitted from the X-ray tube 12a while the rotary frame 15 is rotating, the data acquisition circuit 14 collects projection data groups for the entire circumference (for 360 degrees). Further, the data collection circuit 14 associates the tube position with each collected projection data and transmits it to the console 30 described later. The tube position is information indicating the projection direction of the projection data. Note that the sensitivity correction processing between channels may be performed by the preprocessing circuit 34 described later.

  The couch device 20 is a device on which the subject P is placed, and includes a couch driving device 21 and a top plate 22 as shown in FIG. The couch driving device 21 moves the subject P into the rotary frame 15 by moving the couchtop 22 in the Z-axis direction. The top plate 22 is a plate on which the subject P is placed. In the present embodiment, the change in the relative position between the gantry 10 and the top plate 22 has been described as being realized by controlling the top plate 22, but the embodiment is not limited to this. For example, when the gantry 10 is self-propelled, a change in the relative position between the gantry 10 and the top plate 22 may be realized by controlling the traveling of the gantry 10.

  For example, the gantry 10 executes a helical scan that rotates the rotating frame 15 while moving the top plate 22 to scan the subject P in a spiral shape. Alternatively, the gantry 10 performs a conventional scan in which the subject P is scanned in a circular orbit by rotating the rotating frame 15 while the position of the subject P is fixed after the top plate 22 is moved. Alternatively, the gantry 10 performs a step-and-shoot method in which the position of the top plate 22 is moved at regular intervals and a conventional scan is performed in a plurality of scan areas.

  The console 30 is a device that accepts an operation of the X-ray CT apparatus 100 by an operator and reconstructs CT image data using projection data collected by the gantry 10. As shown in FIG. 19, the console 30 includes an input circuit 31, a display 32, a scan control circuit 33, a preprocessing circuit 34, a storage circuit 35, an image reconstruction circuit 36, and a processing circuit 37. .

  The input circuit 31 includes a mouse, a keyboard, a trackball, a switch, a button, a joystick, and the like that are used by the operator of the X-ray CT apparatus 100 to input various instructions and various settings, and instructions and setting information received from the operator. Is transferred to the processing circuit 37. For example, the input circuit 31 receives, from the operator, imaging conditions for CT image data, reconstruction conditions for reconstructing CT image data, image processing conditions for CT image data, and the like. Further, the input circuit 31 receives an operation for selecting an examination for the subject P. Further, the input circuit 31 accepts a designation operation for designating a part on the image.

  The display 32 is a monitor that is referred to by the operator. The display 32 displays image data generated from the CT image data to the operator under the control of the processing circuit 37, and displays various data from the operator via the input circuit 31. A GUI (Graphical User Interface) for receiving instructions and various settings is displayed. The display 32 displays a plan screen for a scan plan, a screen being scanned, and the like.

  The scan control circuit 33 controls the operations of the X-ray irradiation control circuit 11, the gantry driving circuit 16, the data acquisition circuit 14, and the bed driving device 21 under the control of the processing circuit 37, thereby Control the collection process. Specifically, the scan control circuit 33 controls projection data collection processing in the photographing for collecting the positioning image (scano image) and the main photographing (scanning) for collecting the image used for diagnosis.

  The preprocessing circuit 34 performs logarithmic conversion processing and correction processing such as offset correction, sensitivity correction, and beam hardening correction on the projection data generated by the data acquisition circuit 14 to obtain corrected projection data. Generate. Specifically, the preprocessing circuit 34 generates corrected projection data for each of the projection data of the positioning image generated by the data acquisition circuit 14 and the projection data acquired by the main photographing, and the storage circuit 35. To store.

  The storage circuit 35 stores the projection data generated by the preprocessing circuit 34. Specifically, the storage circuit 35 stores the projection data of the positioning image generated by the preprocessing circuit 34 and the diagnostic projection data collected by the main imaging. The storage circuit 35 stores CT image data reconstructed by an image reconstruction circuit 36 described later. Further, the storage circuit 35 appropriately stores a processing result by a processing circuit 37 described later.

  The image reconstruction circuit 36 reconstructs CT image data using the projection data stored in the storage circuit 35. Specifically, the image reconstruction circuit 36 reconstructs CT image data from the positioning image projection data and the image projection data used for diagnosis. Here, as the reconstruction method, there are various methods, for example, back projection processing. Further, as the back projection process, for example, a back projection process by an FBP (Filtered Back Projection) method can be cited. Alternatively, the image reconstruction circuit 36 can reconstruct CT image data using a successive approximation method.

  The image reconstruction circuit 36 performs image processing on the CT image data to generate image data. The image reconstruction circuit 36 stores the reconstructed CT image data and the image data generated by various image processes in the storage circuit 35.

  The processing circuit 37 performs overall control of the X-ray CT apparatus 100 by controlling the operations of the gantry 10, the couch device 20, and the console 30. Specifically, the processing circuit 37 controls the CT scan performed on the gantry 10 by controlling the scan control circuit 33. The processing circuit 37 controls the image reconstruction circuit 36 and the image generation process in the console 30 by controlling the image reconstruction circuit 36. In addition, the processing circuit 37 controls the display 32 to display various image data stored in the storage circuit 35.

  Then, as illustrated in FIG. 19, the processing circuit 37 executes a control function 37a, a calculation function 37b, and a display control function 37c. The control function 37a controls the entire X-ray CT apparatus 100 and executes the same processing as the control function 351 described above. The calculation function 37b performs the same process as the calculation function 352 described above. The display control function 37c performs the same process as the display control function 353 described above.

  In the above-described embodiment, an example in which each processing function is realized by a single processing circuit (the processing circuit 350 and the processing circuit 37) has been described, but the embodiment is not limited thereto. For example, the processing circuit 350 and the processing circuit 37 may be configured by combining a plurality of independent processors, and each processing function may be realized by each processor executing each program. The processing functions of the processing circuit 350 and the processing circuit 37 may be realized by appropriately distributing or integrating the processing functions in a single or a plurality of processing circuits. For example, the calculation function 352 may be realized by being distributed between the calculation function and the representative value extraction function.

  The term “processor” used in the description of each embodiment described above is, for example, a CPU (Central Processing Unit), a GPU (Graphics Processing Unit), or an application specific integrated circuit (ASIC). Circuits such as programmable logic devices (for example, Simple Programmable Logic Device (SPLD), Complex Programmable Logic Device (CPLD), and Field Programmable Gate Array (FPGA)) Means. Here, instead of storing the program in the storage circuit, the program may be directly incorporated in the circuit of the processor. In this case, the processor realizes the function by reading and executing the program incorporated in the circuit. In addition, each processor of the present embodiment is not limited to being configured as a single circuit for each processor, but may be configured as a single processor by combining a plurality of independent circuits to realize its function. Good.

  Here, the program executed by the processor is provided by being incorporated in advance in a ROM (Read Only Memory), a storage circuit, or the like. This program is a file in a format installable or executable in these apparatuses, such as a CD (Compact Disk) -ROM, an FD (Flexible Disk), a CD-R (Recordable), a DVD (Digital Versatile Disk), or the like. It may be provided by being recorded on a computer-readable storage medium. The program may be provided or distributed by being stored on a computer connected to a network such as the Internet and downloaded via the network. For example, this program is composed of modules including each functional unit. As actual hardware, the CPU reads a program from a storage medium such as a ROM and executes it, whereby each module is loaded on the main storage device and generated on the main storage device.

  According to at least one embodiment described above, the efficiency of diagnosis relating to blood flow can be improved.

  Although several embodiments of the present invention have been described, these embodiments are presented by way of example and are not intended to limit the scope of the invention. These embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the spirit of the invention. These embodiments and their modifications are included in the scope and gist of the invention, and are also included in the invention described in the claims and the equivalents thereof.

100 X-ray CT apparatus 37a, 351 Control function 37b, 352 Calculation function 37c, 353 Display control function 300 Medical information processing apparatus

Claims (31)

An acquisition unit for acquiring image data including blood vessels of the subject;
A calculation unit that performs fluid analysis on the image data acquired by the acquisition unit, and obtains index values related to blood flow in the blood vessel for a plurality of positions of the blood vessel;
For the index value calculated by the calculation unit, a representative value extraction unit that selects a position for obtaining a first value from the plurality of positions, or selects a value to be the first value from the index value at each position;
A display control unit for displaying the first value in a predetermined display area for displaying the first value in the display unit;
A medical information processing apparatus comprising:   The medical information processing apparatus according to claim 1, wherein the index value is a preliminary coronary blood flow amount ratio obtained for the blood vessel by fluid analysis.   The medical information processing according to claim 1 or 2, wherein the representative value extraction unit analyzes a shape of a blood vessel of the subject and sets a position on the blood vessel to obtain the first value based on the shape of the blood vessel. apparatus.   The representative value extraction unit analyzes a shape of a blood vessel of the subject, and sets a position separated from a peripheral position of the blood vessel by a predetermined distance as a position on the blood vessel to obtain the first value. The medical information processing apparatus according to 1 or 2.   The representative value extraction unit analyzes the shape of the blood vessel of the subject, sets the diameter of the blood vessel to a predetermined diameter, and sets the position closest to the periphery as the position on the blood vessel to obtain the first value. The medical information processing apparatus according to claim 1 or 2.   The medical information processing apparatus according to claim 1, wherein the calculation unit calculates a minimum value of an index value related to the blood flow in the blood vessel as the first value.   The representative value extracting unit sets, as an index value at each position of the blood vessel, a position on the blood vessel at which the change amount of the index value in the traveling direction of the blood vessel exceeds a threshold value to obtain the first value. The medical information processing apparatus according to claim 1 or 2.   The representative value extraction unit analyzes the shape of the blood vessel of the subject, and obtains the first value at a position where the amount of change in the cross-sectional area of the blood vessel in the traveling direction of the blood vessel exceeds a threshold value. The medical information processing apparatus according to claim 1, wherein the medical information processing apparatus is set as follows.   The representative value extraction unit analyzes a blood vessel of the subject, and sets a position on the distal side of a lesion site included in the blood vessel as a position on the blood vessel to obtain the first value. The medical information processing apparatus described.   The medical information processing apparatus according to claim 1, wherein the representative value extraction unit sets a position of interest in the blood vessel as a position on the blood vessel from which the first value is obtained.   The position of interest includes a position on the blood vessel included in the past information of the subject, a position where the shape is virtually changed by a fluid analysis simulation on the blood vessel, a position where treatment has been performed on the blood vessel, The medical information processing apparatus according to claim 10, wherein the medical information processing apparatus is a position based on a position designated before treatment for the blood vessel.   The medical information processing apparatus according to any one of claims 1 to 9, wherein the representative value extraction unit extracts the first value for each blood vessel.   The medical information processing apparatus according to claim 1, wherein the representative value extraction unit extracts the first value for each predetermined region or for each predetermined distance in the blood vessel.   The said display control part shows the said 1st value in the schematic diagram which shows the anatomical characteristic of the said blood vessel, and displays it on the said predetermined | prescribed display area. Medical information processing device. An input unit that receives a position specifying operation for the blood vessel included in a display image that is generated using the image data and displayed in a display area different from the predetermined display area;
The calculating unit calculates an index value related to the blood flow at a position specified by a specifying operation received by the input unit;
The medical information processing apparatus according to any one of claims 1 to 14, wherein the display control unit displays an index value related to the blood flow at a position specified by the specifying operation in the predetermined display area.   The said display control part changes the display mode of a value, when displaying the index value regarding the said blood vessel of the position designated by the said designation | designated operation, and the case where the said 1st value is displayed. Medical information processing equipment. An input unit that receives a predetermined input operation on the display area of the display unit;
The display control unit according to claim 1, wherein the display control unit switches display information in a display area of the display unit to a first value of an index value related to the blood flow in response to reception of the predetermined input operation by the input unit. Medical information processing device. An input unit that receives a predetermined input operation on the display area of the display unit;
2. The medical device according to claim 1, wherein the display control unit switches display information in the display area of the display unit to a graph of an index value related to blood flow in the blood vessel in response to reception of the predetermined input operation by the input unit. Information processing device. The input unit further accepts a storage operation of display information displayed on the display unit,
The medical information processing according to claim 17 or 18, wherein the display control unit outputs display information before and after switching displayed on the display unit as image information when the input unit accepts the saving operation. apparatus. The calculation unit further calculates at least one of a difference in index value obtained by subtracting the index value of each position in the blood vessel between the positions, and a stenosis rate for each position of the blood vessel
The medical information processing apparatus according to any one of claims 1 to 19, wherein the display control unit further displays at least one of the difference between the index values and the stenosis rate in a display area of the display unit. An image generation unit that generates a display image using the image data;
The image generation unit generates a display image according to a calculation result by the calculation unit,
The medical information processing apparatus according to any one of Claims 1 to 20, wherein the display control unit displays a display image generated by the image generation unit in a display area of the display unit.   In the image generation unit, a position where an index value related to blood flow in the blood vessel shows a minimum value, or a position where a difference between index values obtained by subtracting the index value between the blood vessel positions shows a maximum value is shown in front. The medical information according to claim 21, wherein at least one of the displayed image and the display image showing a cross section of a position where the index value shows a minimum value or a position where a difference between the index values shows a maximum value is generated. Processing equipment. An image generation unit that generates a display image using the image data;
The image generation unit generates a display image in which a noticed position in the blood vessel is shown on the front,
The medical information processing apparatus according to claim 10, wherein the display control unit causes the display image generated by the image generation unit to be displayed in a display area of the display unit. An image generation unit that generates a display image using the image data;
The medical information processing apparatus according to claim 1, wherein the representative value extraction unit selects a position for obtaining the first value according to a direction of a blood vessel indicated by the display image.   The medical information processing apparatus according to claim 1, wherein the display control unit hides the index value at a predetermined part of the blood vessel.   26. The medical information processing apparatus according to claim 25, wherein the predetermined part of the blood vessel includes a plaque region, a bypass region, a bridge region, a calcification region, and an image artifact region in the blood vessel. The calculation unit calculates the position of the distal end of the blood vessel where pressure measurement is possible on the pressure wire based on the blood vessel structure information and the pressure wire structure information,
The medical information processing apparatus according to claim 1, wherein the representative value extraction unit selects, as the first value, the index value at a position of a distal end where pressure measurement with the pressure wire is possible.   28. The medical device according to claim 27, wherein the calculation unit calculates a position of a distal end of the blood vessel where pressure can be measured with the pressure wire based on the structure information of the blood vessel and the structure information of the pressure wire in a stress state. Information processing device. An input unit for receiving a position specifying operation for the blood vessel included in the display image generated using the image data;
The display control unit changes a display mode of the GUI that receives the designation operation and the index value according to whether or not the position designated by the designation operation is a position where pressure measurement with the pressure wire is possible. The medical information processing apparatus according to claim 27 or 28. A collection unit that collects image data including blood vessels of the subject;
A calculation unit that performs fluid analysis on the image data, and obtains index values related to blood flow in the blood vessels for a plurality of positions of the blood vessels;
For the index value calculated by the calculation unit, a representative value extraction unit that selects a position for obtaining a first value from the plurality of positions, or selects a value to be the first value from the index value at each position;
A display control unit for displaying the first value in a predetermined display area for displaying the first value in the display unit;
An X-ray CT apparatus comprising: An acquisition procedure for acquiring image data including blood vessels of the subject;
A calculation procedure for performing fluid analysis on the image data acquired by the acquisition procedure and obtaining index values related to blood flow in the blood vessel for a plurality of positions of the blood vessel;
For the index value calculated by the calculation procedure, a representative value extraction procedure for selecting a position for obtaining a first value from the plurality of positions, or selecting a value to be the first value from the index value at each position;
A display control procedure for displaying the first value in a predetermined display area for displaying the first value on the display unit;
Medical information processing program that causes a computer to execute.