JP2022017183A - Medical image processing apparatus, system, and method - Google Patents

Abstract

To reduce a user's labor and time in formation or the like of a diagnosis or treatment plan concerning a cardiac disease.SOLUTION: A medical image processing apparatus according to an embodiment includes an extraction unit and a display control unit. The extraction unit extracts a degree of a disease related to the heart from a medical image. The display control unit displays, when the degree of the disease related to the heart is high, a first index value related to a blood vessel and calculated from a blood pressure or a blood flow, and displays, when the degree of the disease related to the heart is low, wall shear stress serving as a second index value related to the blood vessel, as information related to the blood flow of the blood vessel and calculated on the basis of the medical image.SELECTED DRAWING: Figure 1

Description

The embodiments disclosed herein and in the drawings relate to medical image processing devices, systems and methods.

Conventionally, as a technique for supporting diagnosis related to heart disease and formulation of a treatment plan, a technique for calculating and presenting various information regarding blood flow in the blood vessel of the subject based on a medical image of the blood vessel of the heart of the subject has been used. Are known. For example, as one of the information regarding blood flow, there is known a technique of calculating and displaying Wall Shear Stress (WSS) at each position of a blood vessel.

Generally, when a diagnosis or a treatment plan is formulated using such a technique, a user such as a doctor integrates not only WSS but also various information to make a comprehensive judgment. However, when a plurality of pieces of information are presented without limitation, the work of acquiring and understanding the information becomes complicated, and the time and effort of the user increases.

Special Table 2020-518362 Japanese Unexamined Patent Publication No. 2011-62358 Special Table 2016-533815 Gazette

One of the problems to be solved by the embodiments disclosed in the present specification and the drawings is to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan. However, the problems to be solved by the embodiments disclosed in the present specification and the drawings are not limited to the above problems. It is also possible to position the problem corresponding to each effect by each configuration shown in the embodiment described later as another problem.

The medical image processing apparatus according to the embodiment includes an extraction unit and a display control unit. The extraction unit extracts the degree of heart-related disease from the medical image. As information on the blood flow of the blood vessel calculated based on the medical image, the display control unit uses the first index value of the blood vessel calculated from the blood pressure or the blood flow when the degree of the heart-related disease is high. When the degree of the disease related to the heart is low, the wall shear stress is displayed as a second index value related to the blood vessel.

FIG. 1 is a diagram showing a configuration example of a medical image processing system and a medical image processing apparatus according to the first embodiment. FIG. 2 is a diagram showing an example of information display performed by the display control function according to the first embodiment. FIG. 3 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit of the medical image processing apparatus according to the first embodiment. FIG. 4 is a diagram showing an example of information display performed by the display control function according to the first modification of the first embodiment. FIG. 5 is a diagram showing an example of information display performed by the display control function according to the second modification of the first embodiment. FIG. 6 is a diagram showing an example of information display performed by the display control function according to the third modification of the first embodiment. FIG. 7 is a diagram showing an example of information display performed by the display control function according to the third modification of the first embodiment. FIG. 8 is a diagram showing an example of information display performed by the display control function according to the modified example 4 of the first embodiment. FIG. 9 is a diagram showing an example of information display performed by the display control function according to the modified example 4 of the first embodiment. FIG. 10 is a diagram showing a configuration example of the medical image processing system and the medical image processing apparatus according to the second embodiment. FIG. 11 is a diagram showing an example of information display performed by the display control function according to the second embodiment. FIG. 12 is a diagram showing an example of information display performed by the display control function according to the second embodiment. FIG. 13 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit of the medical image processing apparatus according to the second embodiment. FIG. 14 is a diagram showing an example of information display performed by the display control function according to the first modification of the second embodiment. FIG. 15 is a diagram showing an example of a user interface used by the prediction function according to the third modification of the second embodiment. FIG. 16 is a diagram showing an example of a user interface used by the prediction function according to the third modification of the second embodiment. FIG. 17 is a diagram showing an example of a user interface used by the prediction function according to the third modification of the second embodiment. FIG. 18 is a diagram showing an example of information display performed by the display control function according to the modified example 4 of the second embodiment. FIG. 19 is a diagram showing a configuration example of a medical image processing system and a medical image processing apparatus according to a third embodiment. FIG. 20 is a diagram showing an example of information display performed by the display control function according to the third embodiment. FIG. 21 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit of the medical image processing apparatus according to the third embodiment. FIG. 22 is a diagram showing an example of information display performed by the display control function according to the first modification of the third embodiment. FIG. 23 is a diagram showing an example of information display performed by the display control function according to the second modification of the third embodiment. FIG. 24 is a diagram showing a configuration example of the medical image processing system and the medical image processing apparatus according to the fourth embodiment. FIG. 25 is a diagram showing an example of information display performed by the display control function according to the fourth embodiment. FIG. 26 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit of the medical image processing apparatus according to the fourth embodiment. FIG. 27 is a diagram showing an example of information display performed by the display control function according to the first modification of the fourth embodiment. FIG. 28 is a diagram showing an example of information display performed by the display control function according to the fifth embodiment. FIG. 29 is a diagram showing an example of information display performed by the display control function according to the modified example of the fifth embodiment.

Hereinafter, embodiments of the medical image processing apparatus, system, and method will be described in detail with reference to the drawings.

(First Embodiment)
FIG. 1 is a diagram showing a configuration example of a medical image processing system and a medical image processing apparatus according to the first embodiment.

For example, as shown in FIG. 1, the medical image processing system 100 according to the present embodiment includes an X-ray CT (Computed Tomography) device 110, a medical image storage device 120, an electronic chart system 130, and a medical information display device 140. And the medical image processing apparatus 150. Here, each device and system are communicably connected via the network 160.

In addition to the X-ray CT apparatus 110, the medical image processing system 100 includes a magnetic resonance imaging (MRI) apparatus, an ultrasonic diagnostic apparatus, a PET (Positron Emission Tomography) apparatus, and a SPECT (Single Photon Emission Computed Tomography). ) Other medical diagnostic imaging devices such as devices may be further included. Further, the medical image processing system 100 may further include other systems such as HIS (Hospital Information System) and RIS (Radiology Information System) in addition to the electronic medical record system 130.

The X-ray CT apparatus 110 generates a CT image of the subject. Specifically, the X-ray CT apparatus 110 collects projection data showing the distribution of X-rays transmitted through the subject by swirling the X-ray tube and the X-ray detector in a circular orbit surrounding the subject. do. Then, the X-ray CT apparatus 110 generates a CT image based on the collected projection data.

The medical image storage device 120 stores various medical images related to the subject. Specifically, the medical image storage device 120 acquires a CT image from the X-ray CT device 110 via the network 160, stores the CT image in a storage circuit in the device, and stores the CT image. For example, the medical image storage device 120 is realized by a computer device such as a server or a workstation. Further, for example, the medical image storage device 120 is realized by a PACS (Picture Archiving and Communication System) or the like, and stores CT images in a format compliant with DICOM (Digital Imaging and Communications in Medicine).

The electronic medical record system 130 stores various medical data related to the medical record of the subject and the patient information. Specifically, the electronic medical record system 130 generates medical care data related to the subject, or acquires the medical care data from another device via the network 160, and stores and stores the medical care data in a storage circuit in the own system. For example, the electronic medical record system 130 is realized by a computer device such as a server or a workstation.

The medical information display device 140 displays various medical information regarding the subject. Specifically, the medical information display device 140 acquires medical information such as CT images and image processing processing results from the medical image processing device 150 via the network 160, and displays the medical information on a display in the device. do. For example, the medical information display device 140 is realized by a computer device such as a workstation, a personal computer, or a tablet terminal.

The medical image processing apparatus 150 performs various image processing on the subject. Specifically, the medical image processing device 150 acquires a CT image from the X-ray CT device 110 or the medical image storage device 120 via the network 160, acquires medical data from the electronic chart system 130, and obtains the CT image and the medical image. Various image processing is performed using medical data. For example, the medical image processing device 150 is realized by a computer device such as a server or a workstation.

For example, the medical image processing apparatus 150 includes a network (NetWork: NW) interface 151, a storage circuit 152, an input interface 153, a display 154, and a processing circuit 155.

The NW interface 151 controls the transmission and communication of various data transmitted and received between the medical image processing device 150 and other devices connected via the network 160. Specifically, the NW interface 151 is connected to the processing circuit 155, and transmits data received from another device to the processing circuit 155, or transmits data received from the processing circuit 155 to another device. For example, the NW interface 151 is realized by a network card, a network adapter, a NIC (Network Interface Controller), or the like.

The storage circuit 152 stores various data and various programs. Specifically, the storage circuit 152 is connected to the processing circuit 155, and stores the data received from the processing circuit 155, or reads the stored data and transmits it to the processing circuit 155. For example, the storage circuit 152 is realized by a semiconductor memory element such as a RAM (Random Access Memory) or a flash memory, a hard disk, an optical disk, or the like.

The input interface 153 receives various instructions and input operations of various information from the user. Specifically, the input interface 153 is connected to the processing circuit 155, converts the input operation received from the user into an electric signal, and transmits the input operation to the processing circuit 155. For example, the input interface 153 includes a trackball, a switch button, a mouse, a keyboard, a touch pad for performing an input operation by touching an operation surface, a touch screen in which a display screen and a touch pad are integrated, and a non-optical sensor. It is realized by a contact input interface, a voice input interface, and the like. In the present specification, the input interface 153 is not limited to the one provided with physical operating parts such as a mouse and a keyboard. For example, an example of the input interface 153 includes an electric signal processing circuit that receives an electric signal corresponding to an input operation from an external input device provided separately from the device and transmits the electric signal to the control circuit.

The display 154 displays various information and various data. Specifically, the display 154 is connected to the processing circuit 155 and displays various information and various data received from the processing circuit 155. For example, the display 154 is realized by a liquid crystal monitor, a CRT (Cathode Ray Tube) monitor, a touch panel, or the like.

The processing circuit 155 controls the entire medical image processing apparatus 150. For example, the processing circuit 155 performs various processes according to the input operation received from the user via the input interface 153. Further, for example, the processing circuit 155 receives data transmitted by another device from the NW interface 151, and stores the received data in the storage circuit 152. Further, for example, the processing circuit 155 transmits the data received from the storage circuit 152 to the NW interface 151, thereby transmitting the data to another device. Further, for example, the processing circuit 155 displays the data received from the storage circuit 152 on the display 154.

The configuration example of the medical image processing system 100 and the medical image processing device 150 according to the present embodiment has been described above. For example, the medical image processing system 100 and the medical image processing device 150 according to the present embodiment are installed in medical facilities such as hospitals and clinics, and diagnosis and treatment plans for heart diseases performed by users such as doctors are formulated. To support.

Specifically, the medical image processing device 150 calculates and presents various information regarding the blood flow of the blood vessel based on the medical image. For example, the medical image processing apparatus 150 calculates and displays WSS at each position of a blood vessel as one of the information regarding blood flow.

Generally, when a diagnosis or a treatment policy is determined using such a technique, a user such as a doctor integrates not only WSS but also various information to make a comprehensive judgment. However, when a plurality of pieces of information are presented without limitation, the work of acquiring and understanding the information becomes complicated, and the time and effort of the user increases.

Therefore, the medical image processing apparatus 150 according to the present embodiment is configured to reduce the time and effort of the user when diagnosing a heart disease, determining a treatment policy, and the like.

Specifically, the medical image processing apparatus 150 has, as information on the blood flow of the blood vessel calculated based on the medical image, a first index value regarding the blood vessel calculated from the blood pressure or the blood flow, and a second index value regarding the blood vessel. WSS is displayed as an index value. Then, the medical image processing apparatus 150 switches and displays the first index value and the WSS based on the information about the subject.
Here, the first index value is an index value of a type different from the wall shear stress which is the second index value.

Here, the medical image processing apparatus 150 extracts the degree of heart-related disease from the medical image. Then, the medical image processing apparatus 150 uses the information regarding the blood flow of the blood vessel calculated based on the medical image as the first index value regarding the blood vessel calculated from the blood pressure or the blood flow when the degree of the heart-related disease is high. Is displayed, and if the degree of heart-related disease is low, WSS is displayed as a second index value related to blood vessels.

According to such a configuration, the WSS calculated from the medical image and other index values can be appropriately switched and displayed according to the state of the subject. This makes it possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

Hereinafter, the medical image processing apparatus 150 having such a configuration will be described in detail. In the following, an example in which a coronary CT image is used as a medical image and a blood flow reserve ratio (FFR) is displayed as a first index value for a blood vessel calculated from blood pressure or blood flow. To explain.

For example, as shown in FIG. 1, in the present embodiment, the processing circuit 155 of the medical image processing apparatus 150 has an acquisition function 155a, a calculation function 155b, an extraction function 155c, and a display control function 155d. Here, the extraction function 155c is an example of the extraction unit. Further, the display control function 155d is an example of the display control unit.

The acquisition function 155a acquires a coronary CT image of a subject from the X-ray CT device 110 or the medical image storage device 120 via the NW interface 151.

The calculation function 155b calculates FFR and WSS based on the coronary CT image of the subject acquired by the acquisition function 155a.

For example, the calculation function 155b calculates FFR and WSS at each position of the coronary artery from the coronary CT image of the subject by a known method using CFD (Computational Fluid Dynamics), machine learning, or the like.

The extraction function 155c extracts the degree of heart-related disease from the coronary CT images of the subject acquired by the acquisition function 155a. Here, the "degree of disease" includes not only a state with a disease but also a state without a disease. That is, the "degree of illness" can indicate not only the degree of the illness in the presence of the illness, but also the absence of the illness.

For example, the extraction function 155c extracts the degree of coronary artery disease from the coronary artery CT image of the subject acquired by the acquisition function 155a as the degree of heart-related disease.

Specifically, the extraction function 155c extracts the degree of disease indicating the degree of coronary artery disease by analyzing the coronary CT image of the subject. Further, for example, the extraction function 155c extracts the existence probability of myocardial ischemia as a disease degree indicating the degree of coronary artery disease. At this time, for example, the extraction function 155c may extract the existence probability based on the distribution of CT values in each myocardial region, or by machine learning technology, an image in which myocardial ischemia is present and an image in which myocardial ischemia is not present may be extracted. The existence probability may be extracted using a discriminator whose characteristics have been learned in advance.

In the present embodiment, the degree of disease indicating the degree of coronary artery disease extracted by the extraction function 155c is not limited to the existence probability of myocardial ischemia, and the user controls the display of FFR and WSS, which will be described later. Any value may be used as long as it is desired. For example, the extraction function 155c may directly assign a value as the degree of disease from the result of a diagnosis separately performed on the subject by a user such as a doctor, or may be a perfusion index obtained from a coronary artery CT image. A value indicating the severity of myocardial ischemia may be extracted from the disease degree.

The display control function 155d displays the FFR and WSS calculated by the calculation function 155b on the display 154 as information on the blood flow of the coronary artery calculated based on the coronary CT image of the subject acquired by the acquisition function 155a. .. Then, the display control function 155d switches and displays the FFR and the WSS based on the information about the subject.

Here, when the display control function 155d has a high degree of coronary artery disease extracted by the extraction function 155c as information on the blood flow of the coronary artery calculated based on the coronary artery CT image of the subject acquired by the acquisition function 155a. Displays FFR and, if the degree of the coronary artery disease is low, displays WSS.

Specifically, the display control function 155d displays FFR when the degree of disease indicating the degree of coronary artery disease is higher than the first threshold value, and the degree of disease indicating the degree of coronary artery disease is smaller than the first threshold value. If it is lower than the threshold value of 2, WSS is displayed. Further, the display control function 155d displays FFR and WSS when the degree of disease indicating the degree of coronary artery disease is between the first threshold value and the second threshold value.

FIG. 2 is a diagram showing an example of information display performed by the display control function 155d according to the first embodiment.

For example, as shown in FIG. 2, the display control function 155d determines the type of information to be displayed on the display 154 based on the existence probability of myocardial ischemia extracted by the extraction function 155c. At this time, for example, the display control function 155d determines the type of information to be displayed in FFR when the existence probability of myocardial ischemia is higher than the preset first threshold value (existence probability: high). Further, the display control function 155d determines the type of information to be displayed in WSS when the existence probability of myocardial ischemia is lower than the preset second threshold value (<first threshold value) (presence probability: low). do. Further, when the existence probability of myocardial ischemia is included in the range from the first threshold value to the second threshold value (existence probability: medium), the display control function 155d sets the types of information to be displayed to FFR and WSS. Decide on both.

That is, when the existence probability of myocardial ischemia is high, the display control function 155d is expected to be in a situation where an urgent decision on treatment indication or a treatment plan is formulated. Decide to display only information. In addition, since the display control function 155d is expected to formulate a long-term treatment plan when the probability of myocardial ischemia is low, only the WSS information, which is necessary for long-term judgment, is used. Decide to display.

Then, the display control function 155d displays the determined type of information on the display 154. For example, the display control function 155d first three-dimensionally reconstructs the vascular region of the coronary artery in the coronary CT image to create a three-dimensional image of the coronary artery (for example, a VR (Volume Rendering) image or an SR (Surface Rendering) image. Etc.) is generated. Further, the display control function 155d specifies a range in which FFR and WSS can be taken from the maximum and minimum values of FFR and WSS at each position of the coronary artery, and arranges colors (color lookup) based on the range. Table) is set. After that, the display control function 155d generates a color map image by assigning a color corresponding to each position in the three-dimensional image of the coronary artery for each of FFR and WSS. Then, the display control function 155d displays the color map image of FFR on the display 154 when the type of information to be displayed is determined to be FFR, and when the type of information to be displayed is determined to WSS, the display control function 155d displays the color map image of FFR. The color map image is displayed on the display 154. Further, when the display control function 155d determines the type of information to be displayed for both FFR and WSS, the display control function 155d displays the color maps of FFR and WSS side by side on the display 154.

In the present embodiment, the display form of each information displayed by the display control function 155d is not limited to the color map image, and any display form can be used as long as each information can be correctly recognized by the user. May be good. For example, the display control function 155d sets an array of patterns and textures based on the range that can be taken by each of the specified FFR and WSS, and for each of the FFR and WSS, a pattern corresponding to each position in the three-dimensional image of the coronary artery. Images may be generated by assigning textures. Further, for example, the display control function 155d may allow the user to arbitrarily set the display form of each information by using the user interface realized by the input interface 153 and the display 154. Further, for example, when displaying both FFR and WSS, the display control function 155d may display each image in conjunction with each other by calculating the corresponding points in those images, or cine. It may be automatically rotated and displayed by using a display or the like. Further, the display control function 155d may display a moving image by reconstructing each image as a moving image based on a preset rotation speed or angle.

The processing functions of the processing circuit 155 have been described above. Here, for example, the processing circuit 155 is realized by a processor. In that case, each of the above-mentioned processing functions is stored in the storage circuit 152 in the form of a program that can be executed by a computer. Then, the processing circuit 155 realizes a function corresponding to each program by reading and executing each program stored in the storage circuit 152. In other words, the processing circuit 155 has each processing function shown in FIG. 1 in a state where each program is read out.

The processing circuit 155 may be configured by combining a plurality of independent processors, and each processor may execute a program to realize each processing function. Further, each processing function of the processing circuit 155 may be appropriately distributed or integrated into a single processing circuit or a plurality of processing circuits. Further, each processing function of the processing circuit 155 may be realized by mixing hardware such as a circuit and software. Further, here, an example in which a program corresponding to each processing function is stored in a single storage circuit 152 has been described, but the embodiment is not limited to this. For example, a program corresponding to each processing function may be distributed and stored in a plurality of storage circuits, and the processing circuit 155 may read and execute each program from each storage circuit.

FIG. 3 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit 155 of the medical image processing apparatus 150 according to the first embodiment.

For example, as shown in FIG. 3, in the present embodiment, when the acquisition function 155a receives an instruction to start processing from the user via the input interface 153 (steps S101, Yes), the X-ray CT apparatus 110 Alternatively, a CT image of the coronary artery of the subject is acquired from the medical image storage device 120 (step S102). This processing is realized, for example, by the processing circuit 155 calling the program corresponding to the acquisition function 155a from the storage circuit 152 and executing it.

Subsequently, the calculation function 155b calculates FFR and WSS based on the coronary CT image of the subject acquired by the acquisition function 155a (step S103). This processing is realized, for example, by the processing circuit 155 calling the program corresponding to the calculation function 155b from the storage circuit 152 and executing it.

Subsequently, the extraction function 155c extracts the degree of disease indicating the degree of coronary artery disease from the coronary artery CT image of the subject acquired by the acquisition function 155a (step S104). This processing is realized, for example, by the processing circuit 155 calling a program corresponding to the extraction function 155c from the storage circuit 152 and executing it.

Subsequently, the display control function 155d displays the FFR calculated by the calculation function 155b when the degree of disease indicating the degree of coronary artery disease is higher than the first threshold value (step S105, Yes) (step S106). Further, the display control function 155d was calculated by the calculation function 155b when the degree of disease indicating the degree of coronary artery disease is lower than the second threshold value smaller than the first threshold value (step S105, No, step S107, Yes). Display the WSS (step S108). Further, the display control function 155d has FFR and WSS calculated by the calculation function 155b when the degree of disease indicating the degree of coronary artery disease is between the first threshold value and the second threshold value (steps S107, No). Is displayed (step S109). This processing is realized, for example, by the processing circuit 155 calling a program corresponding to the display control function 155d from the storage circuit 152 and executing the program.

As described above, in the first embodiment, the medical image processing apparatus 150 switches and displays WSS and FFR calculated from the coronary CT image according to the state of the subject. As a result, WSS and FFR can be automatically displayed at an appropriate timing when diagnosing a heart disease or formulating a treatment plan. Therefore, according to the first embodiment, it is possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

(Modification 1 of the first embodiment)
In the first embodiment described above, an example of switching between FFR and WSS according to the degree of coronary artery disease has been described, but the embodiment is not limited to this.

Generally, it is known that a one-dimensional FFR (hereinafter, 1D-FFR) and a three-dimensional FFR (hereinafter, 3D-FFR) exist in the FFR depending on the calculation method. Similarly, it is known that WSS has one-dimensional WSS (hereinafter, 1D-WSS) and three-dimensional WSS (hereinafter, 3D-WSS) depending on the calculation method. Specifically, 3D-FFR is a method for calculating FFR at each position in the blood vessel, and 1D-FFR is a method for calculating FFR at each cross-sectional position of the blood vessel with reference to the core line of the blood vessel. .. Similarly, 3D-WSS is a method for calculating WSS at each position in the blood vessel, and 1D-WSS is a method for calculating WSS at each cross-sectional position of the blood vessel with reference to the core line of the blood vessel.

Here, 3D-FFR and 3D-WSS have an advantage that more accurate information can be provided because the WSS and FFR of the local position are calculated, but on the other hand, the calculation time, the processing by the computer, and the storage area are increased. It has the disadvantage that the calculation cost such as the amount used is high. On the other hand, 1D-FFR and 1D-WSS have a demerit that the accuracy of information is lower than that of 3D-FFR and 3D-WSS, but on the other hand, the calculation time, processing by a computer, and storage area are reduced. It has the advantage of low calculation cost such as usage amount.

Therefore, for example, as a modification 1 of the first embodiment, the medical image processing apparatus 150 has at least one of 1D-FFR and 1D-WSS, 3D-FFR, and 3D-FFR, depending on the degree of disease indicating the degree of coronary artery disease. The display may be switched between at least one of the 3D-WSS.

Specifically, the calculation function 155b calculates 1D-FFR and 1D-WSS and 3D-FFR and 1D-WSS as information on the blood flow of the coronary artery based on the coronary CT image of the subject.

Then, the display control function 155d displays at least one of 1D-FFR and 1D-WSS calculated by the calculation function 155b when the degree of disease indicating the degree of coronary artery disease is high. Further, the display control function 155d displays at least one of 3D-FFR and 3D-WSS calculated by the calculation function 155b when the degree of disease indicating the degree of coronary artery disease is low.

FIG. 4 is a diagram showing an example of information display performed by the display control function 155d according to the first modification of the first embodiment.

For example, as shown in FIG. 4, the display control function 155d determines the type of information to be displayed on the display 154 based on the existence probability of myocardial ischemia extracted by the extraction function 155c. At this time, for example, the display control function 155d determines the type of information to be displayed to 1D-FFR and 1D-WSS when the existence probability of myocardial ischemia is higher than the threshold value. Further, the display control function 155d determines the type of information to be displayed to 3D-FFR and 3D-WSS when the existence probability of myocardial ischemia is lower than the threshold value.

That is, the display control function 155d is shorter because when the probability of existence of myocardial ischemia is high, it is necessary to make an urgent decision on treatment indication and formulate a treatment plan, and it is assumed that there is no time to spare. It is determined to display 1D-FFR and 1D-WSS, which are information that can be calculated in time. Further, the display control function 155d is determined to display 3D-FFR and 3D-WSS, which are more accurate information, because it is assumed that there is a time margin when the existence probability of myocardial ischemia is low. do.

The display examples of FFR and WSS according to this modification are not limited to this. For example, the display control function 155d may determine the type of information to be displayed to either 1D-FFR or 1D-WSS when the probability of existence of myocardial ischemia is higher than the threshold value, or may determine the type of information to be displayed for myocardial ischemia. When the existence probability is lower than the threshold value, the type of information to be displayed may be determined to be either 3D-FFR or 3D-WSS. Here, for example, the display control function 155d determines to display the information specified by the user among FFR and WSS in each case. Further, for example, the display control function 155d further provides a threshold value larger than the above-mentioned threshold value, and when the existence probability of myocardial ischemia is higher than the further set threshold value, the type of information to be displayed is determined to be only 1D-FFR. May be.

(Modification 2 of the first embodiment)
Further, in the above-mentioned first embodiment, an example in which the type of information to be displayed is changed according to the degree of coronary artery disease has been described, but the embodiment is not limited to this.

For example, as the second modification of the first embodiment, the medical image processing apparatus 150 may change the size of the display area of the information to be displayed according to the degree of coronary artery disease.

Specifically, the display control function 155d simultaneously displays the FFR and WSS calculated by the calculation function 155b. The display control function 155d makes the display area of FFR larger than the display area of WSS when the degree of disease indicating the degree of coronary artery disease is high, and displays the WSS when the degree of disease indicating the degree of coronary artery disease is low. Make the area larger than the FFR display area.

FIG. 5 is a diagram showing an example of information display performed by the display control function 155d according to the second modification of the first embodiment.

For example, as shown in FIG. 5, the display control function 155d determines the type of information to be displayed on the display 154 based on the existence probability of myocardial ischemia extracted by the extraction function 155c. At this time, for example, the display control function 155d determines that the display size of the FFR color map image is increased and the display size of the WSS color map image is reduced when the existence probability of myocardial ischemia is high. Further, the display control function 155d determines that when the existence probability of myocardial ischemia is low, the display size of the FFR color map image is reduced and the display size of the WSS color map image is increased.

The display examples of FFR and WSS according to this modification are not limited to this. For example, the display control function 155d may change the display color, transparency, display position, or the like of the display area instead of changing the size of the display area between FFR and WSS. For example, the display control function 155d displays FFR and WSS side by side side by side, displays FFR on the left side when the probability of myocardial ischemia is high, and displays FFR on the left side when the probability of myocardial ischemia is low. Determines to display WSS on the left side.

(Modification 3 of the first embodiment)
Further, in the first embodiment described above, an example in which the FFR and WSS are displayed as a color map image based on a color arrangement (color lookup table) has been described, but the embodiment is not limited to this.

For example, when FFR and WSS are displayed in a color map based on an array of the same color, very similar images are generated, and there is a possibility that the user may mistake FFR and WSS for each other.

Therefore, for example, as a modification 3 of the first embodiment, the medical image processing apparatus 150 may display the FFR and the WSS in different display forms.

Specifically, the display control function 155d displays the FFR and WSS calculated by the calculation function 155b in different display forms.

6 and 7 are diagrams showing an example of information display performed by the display control function 155d according to the modification 3 of the first embodiment.

For example, as shown on the left side and the center of FIG. 6, the display control function 155d displays an FFR image and a WSS image at the same time, and one of them is displayed as a color map image to which a color is assigned (expressed in color). ), The other is displayed as an image with a texture assigned (expressed as a texture). Alternatively, the display control function 155d may display, for example, as shown on the right side of FIG. 6, with respect to the WSS image, the size and direction of the WSS are indicated by the number and direction of the arrows (arrows). Expressed in numbers and directions). At this time, for example, when the display control function 155d allows the user to arbitrarily set the display form of each information by using the user interface as described above, the user can arbitrarily set the display form of each image. A warning may be displayed when the same or similar display form is set. Alternatively, the display control function 155d may be controlled so that the user cannot select the same or similar display form in order to prevent a mistake.

Alternatively, for example, as shown in FIG. 7, the display control function 155d may display different characters or marks on the FFR image and the WSS image. At this time, for example, the display control function 155d may activate the display window when any of the images becomes the observation target of the user because the characters or marks to be displayed may interfere with the observation. The characters and marks on the image of the person to be observed may be erased during the operation, the operation of viewing (browsing) the image, the operation of directing the line of sight to the image, etc.). .. Further, for example, when the display control function 155d displays each image in conjunction with each other as described above, the characters and marks on the image to be observed are erased and become an observation target. You may control so that the characters and marks on the image that are not erased are not erased.

(Variation Example 4 of the First Embodiment)
Further, for example, in the first embodiment described above, an example in which FFR and WSS are displayed using a three-dimensional image (VR image, SR image, etc.) of a coronary artery has been described, but the embodiment is limited to this. do not have.

For example, as a modification 4 of the first embodiment, the medical image processing apparatus 150 may display FFR and WSS by using another image showing a coronary artery.

Specifically, the display control function 155d displays an image showing a coronary artery, and FFR and WSS calculated by the calculation function 155b are superimposed or displayed side by side on the image.

For example, the display control function 155d superimposes and displays WSS and FFR corresponding to each position in the coronary artery CT image.

8 and 9 are diagrams showing an example of information display performed by the display control function 155d according to the modified example 4 of the first embodiment.

For example, as shown on the left side of FIG. 8, the display control function 155d reconstructs a curved MPR image in which a coronary artery is linearly represented by a curved MPR (Multi Planar Reconstruction), and corresponds to each position of the curved MPR image. WSS or FFR may be assigned and displayed.

Alternatively, for example, as shown on the right side of FIG. 8, when displaying the curved MPR image, the display control function 155d displays the right half of the blood vessel in a display form corresponding to FFR and the left half corresponds to WSS. It may be displayed in the display form to be displayed. This makes it possible to efficiently observe the position of the blood vessel and FFR and WSS at the same time.

The example of displaying FFR and WSS separately on the left and right is not limited to the example of using curved MPR. For example, the display control function 155d may use a VR image or an SR image. In that case, for example, the display control function 155d divides the VR image or SR image into left and right with the display direction of the display screen (for example, the direction from the front to the back of the screen) as the axis, so that the VR image or SR is used. Even when the image is rotated, it is controlled so that FFR and WSS are always displayed on the left and right of each blood vessel limb. This example is effective when a calculation method having the same value is used for the blood vessel cross section at the same position, such as 1D-FFR and 1D-WSS.

Alternatively, for example, the display control function 155d may display FFR or WSS by using the polar coordinate display (also referred to as a polar map) of the myocardial segment. Here, the polar coordinate display of the myocardial segment is an image in which the myocardium is expanded and schematically represented. This is an image in which the apex of the heart (Apical) is represented by an annular region centered on the short axis (Short-axix), and the region of each portion is further divided into a plurality of segments in the circumferential direction. Then, in the polar coordinate display of the segments of the myocardium, each segment has a region controlled by the Left Anterior Descending artery (LAD), a region controlled by the Left CircumfleX artery (LCX), and a right coronary artery. It is classified as one of the territories controlled by Artery (RCA). In this case, for example, as shown in the lower part of FIG. 9, the display control function 155d divides the region corresponding to each segment in the polar coordinate display of the myocardial segment into upper and lower halves, and displays FFR on one of them. , WSS is displayed on the other side. At this time, for example, the display control function 155d identifies a blood vessel corresponding to each segment in the polar coordinate display of the myocardial segment, and determines the average value, maximum value, etc. of FFR and WSS at each position of the specified blood vessel. Calculate representative values and assign them to each segment.

(Variation Example 5 of the First Embodiment)
Further, in the first embodiment described above, an example of determining the type of information to be displayed on the display 154 according to the degree of coronary artery disease has been described, but the embodiment is not limited to this.

For example, as a modification 5 of the first embodiment, the medical image processing apparatus 150 may determine the type of information to be displayed on the display 154 in response to an instruction from the user.

Specifically, the display control function 155d receives an operation of selecting the type of information to be displayed on the display 154 from the user, and depending on the received operation, at least one of the FFR and WSS calculated by the calculation function 155b is performed. It is displayed on the display 154.

For example, the display control function 155d presents the user with the probability of myocardial ischemia in the coronary CT image using the user interface realized by the input interface 153 and the display 154. Further, the display control function 155d receives from the user an operation of selecting the type of information to be displayed on the display 154 from FFR and WSS by using the user interface. Then, the display control function 155d displays the type of information selected by the user on the display 154 according to the received operation.

(Variation Example 6 of the First Embodiment)
Further, in the first embodiment described above, when the degree of disease indicating the degree of coronary artery disease is higher than the first threshold value, only FFR is displayed, and the degree of disease indicating the degree of coronary artery disease is lower than the second threshold value. In some cases, it was decided to display only WSS, but the embodiment is not limited to this.

For example, as a modification 6 of the first embodiment, the medical image processing apparatus 150 may switch from the display of only one of the FFR and the WSS to the display of the other in response to an instruction from the user.

Specifically, the display control function 155d receives an operation of switching the display of FFR and WSS from the user, and displays either FFR or WSS calculated by the calculation function 155b according to the received operation. To switch to the state where the other is displayed.

For example, when only one of FFR and WSS is displayed, the display control function 155d receives from the user an operation of switching the display via the input interface 153. Then, the display control function 155d switches the display from FFR to WSS or from WSS to FRR according to the received operation.

(Second embodiment)
In the first embodiment described above, an example of displaying FFR or WSS according to the degree of coronary artery disease has been described, but the embodiment is not limited to this.

For example, when the time when the medical image is taken is before the treatment of the subject, the predicted FFR or the predicted WSS after the treatment may be displayed by performing a virtual treatment on the blood vessel using the medical image. .. Hereinafter, such an example will be described as a second embodiment. In the following, the configurations of the medical image processing system and the medical image processing apparatus according to the second embodiment will be described focusing on the differences from the first embodiment, and the same reference numerals will be given to the common configurations. As a matter of fact, a detailed description will be omitted.

FIG. 10 is a diagram showing a configuration example of the medical image processing system and the medical image processing apparatus according to the second embodiment.

For example, as shown in FIG. 10, the medical image processing system 200 according to the present embodiment includes an X-ray CT device 110, a medical image storage device 120, an electronic medical record system 130, a medical information display device 140, and a medical image. Includes processing device 250. Here, each device and system are communicably connected via the network 160.

The medical image processing apparatus 250 performs various image processing on the subject. Specifically, the medical image processing device 250 acquires a CT image from the X-ray CT device 110 or the medical image storage device 120 via the network 160, acquires medical data from the electronic chart system 130, and obtains the CT image and the medical image. Various image processing is performed using medical data. For example, the medical image processing device 250 is realized by a computer device such as a server or a workstation.

For example, the medical image processing apparatus 250 includes a NW interface 151, a storage circuit 152, an input interface 153, a display 154, and a processing circuit 255.

In the present embodiment, the medical image processing apparatus 250 processing circuit 255 has an acquisition function 155a, an identification function 255e, a calculation function 155b, a prediction function 255f, and a display control function 255d. Here, the identification function 255e is an example of the identification unit. Further, the prediction function 255f is an example of a prediction unit. Further, the display control function 255c is an example of the display control unit.

The identification function 255e discriminates whether the coronary CT image of the subject acquired by the acquisition function 155a is taken before or after the treatment of the subject.

For example, the identification function 255e determines whether or not the processing of the next step can be performed based on the time when the coronary artery CT image is taken. At this time, for example, the identification function 255e acquires the patient information of the subject from the electronic medical record system 130 via the NW interface 151, and identifies the time point of taking the coronary artery CT image based on the acquired information. The identification function 255e may acquire patient information from HIS, RIS, or the like. Then, when the identification function 255e determines that the time of imaging is before the operation of the subject, it determines that the processing of the next step can be performed, and determines that the time of imaging is after the operation. It is determined that the processing of the next step is not executed. Alternatively, when the identification function 255e determines that the time of imaging is before the medication of the subject, it determines that the processing of the next step can be performed, and determines that the time of imaging is after administration. It is determined that the processing of the next step is not executed. Here, treatment and dosing are examples of treatment.

The method for identifying the time of shooting is not limited to this, and various methods can be used. For example, the discriminating function 255e may detect a therapeutic device from a coronary CT image by a known method and discriminate whether the imaging time is before or after the treatment depending on the presence or absence of the therapeutic device.

The prediction function 255f performs virtual treatment on the coronary artery using the coronary artery CT image when the identification function 255e identifies that the time when the coronary artery CT image of the subject is taken is before the treatment of the subject. At least one of the predicted FFR, which is the FFR after the treatment, and the predicted WSS, which is the WSS after the treatment, is calculated. Here, the predicted FFR is an example of the first predicted index value, and the predicted WSS is an example of the second predicted index value.

For example, the prediction function 255f uses a coronary CT image of a subject to perform a virtual treatment on a computer for a coronary artery when it is determined by the identification function 255e that the processing of the next step can be performed. Is carried out, and FFR and WSS at each position of the blood vessel after treatment are predicted and calculated. For example, the prediction function 255f is described by Gissen, Frank JH, et al. Virtual treatment is performed by the method shown in "Simulation of stent deployment in a realistic human coronary artery", Biomedical engineering online 7.1 (2008): 23. Here, since the processing of the virtual treatment generally requires a large amount of computer processing cost and processing time, it may be performed using a dedicated calculation processing device. If the identification function 255e determines that the processing of the next step is not performed, the prediction function 255f does not perform the virtual treatment.

The display control function 255d performs at least one of the predicted FFR and the predicted WSS calculated by the predicted function 255f when the discriminating function 255e identifies that the time when the coronary CT image of the subject is taken is before the treatment of the subject. It is displayed on the display 154.

Specifically, the display control function 255d is at least one of FFR and WSS calculated based on the coronary CT image of the subject by the calculation function 155b when the time of imaging is identified as before the treatment of the subject. And at least one of the predicted FFR and the predicted WSS calculated by the prediction function 255f. Further, the display control function 255d displays at least one of FFR and WSS calculated based on the coronary CT image of the subject by the calculation function 155b when it is identified that the time of imaging is after the treatment of the subject. ..

11 and 12 are diagrams showing an example of information display performed by the display control function 255d according to the second embodiment.

For example, as shown in FIG. 11, the display control function 255d determines the type of information to be displayed on the display 154 based on the time when the coronary artery CT image identified by the identification function 255e is taken. At this time, for example, when the identification function 255e identifies the imaging time point as before the treatment of the subject, the display control function 255d determines the type of information to be displayed by the WSS (before treatment) calculated by the calculation function 155b. WSS) and the predicted WSS (post-treatment predicted WSS) calculated by the predictive function 255f. Further, the display control function 255d sets the type of information to be displayed to the WSS (post-treatment WSS) calculated by the calculation function 155b when the identification function 255e identifies that the time of imaging is after the treatment of the subject. decide.

Here, for example, the display control function 255d may further determine to display the FFR calculated by the calculation function 155b when displaying the WSS calculated by the calculation function 155b. Further, for example, the display control function 255d may further determine to display the prediction FFR calculated by the prediction function 255f when displaying the prediction WSS calculated by the prediction function 255f.

Then, the display control function 255d displays the determined type of information on the display 154. For example, the display control function 255d displays the determined type of information as in the first embodiment and its modifications. At this time, for example, the display control function 255d simultaneously displays information such as the treatment history, medication history, and blood test value (hematocrit value, etc.) of the subject based on the patient information of the subject acquired by the identification function 255e. You may. For example, as shown in FIG. 12, the display control function 255d sets the type of treatment device (biological stent, etc.) and the like based on the surgical record included in the patient information of the subject when the imaging time is after the treatment. Information on the detention position is displayed at the same time.

Further, for example, the display control function 255d calculates an image feature amount (for example, information on a calcium score and a blood vessel diameter) related to coronary artery disease by performing known image processing on a coronary artery CT image, and the image feature. The amount may be displayed at the same time. Further, for example, the display control function 255d may simultaneously display incidental information (imaging time, cardiac phase, etc.) of the image obtained from the information of the DICOM header associated with the coronary artery CT image. Further, for example, the display control function 255d may simultaneously display the reliability of the calculation in the calculation of WSS and FFR and the reliability of the calculation in the calculation of the treatment simulation. In this case, the reliability can be calculated from, for example, the magnitude of deviation from the learning model in the target data when machine learning is used.

Further, for example, the display control function 255d may display the FFR and the WSS calculated by the calculation function 155b separately on the left and right by using the curved MPR as in the modification 4 of the first embodiment. Then, the predicted FFR and the predicted WSS calculated by the prediction function 255f may be displayed separately on the left and right. Further, for example, the display control function 255d may display the FFR and WSS calculated by the calculation function 155b separately on the upper and lower sides by using the polar coordinate display of the myocardial segment, or the prediction function 255f may display the FFR and the WSS separately. The predicted FFR and the predicted WSS may be displayed separately on the upper and lower sides.

FIG. 13 is a flowchart showing a processing procedure of processing performed by each processing function of the processing circuit 255 of the medical image processing apparatus 250 according to the second embodiment.

For example, as shown in FIG. 13, in the present embodiment, when the acquisition function 155a receives an instruction to start processing from the user via the input interface 153 (steps S201, Yes), the X-ray CT apparatus 110 Alternatively, a CT image of the coronary artery of the subject is acquired from the medical image storage device 120 (step S202). This processing is realized, for example, by the processing circuit 255 calling the program corresponding to the acquisition function 155a from the storage circuit 152 and executing it.

Subsequently, the identification function 255e identifies whether the coronary CT image of the subject acquired by the acquisition function 155a is taken before or after the treatment (step S203). This processing is realized, for example, by the processing circuit 255 calling a program corresponding to the identification function 255e from the storage circuit 152 and executing the program.

Subsequently, the calculation function 155b calculates FFR and WSS as information regarding blood flow in the coronary artery based on the coronary CT image of the subject acquired by the acquisition function 155a (step S204). This processing is realized, for example, by the processing circuit 255 calling a program corresponding to the calculation function 155b from the storage circuit 152 and executing the program.

Subsequently, when the prediction function 255f identifies by the identification function 255e that the time when the coronary CT image of the subject is taken is before the treatment of the subject (steps S205, Yes), the coronary artery CT image is used to identify the coronary artery. By performing a hypothetical treatment for the treatment, at least one of the predicted FFR and the predicted WSS after the treatment is calculated (step S206). This processing is realized, for example, by the processing circuit 255 calling a program corresponding to the prediction function 255f from the storage circuit 152 and executing the program.

Subsequently, when the display control function 255d is identified by the identification function 255e that the time of imaging is before the treatment of the subject (steps S205, Yes), the calculation function 155b calculates based on the coronary CT image of the subject. At least one of the calculated FFR and WSS and at least one of the predicted FFR and the predicted WSS calculated by the prediction function 255f are displayed (step S207). Further, the display control function 255d is calculated based on the coronary CT image of the subject by the calculation function 155b when the imaging time is identified as after the treatment of the subject by the identification function 255e (steps S205, No). At least one of FFR and WSS is displayed (step S208). This processing is realized, for example, by the processing circuit 255 calling a program corresponding to the display control function 255d from the storage circuit 152 and executing the program.

As described above, in the second embodiment, when the medical image processing apparatus 250 captures the medical image before the treatment of the subject, the medical image is used to perform virtual treatment on the blood vessel. By doing so, the predicted FFR and the predicted WSS after the treatment are calculated and displayed. This makes it possible to automatically display information indicating the effect of treatment when diagnosing a heart disease or formulating a treatment plan. Therefore, according to the second embodiment, it is possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

(Modification 1 of the second embodiment)
In the second embodiment described above, an example of displaying the predicted FFR and the predicted WSS after the treatment when the time of taking the coronary CT image of the subject is before the treatment of the subject has been described. The embodiment is not limited to this.

For example, as a modification 1 of the second embodiment, the medical image processing apparatus 250 may have at least one of 1D-FFR and 1D-WSS, and 3D-FFR and 3D-WSS, depending on the time when the coronary CT image is taken. At least one of them may be switched and displayed.

Specifically, the display control function 255d performs at least one of 3D-FFR and 3D-WSS calculated by the calculation function 155b when the imaging time point is identified by the identification function 255e as before the treatment of the subject. indicate. Further, the display control function 255d displays at least one of 1D-FFR and 1D-WSS calculated by the calculation function 155b when the imaging time point is identified as after the treatment of the subject by the identification function 255e.

FIG. 14 is a diagram showing an example of information display performed by the display control function 255d according to the first modification of the second embodiment.

For example, as shown in FIG. 14, the display control function 255d uses the calculation function 155b to calculate the type of information to be displayed when the identification function 255e identifies the time of imaging as before the treatment of the subject. Decide on 3D-FFR and 3D-WSS. Further, the display control function 255d determines the type of information to be displayed to 1D-WSS calculated by the calculation function 155b when the identification function 255e identifies that the time of imaging is after the treatment of the subject.

The display examples of FFR and WSS according to this modification are not limited to this. For example, the display control function 255d may determine the type of information to be displayed to either 3D-FFR or 3D-WSS when it is identified that the time of imaging is before the treatment of the subject. When it is identified that the time of imaging is before the treatment of the subject, the type of information to be displayed may be determined to be 1D-FFR or both 1D-FFR and 3D-WSS. Here, for example, the display control function 255d may be determined to display the information specified by the user among FFR and WSS in each case.

(Modification 2 of the second embodiment)
Further, in the second embodiment described above, an example in which the predicted FFR and the predicted WSS are calculated before determining the type of information to be displayed has been described, but the embodiment is not limited to this.

For example, as the second modification of the second embodiment, the medical image processing apparatus 250 may calculate the predicted FFR and the predicted WSS after determining the type of information to be displayed.

Specifically, the prediction function 255f calculates at least one of the predicted FFR and the predicted WSS after it is determined by the display control function 255d to display at least one of the predicted FFR and the predicted WSS.

(Modification 3 of the second embodiment)
Further, in the second embodiment described above, an example in which the predicted FFR and the predicted WSS after the treatment are calculated without input from the user by performing a virtual treatment for the coronary artery using the coronary CT image. However, the embodiment is not limited to this.

In general, when performing virtual treatment, it is necessary to assume and set various parameters. For example, anatomical features such as blood vessel hardness, blood physical properties (hematocrit value), post-treatment blood vessel shape (vascular limb curvature, etc.), plaque properties, treatment device type, medication type. And the amount and other treatment methods are assumed and set.

Therefore, for example, as a modification 3 of the second embodiment, the medical image processing apparatus 250 may accept parameters used when performing a virtual treatment from the user.

Specifically, the prediction function 255f receives an operation for inputting parameters used when performing a virtual treatment from the user, and calculates at least one of the prediction FFR and the prediction WSS using the received parameters. ..

For example, the prediction function 255f uses the user interface realized by the input interface 153 and the display 154 to accept the input of each parameter used when performing a virtual treatment. At this time, for example, the prediction function 255f may allow the numerical value of each parameter to be directly specified, or may allow the user to arbitrarily select from a plurality of predetermined parameter set candidates. Then, the prediction function 255f calculates the prediction FFR and the prediction WSS by performing a virtual treatment using the input parameters, and presents the calculated prediction FFR and WSS to the user using the user interface. do.

15 to 17 are diagrams showing an example of a user interface used by the prediction function 255f according to the third modification of the second embodiment.

For example, as shown in FIGS. 15 to 17, the prediction function 255f includes an image to which a prediction WSS (post-treatment prediction WSS) calculated using the input parameters is assigned, and a slider bar corresponding to the value of each parameter. Is displayed on the display 154. Here, the prediction function 255f allows the user to set an arbitrary parameter by receiving an operation for adjusting the slider bar from the user via the input interface 153. Then, when the parameter is adjusted by the user, the prediction function 255f calculates the predicted WSS using the adjusted parameter, and based on the calculated predicted WSS, displays the image displayed on the display 154. Update.

At this time, for example, the prediction function 255f may change the parameter item that can be set by the slider bar according to the enlargement ratio of the image. For example, the predictive function 255f is expected to change the parameters that affect the whole coronary artery when the whole coronary artery is observed by the user at a low enlargement rate, so as shown in FIG. Set parameter items that affect the entire coronary artery, such as "dosing amount". Further, for example, in the prediction function 255f, when each position of the blood vessel is observed by the user at a high enlargement rate, it is expected that the parameters affecting each position will be changed. As shown in, set parameter items such as "curvature" that affect each position of the blood vessel.

Further, for example, as shown in FIG. 17, the prediction function 255f may display the slider bar in a curved shape by bending the slider bar so as to follow the shape of the blood vessel. At this time, for example, the prediction function 255f may be able to set various curvatures with one slider bar by setting fluctuation points for each portion having a specific curvature. For example, the prediction function 255f may set one fluctuation point for each segment of the coronary artery classified by an academic society or the like. Further, for example, the prediction function 255f limits the movement of the fluctuation point on the slider bar (for example, the width and speed at which the fluctuation point can be moved) according to the conditions regarding the structure of the blood vessel and the conditions regarding the treatment device. You may. Further, for example, the prediction function 255f may display characters, marks, scales, etc. at the position of the prediction WSS corresponding to the threshold value for determining the necessity of treatment on the slider bar.

Further, for example, the prediction function 255f may accept input of parameters other than the parameters used when performing the virtual treatment. In this case, for example, the prediction function 255f receives an input of a heart rate, estimates a change in blood pressure from the input heart rate, and calculates a predicted WSS based on the estimated blood pressure.

Although FIGS. 15 to 17 show an example of a user interface for calculating and displaying the predicted WSS, for example, the prediction function 255f accepts the input of parameters using the same user interface, so that the prediction FFR May be calculated and displayed.

(Variation Example 4 of the Second Embodiment)
Further, in the second embodiment described above, an example of displaying information at one time point obtained from the coronary artery CT image to be analyzed has been described, but the embodiment is not limited to this.

For example, as a modification 4 of the second embodiment, the medical image processing apparatus 250 may display information at a plurality of time points.

Specifically, the display control function 255d is calculated by the calculation function 155b based on the coronary artery CT image before the treatment of the subject when the identification function 255e identifies that the imaging time is after the treatment of the subject. At least one of the FFR and WSS and at least one of the FFR and WSS calculated based on the coronary CT image after the treatment of the subject by the calculation function 155b are displayed.

FIG. 18 is a diagram showing an example of information display performed by the display control function 255d according to the modified example 4 of the second embodiment.

For example, as shown in FIG. 18, when the identification function 255e identifies the imaging time point as after the treatment of the subject, the display control function 255d determines the type of information to be displayed by the calculation function 155b before the treatment. The WSS calculated based on the coronary CT image (pre-treatment WSS) and the WSS calculated based on the post-treatment coronary CT image are determined. At this time, for example, the display control function 255d may determine the WSS based on the coronary artery CT image after the treatment as the WSS at a plurality of time points after the treatment. For example, the display control function 255d sets the type of information to be displayed to WSS calculated based on the coronary CT image one week after the treatment and WSS calculated based on the coronary CT image one month after the treatment. decide.

Further, for example, the display control function 255d sets the type of information to be displayed when it is identified that the time of imaging is after the loading of the subject, the WSS calculated based on the coronary CT image before loading, and the loading. It may be determined to be a WSS calculated based on a later coronary CT image.

Further, for example, the display control function 255d may display WSS periodically calculated after the treatment in order to determine the effect of the treatment after the treatment, or may display the WSS before and after the treatment. May be calculated and an image to which the calculated difference is assigned may be displayed.

Although an example of displaying WSS has been described with reference to FIG. 18, for example, the display control function 255d displays FFR at a plurality of time points or both FFR and WSS at a plurality of time points by the same method. May be good.

(Third embodiment)
In the first embodiment described above, an example of displaying FFR or WSS according to the degree of coronary artery disease has been described, but the embodiment is not limited to this.

For example, the position of the plaque generated in each branch of the coronary artery and the probability of failure may be calculated for each branch of the coronary artery, and FFR or WSS may be displayed according to the probability of failure. Hereinafter, such an example will be described as a third embodiment. In the following, the configurations of the medical image processing system and the medical image processing apparatus according to the third embodiment will be described focusing on the differences from the first embodiment, and the same reference numerals will be given to the common configurations. As a matter of fact, a detailed description will be omitted.

FIG. 19 is a diagram showing a configuration example of a medical image processing system and a medical image processing apparatus according to a third embodiment.

For example, as shown in FIG. 19, the medical image processing system 300 according to the present embodiment includes an X-ray CT device 110, a medical image storage device 120, an electronic medical record system 130, a medical information display device 140, and a medical image. Includes processing device 350. Here, each device and system are communicably connected via the network 160.

The medical image processing apparatus 350 performs various image processing related to the subject. Specifically, the medical image processing device 350 acquires a CT image from the X-ray CT device 110 or the medical image storage device 120 via the network 160, acquires medical data from the electronic chart system 130, and obtains the CT image and the medical image. Various image processing is performed using medical data. For example, the medical image processing device 350 is realized by a computer device such as a server or a workstation.

For example, the medical image processing apparatus 350 includes a NW interface 151, a storage circuit 152, an input interface 153, a display 154, and a processing circuit 355.

In the present embodiment, the medical image processing apparatus 350 processing circuit 355 has an acquisition function 155a, a calculation function 155b, a derivation function 355g, and a display control function 355d. Here, the derivation function 355g is an example of the derivation unit. Further, the display control function 355c is an example of the display control unit.

The derivation function 355g derives the position and the probability of collapse of the plaque generated in each vascular branch of the coronary artery for each vascular branch of the coronary artery based on the coronary CT image of the subject acquired by the acquisition function 155a.

For example, the derivation function 355 g derives the position of the plaque and the probability of failure for each vascular branch of the coronary artery by analyzing the CT image of the coronary artery of the subject. For example, the derivation function 355 g derives the position of the plaque and the probability of failure from the information on the blood vessel diameter of the coronary artery. For example, the derivation function 355g derives the plaque position and the failure probability by the threshold processing using the coronary CT image. Alternatively, for example, the derivation function 355g may derive the position and the failure probability of the plaque by using a discriminator in which the characteristics of the distribution of the pixel values inside the plaque are learned in advance by the technique of machine learning.

The display control function 355d displays the FFR or WSS calculated by the calculation function 355b on the display 154 for each vascular branch of the coronary artery according to the position of the plaque derived by the derivation function 355g and the failure probability.

Specifically, the display control function 355d displays the FFR for the blood vessel branch in which the plaque with a high probability of failure derived by the derivation function 355g is present. Further, the display control function 355d displays the WSS for the vascular branch in which the plaque does not exist or the plaque having a low probability of failure exists.

FIG. 20 is a diagram showing an example of information display performed by the display control function 355d according to the third embodiment.

For example, as shown in FIG. 20, the display control function 355d determines the type of information corresponding to each vascular limb to be displayed on the display 154 based on the position and failure probability of the plaque derived by the derivation function 355g. For example, the display control function 355d determines the type of information to be displayed in FFR for the vascular limb (range indicated by the solid arrow in FIG. 20) having a high probability of plaque failure. Further, the display control function 355d determines the type of information to be displayed in WSS for the vascular limb in which no plaque is present or the probability of failure is low (the range indicated by the broken line arrow in FIG. 20).

Then, the display control function 355d displays the determined type of information on the display 154. For example, the display control function 355d displays the determined type of information as in the first embodiment and its modifications. However, in this modification, the display control function 355d displays an image in which FFR and WSS are mixed. At this time, for example, the display control function 355d may display the FFR and the WSS in different display forms as in the modification 3 of the first embodiment.

Further, for example, the display control function 355d may simultaneously display the position and the failure probability of the plaque derived by the derivation function 355g. Further, for example, the display control function 355d may calculate the controlled area of each coronary artery by a known method and simultaneously display the calculated controlled area of each coronary artery. In this way, by displaying the controlled area of each coronary artery at the same time, the controlled area recovered by the treatment can be specified, and the plaque to be treated can be specified more accurately. Further, for example, the display control function 355d may specify an inflamed region from the distribution of pixel values in the myocardial region around the coronary artery and simultaneously display the region. Here, for example, when the position of inflammation is known by another medical image such as a myocardial SPECT image, the display control function 355d acquires the other medical image, and the medical image and the coronary CT image are used. By aligning the image, the area where the inflammation is occurring may be identified.

FIG. 21 is a flowchart showing a processing procedure of processing performed by each processing function of the processing circuit 355 of the medical image processing apparatus 350 according to the third embodiment.

For example, as shown in FIG. 21, in the present embodiment, when the acquisition function 155a receives an instruction to start processing from the user via the input interface 153 (steps S301, Yes), the X-ray CT apparatus 110 Alternatively, a CT image of the coronary artery of the subject is acquired from the medical image storage device 120 (step S302). This processing is realized, for example, by the processing circuit 355 calling the program corresponding to the acquisition function 155a from the storage circuit 152 and executing it.

Subsequently, the calculation function 155b calculates FFR and WSS as information regarding blood flow in the coronary artery based on the coronary CT image of the subject acquired by the acquisition function 155a (step S303). This processing is realized, for example, by the processing circuit 355 calling the program corresponding to the calculation function 155b from the storage circuit 152 and executing it.

Subsequently, the derivation function 355 g derives the position and the probability of failure of the plaque generated in each vascular branch of the coronary artery for each vascular branch of the coronary artery based on the coronary CT image of the subject acquired by the acquisition function 155a (step S304). ). This processing is realized, for example, by the processing circuit 355 calling a program corresponding to the derivation function 355g from the storage circuit 152 and executing it.

Subsequently, the display control function 355d displays the FFR calculated by the calculation function 355b for the blood vessel branch in which the plaque with a high probability of failure derived by the derivation function 355g is present (step S305), and the plaque does not exist or is broken. The WSS calculated by the calculation function 355b is displayed for the blood vessel branch in which the plaque having a low probability is present (step S306). This processing is realized, for example, by the processing circuit 355 calling a program corresponding to the display control function 355d from the storage circuit 152 and executing the program.

As described above, in the third embodiment, the medical image processing apparatus 350 displays FFR and WSS for each vascular branch of the coronary artery according to the position of the plaque generated in each vascular branch and the probability of failure. This makes it possible to automatically display WSS and FFR for each vascular branch of the coronary artery when diagnosing a heart disease or formulating a treatment plan. Therefore, according to the third embodiment, it is possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

(Modification 1 of the third embodiment)
In the third embodiment described above, an example of displaying FFR or WSS for each vascular branch of the coronary artery has been described, but the embodiment is not limited to this.

For example, as a modification 1 of the third embodiment, the medical image processing apparatus 350 may display a representative value of FFR or a representative value of WSS for each vascular branch of the coronary artery.

Specifically, the display control function 355d displays the first representative value of FFR or WSS in the blood vessel branch in which the plaque having a high probability of failure derived by the derivation function 355g is present. Further, the display control function 355d displays a second representative value different from the first representative value of FFR or WSS in the blood vessel branch for the blood vessel branch in which the plaque does not exist and the blood vessel branch in which the plaque having a low probability of failure exists. do.

FIG. 22 is a diagram showing an example of information display performed by the display control function 355d according to the first modification of the third embodiment.

For example, as shown in FIG. 22, the display control function 355d sets a representative value of WSS (maximum WSS, minimum WSS, etc.) for each blood vessel branch according to the position of the plaque derived by the derivation function 355g and the failure probability. Display at the position corresponding to each blood vessel. For example, it has been reported that low WSS correlates with the risk of plaque progression and high WSS correlates with the risk of plaque failure. Therefore, for example, the display control function 355d displays the highest WSS in the blood vessel branch at the position corresponding to the blood vessel branch for the blood vessel branch in which the plaque having a high probability of failure exists. Further, the display control function 355d displays the lowest WSS in the blood vessel branch at the position corresponding to the blood vessel branch for the blood vessel branch in which the plaque does not exist and the blood vessel branch in which the plaque having a low probability of failure exists.

Note that FIG. 22 has described an example in which the representative value of WSS is displayed. For example, the display control function 355d displays the representative value of FFR or the representative value of both FFR and WSS by the same method. It may be displayed.

(Modification 2 of the third embodiment)
Further, in the third embodiment described above, an example of displaying information (FFR, WSS, etc.) calculated from the coronary artery CT has been described, but the embodiment is not limited to this.

For example, as a second modification of the third embodiment, the medical image processing device 350 may display a medical image captured by another medical image diagnostic device or information obtained from the medical image.

Specifically, the display control function 355d is obtained from a medical image taken by a first medical image diagnostic apparatus or a medical image of a blood vessel branch in which a plaque having a high probability of failure derived by the derivation function 355 g is present. Display the information you received. Further, the display control function 355d is a medical image of a blood vessel branch in which no plaque is present and a blood vessel branch in which a plaque having a low failure probability is present, captured by a second medical image diagnostic device different from the first medical image diagnosis device. Alternatively, the information obtained from the medical image is displayed.

For example, the display control function 355d has a HIP (Hiper Intencity Praque) image taken by an MRI device or an intravascular ultrasound (IntraVascular UltraSound) taken by an ultrasonic diagnostic device for a blood vessel branch in which a plaque having a high probability of failure exists. : IVUS) images, intravascular OCT (Optical Coherence Tomography) images, etc. are displayed.

FIG. 23 is a diagram showing an example of information display performed by the display control function 355d according to the second modification of the third embodiment.

For example, as shown in FIG. 23, when the display control function 355d displays an IVUS image or an intravascular OCT image, the WSS corresponding to each position of the blood vessel is around the blood vessel in the IVUS image or the intravascular OCT image. Or FFR may be superimposed and displayed.

(Fourth Embodiment)
In the first embodiment described above, an example of displaying FFR or WSS according to the degree of heart-related disease has been described, but the embodiment is not limited to this.

For example, an FFR or WSS calculated based on a medical image of a specific cardiac phase may be displayed depending on the degree of the disease related to the heart. Hereinafter, such an example will be described as a fourth embodiment. In the following, the configurations of the medical image processing system and the medical image processing apparatus according to the fourth embodiment will be described focusing on the differences from the first embodiment, and the same reference numerals will be given to the common configurations. As a matter of fact, a detailed description will be omitted.

FIG. 24 is a diagram showing a configuration example of the medical image processing system and the medical image processing apparatus according to the fourth embodiment.

For example, as shown in FIG. 24, the medical image processing system 400 according to the present embodiment includes an X-ray CT device 110, a medical image storage device 120, an electronic medical record system 130, a medical information display device 140, and a medical image. Includes processing device 450. Here, each device and system are communicably connected via the network 160.

The medical image processing apparatus 450 performs various image processing related to the subject. Specifically, the medical image processing device 450 acquires a CT image from the X-ray CT device 110 or the medical image storage device 120 via the network 160, acquires medical data from the electronic chart system 130, and obtains the CT image and the medical image. Various image processing is performed using medical data. For example, the medical image processing device 450 is realized by a computer device such as a server or a workstation.

For example, the medical image processing apparatus 450 includes a NW interface 151, a storage circuit 152, an input interface 153, a display 154, and a processing circuit 455.

In the present embodiment, the medical image processing apparatus 450 processing circuit 455 has an acquisition function 155a, an extraction function 455c, a calculation function 455b, and a display control function 455d. Here, the extraction function 455c is an example of the extraction unit. Further, the display control function 455d is an example of the display control unit.

The extraction function 455c extracts the degree of heart-related disease from the coronary artery CT image of the subject acquired by the acquisition function 155a.

For example, the extraction function 455c extracts the degree of myocardial bridge from the coronary CT image of the subject acquired by the acquisition function 155a as the degree of heart-related disease.

Specifically, the extraction function 455c extracts the degree of disease indicating the degree of myocardial bridge by analyzing the coronary CT image of the subject. Further, for example, the extraction function 455c extracts the existence probability of myocardial bridge as a disease degree indicating the degree of myocardial bridge. At this time, for example, the extraction function 455c may extract the existence probability based on the distribution of CT values in each myocardial region, or the feature of the image in which the myocardial bridge is present and the image in which the myocardial bridge is not present by the machine learning technique. The existence probability may be extracted using a discriminator trained in advance.

In the present embodiment, the degree of disease indicating the degree of myocardial bridge extracted by the extraction function 455c is not limited to the existence probability, and may be obtained by the user in order to control the display of FFR and WSS, which will be described later. Any value may be used. For example, the extraction function 455c may directly assign a value as the degree of disease from the result of a diagnosis separately performed on the subject by a user such as a doctor, or may be a Perfusion Index obtained from a coronary artery CT image. A value indicating the severity of the myocardial bridge may be extracted from the disease degree.

The calculation function 455b reconstructs and reconstructs a coronary artery CT image of a specific cardiac phase from the coronary artery CT image of the subject acquired by the acquisition function 155a according to the degree of the disease extracted by the extraction function 455c. FFR and WSS are calculated based on.

Specifically, the calculation function 455b reconstructs a coronary CT image at the end of diastole when the degree of disease indicating the degree of myocardial bridge extracted by the extraction function 455c is high, and is based on the reconstructed coronary CT image. , FFR and WSS are calculated. In addition, the calculation function 455b reconstructs the end-diastolic coronary artery CT image and the end-systolic coronary artery CT image when the degree of disease indicating the degree of myocardial bridge extracted by the extraction function 455c is low, and each coronary artery CT image. At least one of FFR and WSS is calculated based on.

For example, the calculation function 455b reconstructs a coronary artery CT image of a specific cardiac phase according to the existence probability of the myocardial bridge calculated by the extraction function 455c, and calculates FFR and WSS based on the coronary artery CT image. .. At this time, for example, the calculation function 455b reconstructs the coronary artery CT image at the time of the terminal diastole when the existence probability of the myocardial bridge is higher than the preset threshold value, and based on the coronary artery CT image, FFR and WSS. Is calculated. Further, the calculation function 455b reconstructs the coronary artery CT image at the time of end diastole and the coronary artery CT image at the time of end contraction when the probability of existence of the myocardial bridge is lower than the threshold value, and based on each image, Calculate FFR and WSS.

This is usually calculated from images at the end of systole of FFR and WSS, but in the state of myocardial bridge (the coronary artery is buried in the myocardium), it is outside the coronary artery with respect to the coronary artery at the end of systole. This is because FFR and WSS may not be calculated based on the influence of blood flow because the pressure is strongly applied from the myocardium.

The display control function 455d displays at least one of the FFR and the WSS calculated based on the coronary CT image of the specific cardiac phase reconstructed according to the degree of the disease by the calculation function 455b on the display 154.

Specifically, the display control function 455d displays at least one of FFR and WSS calculated based on the end-diastolic coronary artery CT image by the calculation function 455b when the degree of disease indicating the degree of myocardial bridge is high. When the degree of disease indicating the degree of myocardial bridge is low, at least one of FFR and WSS calculated based on the end-diastolic coronary artery CT image and the end-systolic coronary artery CT image by the calculation function 455b is displayed.

FIG. 25 is a diagram showing an example of information display performed by the display control function 455d according to the fourth embodiment.

For example, as shown in FIG. 25, the display control function 455d determines the type of information to be displayed on the display 154 based on the existence probability of the myocardial bridge extracted by the extraction function 455c. At this time, for example, the display control function 455d calculates the type of image to be displayed when the existence probability of the myocardial bridge is higher than the preset threshold value from the coronary artery CT image at the time of the terminal diastole by the calculation function 455b. Decide on WSS. Further, the display control function 455d determines the type of image to be displayed when the probability of existence of the myocardial bridge is lower than the threshold value, such as WSS calculated from the coronary artery CT image at the time of the end diastole by the calculation function 455b and the end contraction stage. It is determined to be the WSS calculated from the coronary CT image at the time point. For example, the calculation function 455b may determine the type of the image to be displayed in FFR or both FFR and WSS.

Then, the display control function 455d displays the determined type of information on the display 154. For example, the display control function 455d displays the determined type of information as in the first embodiment and its modifications. At this time, for example, when the display control function 455d displays both the WSS calculated from the coronary artery CT image at the time of the end of diastole and the WSS calculated from the coronary artery CT image at the time of the end of contraction, those The information may be displayed side by side, or after aligning them, the difference between the FFR and WSS at each time point may be calculated, and the image of the difference between the FFR and WSS may be displayed.

FIG. 26 is a flowchart showing a processing procedure of processing performed by each processing function included in the processing circuit 455 of the medical image processing apparatus 450 according to the fourth embodiment.

For example, as shown in FIG. 26, in the present embodiment, when the acquisition function 155a receives an instruction to start processing from the user via the input interface 153 (steps S401, Yes), the X-ray CT apparatus 110 Alternatively, a CT image of the coronary artery of the subject is acquired from the medical image storage device 120 (step S402). This processing is realized, for example, by the processing circuit 455 calling the program corresponding to the acquisition function 155a from the storage circuit 152 and executing it.

Subsequently, the extraction function 455c extracts the degree of disease indicating the degree of myocardial bridge from the coronary CT image of the subject acquired by the acquisition function 155a (step S403). This processing is realized, for example, by the processing circuit 455 calling the program corresponding to the extraction function 455c from the storage circuit 152 and executing it.

Subsequently, when the calculation function 455b has a high degree of disease indicating the degree of myocardial bridge extracted by the extraction function 455c (step S404, Yes), the coronary CT image at the end of diastole is reconstructed and reconstructed coronary CT. At least one of FFR and WSS is calculated based on the image (step S405). Further, the calculation function 455b reconstructs the end-diastolic coronary artery CT image and the end-systolic coronary artery CT image when the degree of disease indicating the degree of myocardial bridge extracted by the extraction function 455c is low (step S404, No). , At least one of FFR and WSS is calculated based on each coronary CT image (step S406). This processing is realized, for example, by the processing circuit 455 calling the program corresponding to the calculation function 455b from the storage circuit 152 and executing it.

Subsequently, when the display control function 455d has a disease degree higher than the threshold value indicating the degree of myocardial bridge (step S404, Yes), the FFR and WSS calculated by the calculation function 455b based on the end-diastolic coronary artery CT image. At least one is displayed (step S407). Further, the display control function 455d is based on the end-diastolic coronary artery CT image and the end-systolic coronary artery CT image by the calculation function 455b when the disease degree indicating the degree of myocardial bridge is lower than the threshold value (step S404, No). At least one of the calculated FFR and WSS is displayed (step S408). This processing is realized, for example, by the processing circuit 455 calling a program corresponding to the display control function 455d from the storage circuit 152 and executing the program.

As described above, in the fourth embodiment, the medical image processing apparatus 450 displays an FFR or WSS calculated based on a medical image of a specific cardiac phase, depending on the degree of heart-related disease. As a result, when diagnosing a heart disease or formulating a treatment plan, information on the heart phase suitable for each disease can be automatically displayed. Therefore, according to the fourth embodiment, it is possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

(Modification 1 of the fourth embodiment)
In the fourth embodiment described above, an example of determining the cardiac phase of a coronary CT image displaying FFR or WSS according to the degree of myocardial bridge has been described, but the embodiment is not limited to this. ..

For example, as a modification 1 of the fourth embodiment, the medical image processing apparatus 150 may display FFR or WSS according to the degree of valvular disease of each valve included in the heart valve.

For example, the extraction function 455c extracts the degree of valvular disease of each valve included in the heart valve from the coronary artery CT image of the subject acquired by the acquisition function 155a as the degree of the disease related to the heart.

Specifically, the extraction function 455c analyzes the coronary CT image of the subject to extract the degree of disease indicating the degree of valvular disease of each valve. Further, for example, the extraction function 455c extracts the existence probability of valvular disease as a disease degree indicating the degree of valvular disease. At this time, for example, the extraction function 455c may extract the existence probability based on the distribution of CT values in each valve, and the machine learning technique is used to characterize the image in which valvular disease is present and the image in which valvular disease is not present. The existence probability may be extracted using a discriminator trained in advance.

In this modification, the degree of disease indicating the degree of valvular disease extracted by the extraction function 455c is not limited to the existence probability, and may be obtained by the user in order to control the display of FFR and WSS, which will be described later. Any value may be used. For example, the extraction function 455c may directly assign a value as the degree of disease from the result of a diagnosis separately performed on the subject by a user such as a doctor, or may be a Perfusion Index obtained from a coronary artery CT image. A value indicating the seriousness of valvular disease may be extracted from the disease degree.

Further, the calculation function 455b reconstructs a coronary CT image at the end of systole when the degree of disease indicating the degree of valvular disease of the aortic valve extracted by the extraction function 455c is high, and is based on the reconstructed coronary CT image. , FFR and WSS are calculated. Further, the calculation function 455b reconstructs a coronary CT image at the end of diastole when the degree of disease indicating the degree of valvular disease of the mitral valve extracted by the extraction function 455c is high, and is based on the reconstructed coronary CT image. Then, at least one of FFR and WSS is calculated.

For example, the calculation function 455b reconstructs a coronary CT image of a specific cardiac phase according to the existence probability of valvular disease of each valve extracted by the extraction function 455c, and based on the coronary CT image, FFR and WSS. Is calculated. At this time, for example, the calculation function 455b reconstructs the coronary artery CT image at the time of the end of systole when the existence probability of valvular disease of the aortic valve is higher than a preset threshold value, and based on the coronary artery CT image, the calculation function 455b is used. Calculate FFR and WSS. Further, the calculation function 455b reconstructs the coronary artery CT image at the time of the terminal diastole when the existence probability of valvular disease of the mitral valve is lower than the threshold value, and calculates FFR and WSS based on the coronary artery CT image. do. This is to facilitate the evaluation of the effects of FFR and WSS on the opening and closing of various valves.

Then, the display control function 455d displays at least one of FFR and WSS calculated based on the coronary CT image at the end of systole by the calculation function 455b when the degree of disease indicating the degree of valvular disease of the aortic valve is high. Further, the display control function 455d displays at least one of FFR and WSS calculated based on the coronary CT image at the end of diastole by the calculation function 455b when the degree of disease indicating the degree of valvular disease of the mitral valve is low. ..

FIG. 27 is a diagram showing an example of information display performed by the display control function 455d according to the first modification of the fourth embodiment.

For example, as shown in FIG. 27, the display control function 455d determines the type of information to be displayed on the display 154 based on the existence probability of valvular disease of each valve extracted by the extraction function 455c. At this time, for example, the display control function 455d uses the calculation function 455b to calculate the type of image to be displayed when the probability of existence of valvular disease of the aortic valve is higher than a preset threshold value (aortic valve abnormality) at the time of the end of systole. The WSS calculated from the coronary CT image in. Further, the display control function 455d determines the type of image to be displayed when the existence probability of valvular disease of the mitral valve is higher than a preset threshold value (mitral valve abnormality) by the calculation function 455b at the time of the end stage of expansion. The WSS calculated from the coronary CT image is determined. For example, the calculation function 455b may determine the type of the image to be displayed in FFR or both FFR and WSS.

Then, the display control function 455d displays the determined type of information on the display 154. For example, the display control function 455d displays the determined type of information as in the first embodiment and its modifications.

In the fourth embodiment and modification described above, an example in which the FFR or WSS display is determined according to the degree of myocardial bridge and the degree of valvular disease of each valve included in the heart valve has been described. However, the embodiment is not limited to this. For example, if it is possible to determine the cardiac phase to be reconstructed based on the information obtained in advance (before the calculation of FFR and WSS) such as the original image and the patient information, any state can be used. A determination regarding the display of FFR or WSS may be made.

(Fifth Embodiment)
Further, for example, in the first embodiment described above, an example in which WSS is displayed using an image showing a coronary artery has been described, but the embodiment is not limited to this.

For example, the medical image processing apparatus 150 may display the relationship between the distance along the coronary artery from the reference position at the predetermined position on the coronary artery and the magnitude of the WSS at the predetermined position. A graph may be used as the display form. Hereinafter, such an example will be described as a fifth embodiment. In the following, the configurations of the medical image processing system and the medical image processing apparatus according to the fifth embodiment will be described focusing on the differences from the first embodiment, and the same reference numerals will be given to the common configurations. As a matter of fact, a detailed description will be omitted.

In the present embodiment, for example, in the display control function 155d, when the degree of coronary artery disease extracted by the extraction function 155c is low, the vertical axis is the size of WSS and the horizontal axis is the distance along the coronary artery from the reference position. The graph is displayed on the display 154. Further, information indicating the range of the distance in which the third index value relating to the blood vessel is an abnormal value is displayed on the display 154 together with the graph.

Here, for example, the third index value is an index value indicating a lesion portion formed in a coronary artery. For example, the third index value is the CT value of the coronary artery wall, and the case where the index value shows the CT value in the range indicating plaque or the CT value in the range indicating calcium is determined as an abnormal value.

FIG. 28 is a diagram showing an example of information display performed by the display control function 155d according to the fifth embodiment.

For example, as shown in FIG. 28, in the display control function 155d, based on the WSS calculated by the calculation function 155b, the vertical axis is the size of the WSS and the horizontal axis is the distance along the coronary artery from the reference position. Display a graph showing the relationship between the size of and the distance.

Further, the display control function 155d displays information indicating the range of the distance in which the third index value is an abnormal value, superimposed on the position on the graph indicating the distance.

For example, as shown in FIG. 28, the display control function 155d is based on the coronary CT image of the subject acquired by the acquisition function 155a, and the coronary artery from the reference position at the position on the coronary artery having the CT value indicating the plaque. The information indicating the distance along the coronary artery and the information indicating the distance along the coronary artery from the reference position at the position on the coronary artery having the CT value indicating calcium are displayed superimposed on the position on the graph indicating the distance.

For example, the display control function 155d has information indicating the distance along the coronary artery from the reference position at the position on the coronary artery having the CT value indicating plaque, and the information indicating the distance along the coronary artery from the reference position at the position on the coronary artery having the CT value indicating calcium. Information indicating the distance along the coronary artery is displayed in different display modes. For example, the display control function 155d displays a region indicating each range with a different color, pattern, or texture.

Here, an example of displaying information indicating a range in which the third index value is an abnormal value is superimposed on the graph has been described, but the embodiment is not limited to this. For example, the display control function 155d displays information indicating a range in which the third index value is an abnormal value side by side above or below the graph corresponding to the position of the distance along the coronary artery from the reference position. You may.

Further, here, an example in which the third index value is an index value indicating a lesion portion generated in a coronary artery has been described, but the embodiment is not limited to this.

For example, the third index value may be an index value calculated from a change in blood pressure, blood flow, shape, or position of the coronary artery. For example, the third index value may be the value of a fluid parameter such as FFR, pressure, and flow velocity. Further, for example, the third index value may be the value of a shape parameter such as the curvature of the blood vessel, the stenosis rate, the outer diameter, the inner diameter, and the cross-sectional area. Further, for example, the third index value may be the amount of movement of blood vessels accompanying the movement of the heart.

Further, for example, the third index value may be an index value predicted by performing a virtual operation or treatment on the coronary artery using a coronary artery CT image. For example, the third index value may be a value such as a fluid parameter or a shape parameter after surgery or after treatment predicted by performing a virtual surgical simulation or treatment simulation using a coronary artery CT image. ..

In this case, for example, the display control function 155d receives from the operator the position where the therapeutic device such as a stent or the balloon is arranged with respect to the coronary artery by using the coronary CT image, so that the position where the therapeutic device is arranged is arranged. The information indicating the above is displayed superimposed on the graph showing the relationship between the distance along the coronary artery from the reference position at the predetermined position on the coronary artery and the size of the WSS at the predetermined position. Then, the display control function 155d further provides information indicating a range in which the values such as the fluid parameter and the shape parameter after the arrangement of the therapeutic device calculated by performing the surgical simulation or the treatment simulation are abnormal values. It is displayed overlaid on the graph.

(Variation example of the fifth embodiment)
In the fifth embodiment described above, an example of displaying a graph showing the relationship between the distance along the coronary artery from the reference position at a predetermined position on the coronary artery at one time point and the size of WSS at the predetermined position. However, the embodiment is not limited to this.

For example, in the display control function 155d, when the degree of coronary artery disease extracted by the extraction function 155c is low, the vertical axis is the size of WSS and the horizontal axis is along the coronary artery from the reference position at each of a plurality of different time points. As the distance, a graph showing the relationship between the size of WSS and the distance may be created and displayed on the display 154 at each time point.

FIG. 29 is a diagram showing an example of information display performed by the display control function 155d according to the modified example of the fifth embodiment.

For example, as shown in FIG. 29, the display control function 155d has the vertical axis as the size of WSS and the horizontal axis as the reference position based on the WSS calculated from the coronary artery CT images of multiple time phases by the calculation function 155b. As the distance along the coronary artery, a graph showing the relationship between the size of WSS and the distance as a curve is created for each of a plurality of different cardiac phases included in one heartbeat, and the graphs are superimposed and displayed.

Further, for example, the display control function 155d further displays information indicating a range in which the temporal fluctuation amount of WSS exceeds the threshold value at a distance along the coronary artery from the reference position together with a graph. For example, the display control function 155d displays information indicating the range in which the temporal fluctuation amount of WSS exceeds the threshold value in the distance along the coronary artery from the reference position, superimposed on the graph together with the position indicating the distance. do.

For example, the display control function 155d displays a region indicating the range as information indicating a range in which the temporal fluctuation amount of WSS exceeds a threshold value in a predetermined display mode. For example, the display control function 155d displays a region indicating the range with a predetermined color, pattern, or texture.

Here, for example, the display control function 155d indicates the range of the distance along the coronary artery from the reference position where the third index value regarding the blood vessel is an abnormal value, as in the fifth embodiment described above. Further information may be displayed with the graph.

Here, an example of displaying information indicating a change in WSS for each of a plurality of different cardiac phases included in one heartbeat as a plurality of different time points has been described, but the embodiment is not limited to this. For example, a plurality of different time points may be before or after surgery or treatment (eg, drug treatment, etc.), or at predetermined time intervals (eg, fixed intervals such as one month). May be.

Further, in the fifth embodiment and modification described above, an example of displaying information indicating a change in WSS with respect to one blood vessel has been described, but the embodiment is not limited to this. For example, information indicating changes in WSS may be displayed for a plurality of blood vessels. Here, for example, the plurality of blood vessels may be a plurality of blood vessel branches contained in the coronary arteries.

In this case, for example, the display control function 155d displays information such as WSS and a third index value for each of a plurality of blood vessels by the display method described in the fifth embodiment or the modification described above. At this time, for example, the display control function 155d displays information indicating changes in WSS with respect to a plurality of blood vessels side by side in a plurality of graphs or superimposed in one graph.

Further, in the fifth embodiment and modification described above, for example, the display control function 155d may further display a cross-sectional image of the coronary artery corresponding to the position of the distance along the coronary artery from the reference position. Here, for example, the cross-sectional image may be a curved MPR image of a coronary artery.

(Sixth Embodiment)
Further, the above-described embodiments and modifications may be carried out individually, or one or a plurality of embodiments and modifications may be appropriately combined and carried out.

For example, after displaying FFR or WSS by any of the methods described in the above-described embodiment and modification, when a predetermined condition is satisfied, automatically or in response to an instruction from the user. Then, FFR and WSS may be displayed by another method.

As a specific example, for example, in the first embodiment, the display control function 155d displays FFR when the degree of disease indicating the degree of coronary artery disease is higher than the first threshold value, and the modified examples 1 to 6 An instruction to display FFR or WSS may be received from the user by any of the above methods. Then, the display control function 155d may further display FFR and WSS by the method instructed by the user.

Further, for example, in the second embodiment, the display control function 255d displays the predicted FFR and the predicted WSS when the coronary artery CT image is taken before the treatment of the subject, and the modified examples 1 to 4 are displayed. An instruction to display FFR or WSS may be received from the user by either method. Then, the display control function 255d may further display FFR and WSS by the method instructed by the user.

Further, for example, in the third embodiment, the display control function 355d displays FFR and WSS for each blood vessel branch of the coronary artery, and displays FFR and WSS for each blood vessel branch by any method of Modifications 1 and 2. You may accept the instruction to display from the user. Then, the display control function 355d may further display FFR and WSS by the method instructed by the user.

Further, for example, in the fourth embodiment, the display control function 455d displays FFR or WSS calculated based on the coronary CT image at the end of diastole when the disease degree indicating the degree of myocardial bridge is higher than the threshold value. However, an instruction to display the FFR or WSS by the method of the modification 1 may be received from the user. Then, the display control function 455d may further display FFR and WSS according to the degree of disease indicating the degree of valvular disease of each valve when the instruction is received from the user.

Further, for example, the display control function displays FFR or WSS by any of the methods of the first to fifth embodiments, and the FFR or WSS is displayed by any of the other embodiments or modifications. The user may accept an instruction to display the WSS. In this case as well, the display control function may further display the FFR or WSS by the method instructed by the user.

In any of the above-mentioned examples, the display control function automatically performs in advance when the predetermined predetermined conditions are satisfied while the FFR or WSS is displayed by any method. The FFR and WSS may be further displayed by other predetermined methods.

(7th Embodiment)
Further, in the above-described embodiment and modification, an example in which the medical image processing apparatus displays the FFR and WSS on the display provided in the own apparatus has been described, but the embodiment is not limited to this.

For example, the medical information display device may acquire and display the FFR and WSS from the medical image processing device via the network.

Specifically, in the present embodiment, the medical image processing device extracts the degree of coronary artery disease from the medical image in response to a request transmitted from the medical information display device, and relates to blood flow based on the medical image. As information, if the degree of coronary artery disease is high, FFR is calculated, and if the degree of coronary artery disease is low, WSS is calculated. Then, the medical information display device acquires information on blood flow from the medical image processing device and displays it on the display provided in the own device.

In this case, for example, the medical image processing device and the medical information display device may be realized as a client server system using the medical image processing device as a server and the medical information processing device as a client.

(Other embodiments)
In the above-described embodiments and modifications, an example in which a coronary artery CT image is used as a medical image has been described, but the embodiment is not limited to this. For example, any kind of medical image may be used as long as it is an image of a kind that can calculate flow information such as the shape of a blood vessel and the flow velocity of blood. For example, an ultrasonic image obtained by an ultrasonic diagnostic image, an MR image obtained by an MRI apparatus, or the like may be used. Further, the target site may be not only a blood vessel of the heart but also a blood vessel of another site such as a cerebral blood vessel, a hepatic artery, or a portal vein.

Further, in the above-described embodiments and modifications, an example in which FFR is used as the first index value displayed by switching to or simultaneously with WSS has been described, but the embodiment is not limited to this. For example, any index value may be used as long as it is an index value relating to a blood vessel calculated from blood pressure or blood flow.

According to the above-described embodiment and modification, for example, WSS and information on various blood flows can be displayed at an appropriate time point or in an appropriate display form, so that the user's labor can be reduced. Further, for example, since the information to be displayed can be automatically changed according to the characteristics of the coronary artery CT image which is the analysis source image, the user can obtain the necessary information at the necessary timing. Further, for example, since the WSS calculated from the coronary CT image can be displayed together with different information about the coronary artery, it is possible to more appropriately support the diagnosis by the doctor, the formulation of the treatment plan, the judgment of the treatment effect, and the like. ..

In the above-described embodiments and modifications, the extraction unit, the display control unit, the identification unit, the prediction unit, and the derivation unit in the present specification are divided into the extraction function, the display control function, the identification function, the prediction function, and the derivation unit of the processing circuit, respectively. Although an example of the case where it is realized by the derivation function has been described, the embodiment is not limited to this. For example, the extraction unit, the display control unit, the identification unit, the prediction unit, and the derivation unit in the present specification are realized by the extraction function, the display control function, the identification function, the prediction function, and the derivation function described in the embodiment. The same function may be realized by hardware only, software only, or a mixture of hardware and software.

Further, the term "processor" used in the description of the above-described embodiment means, for example, a CPU (Central Processing Unit), a GPU (Graphics Processing Unit), or an integrated circuit for a specific application (Application Specific Integrated Circuit: ASIC). Circuits such as programmable logic devices (eg, 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 configured to be directly embedded in the circuit of the processor. In this case, the processor realizes the function by reading and executing the program embedded in the circuit. Further, each processor of the present embodiment is not limited to the case where each processor is configured as a single circuit, and a plurality of independent circuits may be combined to be configured as one processor to realize its function. good.

Here, the program executed by the processor is provided by being incorporated in a ROM (Read Only Memory), a storage circuit, or the like in advance. This program is a file in a format that can be installed or executed on these devices, such as CD (Compact Disk) -ROM, FD (Flexible Disk), CD-R (Recordable), DVD (Digital Versatile Disk), etc. It may be recorded and provided on a non-transient storage medium that can be read by a computer. Further, this program may be stored on a computer connected to a network such as the Internet, and may be provided or distributed by being downloaded via the network. For example, this program is composed of modules including each of the above-mentioned processing functions. As actual hardware, the CPU reads a program from a storage medium such as a ROM and executes the program, so that each module is loaded on the main storage device and generated on the main storage device.

Further, in the above-described embodiments and modifications, each component of each of the illustrated devices is functionally conceptual, and does not necessarily have to be physically configured as shown in the figure. That is, the specific form of distribution or integration of each device is not limited to the one shown in the figure, and all or part of them may be functionally or physically dispersed or physically distributed in arbitrary units according to various loads and usage conditions. Can be integrated and configured. Further, each processing function performed by each device may be realized by a CPU and a program analyzed and executed by the CPU, or may be realized as hardware by wired logic.

Further, among the processes described in the above-described embodiments and modifications, all or part of the processes described as being automatically performed can be manually performed, or can be performed manually. It is also possible to automatically perform all or part of the described processing by a known method. In addition, the processing procedure, control procedure, specific name, and information including various data and parameters shown in the above document and drawings can be arbitrarily changed unless otherwise specified.

According to at least one embodiment described above, it is possible to reduce the time and effort of the user when diagnosing a heart disease and formulating a treatment plan.

Although some embodiments have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other embodiments, and various omissions, replacements, and changes can be made without departing from the gist of the invention. These embodiments and variations thereof are included in the scope of the invention described in the claims and the equivalent scope thereof, as are included in the scope and gist of the invention.

Regarding the above embodiments, the following appendices are disclosed as one aspect and selective features of the invention.

(Appendix 1)
An extractor that extracts the degree of heart-related disease from medical images,
As information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is displayed, and the heart is described. When the degree of the disease related to the blood vessel is low, a display control unit that displays the wall shear stress as a second index value related to the blood vessel is provided.
Medical image processing equipment.
(Appendix 2)
The display control unit displays the first index value when the degree of the disease related to the heart is higher than the first threshold value, and the second threshold value in which the degree of the disease related to the heart is smaller than the first threshold value. When it is lower, the second index value is displayed, and when the degree of the disease related to the heart is between the first threshold value and the second threshold value, the first index value and the first index value are displayed. The index value of 2 may be displayed.
(Appendix 3)
The display control unit further displays at least one of the one-dimensional first index value and the one-dimensional second index value when the degree of the heart-related disease is high, and the degree of the heart-related disease is low. In some cases, at least one of the three-dimensional first index value and the three-dimensional second index value may be further displayed.
(Appendix 4)
The display control unit further displays the first index value and the second index value at the same time, and when the degree of the disease related to the heart is high, the display area of the first index value is displayed as the first index value. The display area of the second index value may be larger than the display area of the first index value when the display area of the second index value is larger than the display area of the index value 2 and the degree of the disease related to the heart is low.
(Appendix 5)
The display control unit may display the first index value and the second index value in different display forms.
(Appendix 6)
The display control unit may further display an image showing the blood vessel, and the first index value and the second index value may be superimposed or displayed side by side on the image.
(Appendix 7)
The display control unit further receives an operation for selecting the type of information to be displayed from the user, and displays at least one of the first index value and the second index value according to the received operation. May be good.
(Appendix 8)
The display control unit further receives an operation of switching the display of the first index value and the second index value from the user, and according to the accepted operation, the first index value and the second index value. You may switch from the state where one of the index values is displayed to the state where the other is displayed.
(Appendix 9)
The medical image processing device is
An identification unit that identifies whether the medical image was taken before or after the treatment of the subject.
When it is identified that the time when the medical image is taken is before the treatment of the subject, it is a first index value after the treatment by performing a virtual treatment for the blood vessel using the medical image. It may further include a prediction unit that calculates at least one of a first prediction index value and a second prediction index value that is a second index value after treatment.
The display control unit further displays at least one of the first predictive index value and the second predictive index value when it is determined that the time when the medical image is taken is before the treatment of the subject. May be good.
(Appendix 10)
When the display control unit identifies that the time of imaging is before the treatment of the subject, the display control unit includes at least one of the first index value and the second index value calculated based on the medical image, and the above. A second predicted index value calculated based on the medical image when the first predictive index value and at least one of the second predicted index value are displayed and the time of imaging is identified as after the treatment of the subject. At least one of the index value 1 and the index value 2 may be displayed.
(Appendix 11)
When it is identified that the time of imaging is before the treatment of the subject, the display control unit further displays at least one of the three-dimensional first index value and the three-dimensional second index value. When it is identified that the time of imaging is after the treatment of the subject, at least one of the one-dimensional first index value and the one-dimensional second index value may be further displayed.
(Appendix 12)
After the display control unit determines that the display control unit displays at least one of the first prediction index value and the second prediction index value, the prediction unit has the first prediction index value and the second prediction index value. At least one of the predictive index values may be calculated.
(Appendix 13)
The prediction unit receives an operation for inputting parameters used when performing the virtual treatment from the user, and uses the received parameters to perform the first prediction index value and the second prediction index value. At least one of may be calculated.
(Appendix 14)
The display control unit is associated with at least one of the first index value and the second index value calculated based on the medical image before the treatment when the time of the imaging is identified as after the treatment of the subject. , At least one of the first index value and the second index value calculated based on the medical image after the treatment may be further displayed.
(Appendix 15)
The medical image processing device is
Based on the medical image, each vascular branch of the coronary artery may further be provided with a derivation unit for deriving the position of the plaque generated in each vascular branch and the probability of failure.
The display control unit may display the first index value or the second index value for each blood vessel branch, depending on the position of the plaque and the probability of failure.
(Appendix 16)
The display control unit displays the first index value for the blood vessel branch in which the plaque having a high failure probability exists, and the display control unit displays the first index value for the blood vessel branch in which the plaque does not exist or the plaque having a low failure probability exists. The index value of 2 may be displayed.
(Appendix 17)
The display control unit displays the first index value or the first representative value of the second index value in the blood vessel branch for the blood vessel branch in which the plaque having a high probability of failure is present, and the plaque is present. For a blood vessel branch that does not have a blood vessel branch and a blood vessel branch in which a plaque having a low probability of failure is present, a second representative value different from the first representative value of the first index value or the second index value of the blood vessel branch is used. It may be displayed.
(Appendix 18)
The display control unit further displays a medical image captured by the first medical image diagnostic apparatus or information obtained from the medical image for a blood vessel branch in which the plaque having a high failure probability is present, and the plaque is present. Information obtained from a medical image taken by a second medical image diagnostic device different from the first medical image diagnostic device or information obtained from the medical image with respect to a blood vessel branch that does not have a blood vessel branch and a blood vessel branch in which the plaque having a low failure probability is present. May be further displayed.
(Appendix 19)
The display control unit further displays at least one of a first index value and a second index value calculated based on a medical image of a specific heart phase reconstructed according to the degree of the disease related to the heart. You may.
(Appendix 20)
The extraction unit extracts the degree of myocardial bridge as the degree of the disease related to the heart.
When the degree of the myocardial bridge is high, the display control unit displays at least one of the first index value and the second index value calculated based on the medical image at the end of diastole, and the degree of the myocardial bridge. When is low, at least one of the first index value and the second index value calculated based on the medical image at the end of diastole and the medical image at the end of contraction may be displayed.
(Appendix 21)
The extraction unit extracts the degree of valvular disease of each valve contained in the heart valve as the degree of the disease related to the heart.
The display control unit displays at least one of the first index value and the second index value calculated based on the medical image at the end of systole when the degree of valvular disease of the aortic valve is high, and displays the mitral valve. When the degree of valvular disease is low, at least one of the first index value and the second index value calculated based on the medical image of the terminal diastole may be displayed.
(Appendix 22)
When the degree of the disease related to the heart is low, the display control unit has the magnitude of the wall shear stress as the vertical axis and the distance along the blood vessel from the reference position as the horizontal axis. A graph showing the relationship with the distance may be displayed, and information indicating the range of the distance in which the third index value for the blood vessel is an abnormal value may be displayed together with the graph.
(Appendix 23)
In the display control unit, when the degree of the heart-related disease is low, the vertical axis is the magnitude of the wall shear stress and the horizontal axis is the distance along the blood vessel from the reference position at each of a plurality of different time points. , A graph showing the relationship between the magnitude of the wall shear stress and the distance may be displayed.
(Appendix 24)
The display control unit may further display information indicating a range in which the temporal fluctuation amount of the wall shear stress exceeds the threshold value at the distance together with the graph.
(Appendix 25)
The display control unit may further display information indicating a range in which the third index value relating to the blood vessel is an abnormal value at the distance together with the graph.
(Appendix 26)
The display control unit may display information indicating a range in which the third index value is an abnormal value at the distance by superimposing the information indicating the position indicating the distance on the graph.
(Appendix 27)
The third index value is an index value indicating a lesion formed in the blood vessel, an index value calculated from a change in blood pressure, blood flow, shape, or position of the blood vessel, or the medical image. It may be an index value predicted by performing a virtual operation or treatment on the blood vessel.
(Appendix 28)
As information on the blood flow of the blood vessel calculated based on the medical image, the first index value for the blood vessel calculated from the blood pressure or the blood flow and the wall shear stress as the second index value for the blood vessel are displayed. Equipped with a display control unit
The display control unit switches and displays the first index value and the second index value based on the information about the subject.
Medical image processing equipment.
(Appendix 29)
A medical image processing system including a medical image processing device and a medical information display device.
The medical image processing device
Extracting the degree of heart disease from medical images,
As information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is calculated, and the heart is said. If the degree of the disease is low, the wall shear stress is calculated as the second index value for the blood vessel.
The medical information display device
Obtaining and displaying information on the blood flow of the blood vessel from the medical image processing device.
Medical image processing system.
(Appendix 30)
Extracting the degree of heart disease from medical images,
As information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is displayed, and the heart is described. A medical imaging method comprising displaying wall shear stress as a second index value for said blood vessel when the degree of the disease is low.

100, 200, 300, 400 Medical image processing system 140 Medical information display device 150, 250, 350, 450 Medical image processing device 155, 255, 355, 455 Processing circuit 155c, 455c Extraction function 155d, 255d, 355d, 455d Display control Function 255e Identification function 255f Prediction function 355g Derivation function

Claims (30)

An extractor that extracts the degree of heart-related disease from medical images,
As information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is displayed, and the heart is described. A medical image processing apparatus including a display control unit that displays wall shear stress as a second index value for the blood vessel when the degree of the disease related to the blood vessel is low. The display control unit displays the first index value when the disease degree indicating the degree of the heart-related disease is higher than the first threshold value, and the disease degree indicating the degree of the heart-related disease is the first. When it is lower than the second threshold value smaller than the threshold value of, the second index value is displayed, and the degree of disease indicating the degree of the disease related to the heart is between the first threshold value and the second threshold value. In some cases, the first index value and the second index value are displayed.
The medical image processing apparatus according to claim 1. The display control unit further displays at least one of the one-dimensional first index value and the one-dimensional second index value when the degree of disease indicating the degree of the heart-related disease is high, and the display control unit further displays the one-dimensional first index value and the one-dimensional second index value. When the degree of disease indicating the degree of the disease is low, at least one of the three-dimensional first index value and the three-dimensional second index value is further displayed.
The medical image processing apparatus according to claim 1 or 2. The display control unit further displays the first index value and the second index value at the same time, and displays the first index value when the degree of disease indicating the degree of the disease related to the heart is high. When the area is made larger than the display area of the second index value and the degree of disease indicating the degree of the disease related to the heart is low, the display area of the second index value is larger than the display area of the first index value. Enlarge,
The medical image processing apparatus according to any one of claims 1 to 3. The display control unit displays the first index value and the second index value in different display forms.
The medical image processing apparatus according to any one of claims 1 to 4. The display control unit further displays an image showing the blood vessel, and displays the first index value and the second index value on the image in an overlapping manner or side by side.
The medical image processing apparatus according to any one of claims 1 to 5. The display control unit further accepts an operation of selecting the type of information to be displayed from the user, and displays at least one of the first index value and the second index value according to the accepted operation.
The medical image processing apparatus according to any one of claims 1 to 6. The display control unit further receives an operation of switching the display of the first index value and the second index value from the user, and according to the accepted operation, the first index value and the second index value. Switch from the state where one of the index values is displayed to the state where the other is displayed,
The medical image processing apparatus according to any one of claims 1 to 7. An identification unit that identifies whether the medical image was taken before or after the treatment of the subject.
When it is identified that the time when the medical image is taken is before the treatment of the subject, it is a first index value after the treatment by performing a virtual treatment for the blood vessel using the medical image. Further provided with a prediction unit for calculating at least one of a first prediction index value and a second prediction index value which is a second index value after treatment.
The display control unit further displays at least one of the first predictive index value and the second predictive index value when it is determined that the time when the medical image is taken is before the treatment of the subject.
The medical image processing apparatus according to any one of claims 1 to 8. When the display control unit identifies that the time of imaging is before the treatment of the subject, the display control unit includes at least one of the first index value and the second index value calculated based on the medical image, and the above. A second predicted index value calculated based on the medical image when the first predictive index value and at least one of the second predicted index value are displayed and the time of imaging is identified as after the treatment of the subject. Display at least one of the index value of 1 and the index value of the second index,
The medical image processing apparatus according to claim 9. When it is identified that the time of imaging is before the treatment of the subject, the display control unit further displays at least one of the three-dimensional first index value and the three-dimensional second index value. When it is identified that the time of imaging is after the treatment of the subject, at least one of the one-dimensional first index value and the one-dimensional second index value is further displayed.
The medical image processing apparatus according to claim 9 or 10. After the display control unit determines that the display control unit displays at least one of the first prediction index value and the second prediction index value, the prediction unit has the first prediction index value and the second prediction index value. Calculate at least one of the forecast index values,
The medical image processing apparatus according to any one of claims 9 to 11. The prediction unit receives an operation for inputting parameters used when performing the virtual treatment from the user, and uses the received parameters to perform the first prediction index value and the second prediction index value. Calculate at least one of
The medical image processing apparatus according to any one of claims 9 to 12. The display control unit is associated with at least one of the first index value and the second index value calculated based on the medical image before the treatment when the time of the imaging is identified as after the treatment of the subject. , At least one of the first index value and the second index value calculated based on the medical image after treatment is further displayed.
The medical image processing apparatus according to any one of claims 9 to 13. Based on the medical image, each vascular branch of the coronary artery is further provided with a derivation unit for deriving the position of the plaque generated in each vascular branch and the probability of failure.
The display control unit displays the first index value or the second index value for each blood vessel branch according to the position of the plaque and the probability of failure.
The medical image processing apparatus according to any one of claims 1 to 14. The display control unit displays the first index value for the blood vessel branch in which the plaque having a high failure probability exists, and the display control unit displays the first index value for the blood vessel branch in which the plaque does not exist or the plaque having a low failure probability exists. Display the index value of 2,
The medical image processing apparatus according to claim 15. The display control unit displays the first index value or the first representative value of the second index value in the blood vessel branch for the blood vessel branch in which the plaque having a high failure probability is present, and the plaque is present. For a blood vessel branch that does not have a blood vessel branch and a blood vessel branch in which a plaque having a low probability of failure is present, a second representative value different from the first representative value of the first index value or the second index value of the blood vessel branch is used. indicate,
The medical image processing apparatus according to claim 15. The display control unit further displays a medical image captured by the first medical image diagnostic apparatus or information obtained from the medical image for a blood vessel branch in which the plaque having a high failure probability is present, and the plaque is present. Information obtained from a medical image taken by a second medical image diagnostic device different from the first medical image diagnostic device or information obtained from the medical image with respect to a blood vessel branch that does not have a blood vessel branch and a blood vessel branch in which the plaque having a low failure probability is present. To display further,
The medical image processing apparatus according to any one of claims 15 to 17. The display control unit further displays at least one of a first index value and a second index value calculated based on a medical image of a specific heart phase reconstructed according to the degree of the disease related to the heart. ,
The medical image processing apparatus according to any one of claims 1 to 18. The extraction unit extracts the degree of myocardial bridge as the degree of the disease related to the heart.
The display control unit displays at least one of a first index value and a second index value calculated based on a medical image at the end of diastole when the degree of disease indicating the degree of the myocardial bridge is high. When the degree of disease indicating the degree of myocardial bridge is low, at least one of the first index value and the second index value calculated based on the medical image at the end of diastole and the medical image at the end of contraction is displayed.
The medical image processing apparatus according to claim 19. The extraction unit extracts the degree of valvular disease of each valve contained in the heart valve as the degree of the disease related to the heart.
The display control unit displays at least one of a first index value and a second index value calculated based on a medical image at the end of systole when the degree of disease indicating the degree of valvular disease of the aortic valve is high. , Display at least one of the first index value and the second index value calculated based on the medical image of the terminal diastole when the disease degree indicating the degree of valvular disease of the mitral valve is low.
The medical image processing apparatus according to claim 19. When the degree of the disease related to the heart is low, the display control unit has the magnitude of the wall shear stress as the vertical axis and the distance along the blood vessel from the reference position as the horizontal axis. A graph showing the relationship with the distance is displayed, and information indicating the range of the distance in which the third index value for the blood vessel is an abnormal value is displayed together with the graph.
The medical image processing apparatus according to claim 1 or 2. In the display control unit, when the degree of the heart-related disease is low, the vertical axis is the magnitude of the wall shear stress and the horizontal axis is the distance along the blood vessel from the reference position at each of a plurality of different time points. , Display a graph showing the relationship between the magnitude of the wall shear stress and the distance.
The medical image processing apparatus according to claim 1 or 2. The display control unit further displays information indicating a range in which the temporal fluctuation amount of the wall shear stress exceeds the threshold value at the distance together with the graph.
The medical image processing apparatus according to claim 23. The display control unit further displays information indicating a range in which the third index value relating to the blood vessel is an abnormal value at the distance together with the graph.
The medical image processing apparatus according to claim 23 or 24. The display control unit displays information indicating a range in which the third index value is an abnormal value at the distance, aligned with the position indicating the distance, on the graph.
The medical image processing apparatus according to claim 22 or 25. The third index value is an index value indicating a lesion formed in the blood vessel, an index value calculated from a change in blood pressure, blood flow, shape, or position of the blood vessel, or the medical image. An index value predicted by performing a virtual operation or treatment on the blood vessel.
The medical image processing apparatus according to any one of claims 22, 25, and 26. As information on the blood flow of the blood vessel calculated based on the medical image, the first index value for the blood vessel calculated from the blood pressure or the blood flow and the wall shear stress as the second index value for the blood vessel are displayed. Equipped with a display control unit
The display control unit switches and displays the first index value and the second index value based on the information about the subject.
Medical image processing equipment. A medical image processing system including a medical image processing device and a medical information display device.
The medical image processing device
Extracting the degree of heart disease from medical images,
As the information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is calculated, and the heart is said. If the degree of the disease is low, the wall shear stress is calculated as the second index value for the blood vessel.
The medical information display device
Obtaining and displaying information on the blood flow of the blood vessel from the medical image processing apparatus.
Medical image processing system. Extracting the degree of heart disease from medical images,
As information on the blood flow of the blood vessel calculated based on the medical image, when the degree of the disease related to the heart is high, the first index value related to the blood vessel calculated from the blood pressure or the blood flow is displayed, and the heart is described. A medical imaging method comprising displaying wall shear stress as a second index value for said blood vessel when the degree of the disease is low.

Images