JP2022547103A - Method, apparatus and system for simply measuring coronary artery vascular assessment parameters - Google Patents

Abstract

A method, apparatus and system for simply measuring a coronary vascular assessment parameter comprising the steps of measuring pressure Pd distal to a coronary artery stenosis and/or coronary inlet pressure Pa via a pressure guidewire. (S100); performing coronary angiography on the blood vessel to be measured (S200); selecting the first and second postural angiography images of the blood vessel to be measured (S300); A step (S400) of obtaining a three-dimensional model of the coronary artery by selecting and dividing one section of the blood vessel to and through three-dimensional modeling; Obtaining a time Ta (S500); obtaining a time Tmax for the contrast agent to pass from the vascular stage entrance to the exit in the maximum dilation state based on the hydrodynamic equation (S600); obtaining a coronary vessel rating parameter; and a step (S700). The method can perform modeling based on contrast-enhanced images at any time within the cardiac cycle, is simple to perform three-dimensional modeling, reduces the injection time of dilators, has a simple measurement process, and provides good results. is accurate.

Description

This application is the priority of the Chinese patent application of Application No. 201910835038.3, entitled "Method, device and system for simply measuring coronary artery vessel assessment parameters", filed with the Chinese Patent Office on September 5, 2019. , the entire contents of which are incorporated in this application by reference.

[Technical field]
The present invention relates to the field of coronary artery medical technology, and more particularly to a method, apparatus, coronary artery analysis system and computer storage medium for simply measuring coronary artery vessel assessment parameters.

The heart is an organ with high energy consumption. At rest, myocardial metabolic oxygen uptake can reach 60% to 80% of blood oxygen content. Therefore, under stress conditions such as exercise, the heart finds it difficult to meet the increased demand for myocardial oxygen deficiency by increasing the tissue's oxygen uptake capacity, and usually secures the oxygen demand for myocardial metabolism by increasing myocardial blood flow. do. The myocardial microcirculation accounts for 95% of the composition of the coronary artery circulation and functions to regulate and control myocardial blood flow through various factors such as some metabolites, endothelial, neuroendocrine and myogenic factors. Studies have shown that coronary artery microcirculatory dysfunction is an important predictor of poor long-term prognosis in patients with ischemic heart disease.

According to the revised guidelines in 2013, “In patients with suspected microvascular angina pectoris, if there are no obvious abnormalities on coronary angiography, intraluminal injection of acetylcholine or adenosine at the time of angiography and Doppler measurement should be performed. , endothelium-dependent or non-endothelium-dependent CFR may be calculated to clarify the presence or absence of spasm of microcirculatory/epicardial vessels”, and was classified into recommendation class IIB.

The 2019 guidelines added one class IIA recommendation and two class IIB recommendations, stating, “Patients who remain symptomatic but who have normal or moderate stenosis on coronary angiography and have an iWfr/FFR value. For retained patients, the use of guidewire-based CFR and/or microcirculatory resistance measurements should be considered,” and was classified as Class IIA recommendation.

A coronary artery microvascular function test is completed by detecting the microvascular response to a vasodilator. The above two revisions of the guideline also indicate the importance of coronary artery microvascular function tests. The measurement index used in coronary artery microvascular function tests refers to the degree of maximum expansion of coronary artery microvessels, that is, coronary flow reserve (CFR). There are non-endothelium-dependent vasodilators that act on smooth muscle and endothelium-dependent vasodilators that act on vascular endothelial cells, including adenosine and acetylcholine.

For patients with suspected ischemic heart disease (CAD) who have no apparent stenosis on coronary angiography, conventional testing measures microvascular responses to vasodilators by injecting adenosine and acetylcholine. was to detect Current examination methods mainly include coronary artery flow reserve ratio (FFR) and microcirculatory resistance index (IMR). If the two thermoreceptors detect the time difference in temperature change, it is possible to know the transit mean time (Tmn) for the saline solution to pass from the guiding catheter to the thermoreceptor at the tip of the guidewire. An IMR value can be obtained based on the product of the pressure Pd and Tmn, defined as the order of magnitude. Overall, however, there are not many methods to assess the current microcirculation. The guideline's recommendation level is slightly higher than before, as traditional testing methods have simplified flows, improved safety, and optimized results. Other non-invasive techniques, such as transthoracic Doppler ultrasound, radionuclide imaging techniques, and nuclear magnetic resonance imaging techniques, are useful in diagnosing microcirculatory disease, but each has different degrees of drawbacks. It cannot be a recommended method for evaluating microcirculatory function.

Conventional CFR measurement methods include the following methods: (1) Doppler guidewire measurement method. In this method, a Doppler guide wire is inserted into the coronary artery (distal from the lesion), and the blood flow velocity in the coronary artery is directly measured at rest and in the state of maximal hyperemia to calculate the CFR. (2) Thermodilution curve measurement method. It directly senses temperature changes in the coronary arteries by mounting temperature-baroreceptors on a double-sensing guidewire, and obtains intracoronary thermodilution curves in resting and maximally hyperemic conditions, which can be used as a proxy for coronary artery flow velocities. Then, the CFR is calculated using the blood flow mean transit time.

When measuring IMR and CFR with a pressure guidewire sensor, there are the following problems: (1) If the pressure guidewire sensor is too close to the ostia of the coronary arteries, the measured Tmn will be too small, and the IMR results will tend to be small. . Also, if it is too far, the IMR result tends to be large because the Tmn to be measured is too large. (2) A total of 6 saline injections should be performed in the resting state and the maximal hyperemia state. It is troublesome. (3) Each time, the difference in Tmn obtained when injecting saline may be large, and if the difference between one value and the other two values exceeds 30%, inject saline again. and the number of saline injections increases. (4) In the measurement of the pressure guidewire receptor, if the rate of decrease in injection saline temperature is not fast enough, the numerical value cannot be recorded. water will have to be used. Too many influencing factors. (5) If the temperature recovers to the original value after injection is not fast enough, an error occurs and the time from the start of injection until the temperature recovers to normal is too long (>0.6 seconds). In addition, problems such as too slow injection speed, uneven injection speed, and too large injection volume may occur. Therefore, the distance of the pressure guidewire receptacle, the speed at which the saline solution is injected, the injection volume, and the temperature of the saline solution all directly affect the measurement result, which makes the result inaccurate and the measurement process cumbersome. On top of that, long continuous injections of dilators can have a great impact on the patient and cause severe discomfort.

According to the method, device, coronary artery analysis system and computer storage medium for simply measuring coronary vascular assessment parameters provided by the present invention, the prior art measures CFR and IMR with a pressure guidewire , which eliminates the problem of long-term continuous injection of dilating drugs, which has a large impact on the patient and causes severe discomfort, and the problem of the pressure guidewire measurement process being cumbersome and resulting in inaccurate measurement results. can.

To achieve the above objects, in a first aspect, the present application provides the following methods:

measuring the pressure P _d distal to the coronary artery stenosis and/or the coronary inlet pressure P _a with a pressure guidewire;
performing coronary angiography on the measurement vessel;
selecting a first postural contrast image and a second postural contrast image of the measured blood vessel;
A section of the blood vessel from the proximal to the distal coronary artery is selected and divided, and three-dimensional modeling is performed based on the first and second postural angiographic images to obtain a three-dimensional coronary artery model. a step;
injecting a contrast agent and obtaining an average time T _a during which the contrast agent passes from the entrance to the exit of the vessel stage based on the three-dimensional coronary artery model;
obtaining the time T _max during which the contrast medium passes from the entrance to the exit of the vessel stage in the maximum expansion state based on the three-dimensional coronary artery model and the hydrodynamic equation;
obtaining a coronary vessel assessment parameter based on said T _a , T _max and/or P _d and/or P _a ;
including,
A simple method for measuring coronary vascular assessment parameters.

Optionally, said coronary vascular rating parameters include coronary blood flow reserve CFR, microvascular resistance coefficient IMR when coronary blood flow increases from resting to hyperemic conditions.
A simplified method for measuring the above coronary vascular assessment parameters.

Optionally, said CFR is CFR=T _a /T _max
and/or
the IMR is IMR = _Pd x _Tmax ;
A simplified method for measuring the above coronary vascular assessment parameters.

である、
ことを含む、
上記の冠状動脈血管評定パラメータを簡単に測定する方法。 Optionally, said obtaining the average time T _a that said contrast agent has passed from the vessel stage entrance to the exit comprises:
Acquiring the time T1 during which the contrast agent in the _first unitary contrast image passes from the entrance to the exit of the blood vessel stage,
Obtaining a time T2 during which the contrast agent in the _second postural contrast image passes from the entrance to the exit of the blood vessel stage,

is
including
A simplified method for measuring the above coronary vascular assessment parameters.

Optionally, said _times T1 and T2 _are calculated based on the ratio of the number of frames of the sub-segment image into which the cardiac cycle segment is divided and the number of frames transmitted per second.
A simplified method for measuring the above coronary vascular assessment parameters.

Optionally, obtaining the time T _max for the contrast agent to pass from the vessel stage entrance to the exit in said maximum expansion state comprises:
measuring the length L of the segmented vessel;
estimating the blood flow velocity V in the dilated state based on the three-dimensional coronary artery model, Pa, Pd, by a fluid dynamics calculation method;
obtaining the time T _max for the contrast agent to pass from the vessel stage entrance to the exit in the maximally dilated state according to the equation T _max =L/V;
including,
A simplified method for measuring the above coronary vascular assessment parameters.

Optionally, the method of estimating the blood flow velocity V in the dilated state by hydrodynamic calculation based on the coronary artery three-dimensional vessel model, Pa, Pd, comprises:
obtaining the vessel stage diameter D _t once every t hours;
once every t hours, the pressure guidewire distal to the coronary artery stenosis P _d and the coronary ostial pressure P _a are obtained;
calculating one FFR _t value every t time based on D _t , P _a , and P _d , and inversely estimating and solving based on the FFR definition to obtain the blood flow velocity V _t value;
Injecting a dilating drug, measuring the FFR value in the dilated state, comparing the FFR value in the dilated state with the real-time FFR _t value, and correspondingly determining the blood flow velocity V _t value, i.e. blood flow in the dilated state obtaining a velocity V value;
including,
A simplified method for measuring the above coronary vascular assessment parameters.

optionally, an included angle between said first and second positions is greater than 30°;
A simplified method for measuring the above coronary vascular assessment parameters.

Optionally, obtaining a coronary artery three-dimensional vessel model based on three-dimensional modeling of said first postural angiographic image and said second postural angiographic image comprises:
removing interfering blood vessels in the first postural contrast image and the second postural contrast image to obtain a resulting image;
extracting the coronary artery centerline and diameter of each of the resulting images along the extending direction of the coronary artery;
projecting the centerline and diameter of each coronary artery into a three-dimensional space for three-dimensional modeling to obtain a three-dimensional coronary artery model;
including,
A simplified method for measuring the above coronary vascular assessment parameters.

In a second aspect, the present application provides an apparatus for:

comprising a pressure guidewire measurement unit, a coronary angiography extraction unit, a three-dimensional modeling unit and a parameter measurement unit;
the coronary angiography extraction unit is connected to a three-dimensional modeling unit;
the parameter measurement unit is connected to the pressure guide wire measurement unit and the three-dimensional modeling unit;
the pressure guidewire measuring unit is for measuring the pressure P _d distal to the coronary artery stenosis and the coronary inlet pressure P _a by means of a pressure guidewire;
wherein the coronary angiography extraction unit is for selecting a first postural contrast image and a second postural contrast image of the measurement vessel;
The three-dimensional modeling unit is for receiving the first postural contrast image and the second postural contrast image transmitted by the coronary angiography extraction unit, and obtaining a coronary artery three-dimensional blood vessel model by three-dimensional modeling. ,
The parameter measurement unit receives the coronary artery three-dimensional blood vessel model transmitted by the three-dimensional modeling unit, obtains an average time T _a during which the contrast agent passes from the blood vessel stage entrance to the blood vessel stage exit, and calculates _the coronary artery three-dimensional blood vessel model. and based on the fluid dynamics formula, obtain the time T _max during which the contrast agent passes from the entrance to the exit of the vessel stage in the maximum expansion state, and based on the _Ta , T _max and/or P _d and/or _Pa , the coronary artery for obtaining vascular rating parameters,
A measuring device for simply measuring a coronary artery vessel rating parameter used in the above-described method for simply measuring a coronary artery vessel rating parameter.

optionally, said parameter measurement unit comprises a coronary flow reserve module, a microvascular resistance coefficient module and/or a coronary flow reserve ratio module,
the coronary flow reserve module and the microvascular resistance coefficient module are both connected to the three-dimensional modeling unit;
both the microvascular resistance coefficient module and the coronary blood flow reserve ratio module are connected to the pressure guidewire measurement unit;
the coronary blood flow reserve module is for measuring coronary blood flow reserve CFR when coronary artery blood flow increases from a resting state to a hyperemic state, wherein the CFR is CFR=T _a /T _max ;
said microvascular resistance coefficient module is for measuring a microvascular resistance coefficient IMR, said IMR is IMR = _Pd x _Tmax ;
wherein said fractional coronary flow reserve module is for measuring fractional coronary flow reserve FFR, said FFR being FFR=P _d /P _a ;
A measurement device for simply measuring the coronary artery vascular assessment parameters described above.

In a third aspect, the application provides the following system:

including a measuring device for simply measuring coronary artery vessel assessment parameters according to technical solution 10 or 11;
Coronary artery analysis system.

In a fourth aspect, the application provides the following computer storage medium:

implementing a method for simply measuring the above coronary vessel assessment parameters when the computer program is executed by a processor;
computer storage medium.

The solutions provided by the embodiments of the present application have at least the following beneficial effects:

According to the method for simply measuring the coronary artery vessel rating parameters provided by the present application, modeling can be performed based on contrast-enhanced images at any time within the cardiac cycle, and three-dimensional modeling is simple and extended. Only need to inject dilator when measuring FFR in the condition, no need to inject dilator in other processes, can reduce dilator injection time as much as possible, then coronary angiography image to perform three-dimensional modeling, based on the coronary artery three-dimensional blood vessel model, obtain the average time T _a during which the contrast agent passes from the vascular stage entrance to the exit, and based on the coronary artery three-dimensional blood vessel model and the hydrodynamic formula , obtaining the time T _max for the contrast medium to pass from the entrance to the exit of the vessel stage in the maximally dilated state, and calculating coronary vessel assessment parameters such as IMR and CFR based on T _a , T _max and/or P _d and/or P _a , the measurement process is simple and the measurement results are accurate, all of which can overcome the problems of measuring coronary vascular assessment parameters such as IMR, CFR, etc. using a pressure guidewire.

The drawings described herein are for a further understanding of the invention and form a part thereof, and the schematic embodiments of the invention and the description thereof are for the purpose of illustrating the invention and the present invention. It does not constitute an undue limitation of the invention.

FIG. 1 is a flow chart of one embodiment of a method for simply measuring a coronary vascular assessment parameter of the present application. FIG. 2 is a flowchart of another embodiment of a method for simply measuring a coronary vascular assessment parameter of the present application. FIG. 3 is a flow chart of step S400 of the present application. FIG. 4 is a flow chart of step S600 of the present application. FIG. 5 is a flow chart of step S620 of the present application. FIG. 6 is a structural block diagram of a measuring device for simply measuring coronary artery vessel assessment parameters of the present application. FIG. 7 is a structural block diagram of the parameter measurement unit of the present application. FIG. 8 is a structural block diagram of one embodiment of the 3D modeling unit of the present application. FIG. 9 is a structural block diagram of another embodiment of the 3D modeling unit of the present application. FIG. 10 is a structural block diagram of the image processing module of the present application. FIG. 11 is a reference image. FIG. 12 is one target image to be segmented. FIG. 13 is another target image to be segmented. FIG. 14 is a catheter image after amplification. FIG. 15 is a binarized image of catheter feature points. FIG. 16 is the target image after amplification. FIG. 17 is a sectional image of the location where coronary arteries are present. FIG. 18 is the resulting image. FIG. 19 shows two postural angiography images. FIG. 20 is a coronary artery three-dimensional blood vessel model diagram generated by combining the body posture angle and the coronary artery centerline in FIG.

In order to make the purpose, technical solution and advantages of the present invention clearer, the technical solution of the present invention will be clearly and completely described below in combination with the specific embodiments of the present invention and the corresponding drawings. Of course, the described embodiments are some but not all embodiments of the present invention. Based on the embodiments in the present invention, all other embodiments obtained by those skilled in the art without creative efforts also fall within the protection scope of the present invention.

A number of embodiments of the invention are disclosed below with reference to the drawings. For clarity, many practical details are grouped together in the following description. However, it should be understood that these practical details are not used to limit the invention. Thus, in some embodiments of the invention, these practical details are not required.

As shown in FIG. 1, the present application provides a method for simply measuring coronary vascular assessment parameters including the following steps:

measuring the pressure P _d distal to the coronary artery stenosis and/or the coronary inlet pressure P _a with an S100 pressure guidewire;
S200 performing coronary angiography on the measurement vessel;
S300 selecting a first postural contrast image and a second postural contrast image of the blood vessel to be measured in a resting state;
S400 Select and divide one section of blood vessels from proximal to distal coronary arteries, perform three-dimensional modeling based on the first and second postural angiographic images, and obtain a three-dimensional coronary artery model. and
S500 injecting a contrast agent and obtaining an average time T _a during which the contrast agent passes from the entrance to the exit of the vessel stage based on the three-dimensional coronary artery model;
S600 obtaining the time T _max during which the contrast agent passes from the vascular stage inlet to the outlet in the maximum dilation state based on the three-dimensional coronary artery model and hydrodynamic equation;
S700 obtaining a coronary vessel assessment parameter based on said T _a , T _max and/or P _d and/or P _a ;
including.

In one embodiment of the present application, the coronary vascular assessment parameters in S700 include coronary blood flow reserve CFR, microvascular resistance coefficient IMR when coronary blood flow increases from resting to hyperemic conditions. In one embodiment of the present application, the CFR is CFR=T _a /T _max and the IMR is IMR=P _d ×T _max .

The present application provides methods for easily measuring the following coronary vascular assessment parameters:

Only when measuring FFR in the dilated state, the dilator needs to be injected, and there is no need to inject the dilator in other processes, so that the dilator injection time can be reduced as much as possible, and then coronary angiography. Three-dimensional modeling is performed using the image, and based on the three-dimensional coronary artery model, the average time T _a during which the contrast agent passes from the entrance to the exit of the blood vessel stage is obtained, and the three-dimensional coronary artery model and the hydrodynamic equation _acquire the time _Tmax for the contrast agent to pass from the entrance to the exit of the vascular stage in the maximum expansion state, and _perform coronary vessel assessment such as _IMR , _CFR , etc. Because the parameters are measured, the measurement process is simple and the measurement results are accurate, all of which can overcome the problems of measuring coronary vascular assessment parameters such as IMR, CFR, etc. using a pressure guidewire.

Injecting a dilator includes injecting a dilator into a vein or a coronary artery. It may be divided into injections at intervals, all of which fall within the protection scope of the present application. Any drug with dilation effect, such as adenosine, ATP, etc., is within the scope of protection of the present application.

As shown in FIG. 2, one embodiment of the present application includes the following steps after S100 and before S200:

S110 Injecting a contrast agent into the blood vessel.

As shown in FIG. 3, in one embodiment of the present application, S400 includes the following steps:

S410 removing interfering vessels in the first and second stereoscopic images to obtain a resulting image;
Specifically, the steps are:
removing interfering blood vessels in the first and second postural angiographic images;
removing noise including static noise and dynamic noise from coronary angiography images;
defining the first frame segmented image in which the catheter appears as the reference image, and the segmented image of the k-th frame in which the complete coronary artery appears as the target image, k being a positive integer greater than 1;
subtracting the target image from the reference image to extract feature points O of the catheter;
Specifically, the target image is subtracted from the reference image, noise including static noise and dynamic noise is removed, the image after removing the noise is image-amplified, and the amplified catheter image is to obtain a binarized image having a set of catheter feature points O,
Subtracting the reference image from the target image to extract an area image where the coronary artery is present;
Specifically, the reference image is subtracted from the target image, noise including static noise and dynamic noise is removed, image amplification is performed on the image after removing the noise, and the target image after amplification is Based on the positional relationship between each segment and the catheter feature point, identify and extract a segment image of the coronary artery segment, that is, the position where the coronary artery exists;
dynamically growing the segment image using the feature points of the catheter as seed points to obtain the resulting image;
Specifically, a binarized coronary artery image is obtained by performing a binarization process on the segmental image of the position where the coronary artery exists, and a morphological operation is performed on the binarized coronary artery image. Using the feature points of the catheter as seed points, the binarized coronary artery image is subjected to dynamic region growing according to the positions of the seed points to obtain the resulting image.

S420 Extracting the coronary artery centerline and diameter of each resulting image along the direction of extension of the coronary artery.

S430 A step of projecting the centerline and diameter of each coronary artery into a three-dimensional space for three-dimensional modeling to obtain a three-dimensional coronary artery model.
Specifically, the steps are:
Obtaining the postural imaging angle of each coronary angiography image,
Each coronary artery centerline is combined with the postural imaging angle and projected onto a three-dimensional space, and projection is performed to generate a three-dimensional coronary artery model.

In one embodiment of the present application, S500 includes:

であり、
時間Ｔ₁及びＴ₂は心周期区域が分けられてなる部分区域画像のフレーム数と毎秒伝送フレーム数の比に基づいて計算され、
即ち、Ｔ＝Ｎ／ｆｐｓであり、
但しＮは心周期区域が分けられてなる部分区域画像のフレーム数を表し、ｆｐｓは画像の毎秒再生フレーム数を表し、つまり、一般的に言う動画又はビデオの画面数であり、Ｔはある一体位造影画像における造影剤が血管段入口から出口まで通過した時間Ｔを表し、
よって、Ｔ₁及びＴ₂は上記式に基づき算出できる。
本出願の一つの実施例において、ｆｐｓ＝１０～３０であり、好ましくは、ｆｐｓ＝１５である。 Acquiring the time T1 during which the contrast agent in the _first unitary contrast image passes from the entrance to the exit of the blood vessel stage,
Obtaining a time T2 during which the contrast agent in the _second postural contrast image passes from the entrance to the exit of the blood vessel stage,

and
The _times T1 and T2 _are calculated based on the ratio of the number of frames of sub-segment images in which the cardiac cycle segment is divided to the number of transmission frames per second,
That is, T=N/fps,
where N represents the number of frames of a partial segment image in which the cardiac cycle segment is divided, fps represents the number of frames played back per second of an image, that is, the number of screens of a moving image or video in general, and T is a certain unit. Represents the time T during which the contrast agent in the contrast image passes from the entrance to the exit of the blood vessel stage,
Therefore, T ₁ and T ₂ can be calculated based on the above formulas.
In one embodiment of the present application, fps=10-30, preferably fps=15.

Since both T ₁ and T ₂ are measured based on the coronary artery three-dimensional blood vessel model acquired by the contrast image, the CFR is also measured by the coronary artery three-dimensional blood vessel model and does not need to depend on the pressure guidewire sensor. Therefore, the pressure guide wire sensor is likely to move due to the impact of saline solution, which solves the problem of inaccurate measurement, and there is no need to inject saline solution. It can prevent the influence of injection speed, injection amount and saline temperature on the CFR measurement result, and improve the measurement accuracy rate.

Because the IMR measurement is based on the pressure guidewire and the contrast image, the pressure P _d distal to the coronary artery stenosis measured by the pressure guidewire is more accurate, and then again based on the contrast image to measure the time T2. , the dilator injection time is reduced, the number of saline injections is reduced, the influence of saline on the measurement results is reduced, the accuracy rate of the IMR measurement results is improved, and the measurement process is simple.

As shown in FIG. 4, in one embodiment of the present application, S600 includes the following steps:

S610 Measuring the length L of the divided vessel.
S620 A step of estimating the blood flow velocity V in the dilated state based on the three-dimensional coronary artery model, P _a , P _d , by hydrodynamic calculation.
S630 Obtaining the time T _max for the contrast medium to pass from the vessel stage entrance to the exit in the maximum expansion state according to the equation T _max =L/V.

As shown in FIG. 5, in one embodiment of the present application, the step of S620 includes the following steps:

S621 Obtaining the vessel stage diameter D _t once every t time.
S622 Obtaining the pressure P _d distal to the coronary artery stenosis and the coronary inlet pressure P _a by the pressure guide wire once every t time.
S623 calculating one FFR _t value every t time based on D _t , P _a , P _d , back-estimating and solving based on the FFR definition to obtain the blood flow velocity V _t value;
S624 injecting a dilating drug, measuring the FFR value in the dilated state, comparing the FFR value in the dilated state with the real-time FFR _t value, and correspondingly the blood flow velocity V _t value, i.e. the blood flow in the dilated state Obtaining the flow velocity V value.

The present application reduces the injection volume and injection frequency of dilators, and is safer and more reliable.

In one embodiment of the present application, the coronary vascular assessment parameters at S600 include coronary flow reserve ratio FFR, where FFR=P _d /P _a .

In one embodiment of the present application, the included angle between the first posture selected in the first posture image and the second posture selected in the second posture image in S300 is greater than 30°. The present application can select any two posture images with an included angle greater than 30° to perform three-dimensional reconstruction, which reduces the difficulty of taking posture images, simplifies the process, and is easy and quick to model. .

As shown in FIG. 6, the present application provides a measuring device for simply measuring the following coronary artery vascular assessment parameters, which is used in the above method for simply measuring coronary vascular assessment parameters:

a pressure guidewire measurement unit 110, a coronary angiography extraction unit 120, a three-dimensional modeling unit 130 and a parameter measurement unit 140;
the coronary angiography extraction unit 120 is connected to the three-dimensional modeling unit 130;
the parameter measurement unit 140 is connected to the pressure guidewire measurement unit 110, the three-dimensional modeling unit 130;
The pressure guidewire measuring unit 110 is for measuring the pressure P _d distal to the coronary artery stenosis and the coronary inlet pressure P _a by means of a pressure guidewire,
the coronary angiography extraction unit 120 selects the first and second postural angiographic images of the measured vessel;
The three-dimensional modeling unit 130 is for receiving the first and second postural contrast images transmitted by the coronary angiography extraction unit and obtaining a three-dimensional coronary artery model by three-dimensional modeling;
The parameter measurement unit 140 receives the coronary artery three-dimensional blood vessel model transmitted by the three-dimensional modeling unit, obtains the average time T _a during which the contrast medium passes from the blood vessel stage entrance to the exit, and measures the coronary artery three-dimensional blood vessel model and _Based on the fluid _dynamics formula, _obtaining the time T _max during which the contrast medium passes from the entrance to the exit of the vessel stage in the _maximum expansion state, It is for getting the rating parameters.

As shown in Figure 7, in one embodiment of the present application:
the parameter measurement unit 140 comprises a coronary flow reserve module 141, a microvascular resistance coefficient module 142, and/or a coronary flow reserve ratio module 143;
The coronary blood flow reserve module 141 and the microvascular resistance coefficient module 142 are both connected to the three-dimensional modeling unit 130,
Both the microvascular resistance coefficient module 142 and the coronary blood flow reserve ratio module 143 are connected to the pressure guidewire measurement unit 110,
The coronary artery flow reserve module 141 is for measuring the coronary artery flow reserve CFR when the coronary artery blood flow increases from the resting state to the hyperemic state, where CFR=T _a /T _max ,
The microvascular resistance coefficient module 142 is for measuring the microvascular resistance coefficient IMR, where IMR=P _d ×T _max , and
The coronary flow reserve ratio module 143 is for measuring the coronary flow reserve ratio FFR, where FFR=P _d /P _a .

The parameter measurement unit 140 further _{comprises a} T1 measurement module, _a T2 measurement module and a CFR measurement module, all of which are connected to the _three -dimensional modeling unit 130; connected to

As shown in Figure 8, in one embodiment of the present application:
The 3D modeling unit 130 comprises an image reading module 131, a segmentation module 132, a vessel length measurement module 133 and a 3D modeling module 134,
The segmentation module 132 is connected to the image reading module 131, the blood vessel length measurement module 133, and the three-dimensional modeling module 134,
The image reading module 131 is for reading a contrast image,
segmentation module 132 for picking out one cardiac cycle segment of the coronary angiography image;
the vessel length measurement module 133 is for measuring the length L of the vessel within the cardiac cycle segment and transmitting the vessel length L to the segmentation module 132;
The 3D modeling module 134 is for performing 3D modeling based on the coronary angiography image selected by the segmentation module 132 to obtain a 3D coronary artery model.

As shown in Figure 9, in one embodiment of the present application:
The 3D modeling unit 130 further comprises an image processing module 135, a coronary artery centerline extraction module 136 and a vessel diameter measurement module 137,
The image processing module 135 is connected to the coronary artery centerline extraction module 136;
The three-dimensional modeling module 134 is connected to a coronary artery centerline extraction module 136 and a vessel diameter measurement module 137,
The image processing module 135 is for receiving the coronary angiography images of at least two positions transmitted by the segmentation module 132 and removing interfering vessels in the coronary angiography images to obtain the resulting image shown in FIG. 17;
a coronary artery centerline extraction module 136 for extracting the coronary artery centerline of each resulting image shown in FIG. 17 along the direction of extension of the coronary artery;
The blood vessel diameter measurement module 137 is for measuring the blood vessel diameter D,
The three-dimensional modeling module 134 projects the centerline and diameter of each coronary artery into a three-dimensional space to perform three-dimensional modeling and obtain a three-dimensional coronary artery model.

This application synthesizes a coronary artery three-dimensional blood vessel model based on coronary angiography images, fills a void in the industry, and plays an active role in the medical technology field.

In one embodiment of the present application,
An image denoising module 1350 is provided within the image processing module 135 to denoise the coronary angiography image, including static and dynamic noise.
A noise removal module 1350 removes interference factors in the coronary angiography image to improve the quality of image processing.

As shown in FIG. 10, in one embodiment of the present application,
The image processing module 135 includes a catheter feature point extraction module 1351 and a coronary artery extraction module 1352, both of which are connected to the coronary artery centerline extraction module 136;
Catheter feature point extraction module 1351 is connected to coronary artery extraction module 1352, image denoising module 1350,
The catheter feature point extraction module 1351 defines the first frame-segment image in which the catheter appears as the reference image shown in FIG. 11, and the k-th frame-segment image in which the complete coronary artery appears as the target image shown in FIGS. image, k being a positive integer greater than 1, performing amplification on the target images shown in FIGS. 12 and 13 to obtain the post-amplification images shown in FIGS. 12 and 13 from the reference images shown to extract the catheter feature points O shown in FIG. 15;
A coronary artery extraction module 1352 subtracts the reference image shown in FIG. 11 from the target images shown in FIGS. Based on this, for identifying and extracting the area of the coronary artery, that is, the area image of the position where the coronary artery shown in FIG. 17 exists,
The area image shown in FIG. 17 is dynamically grown using the catheter feature points shown in FIG. 15 as seed points to obtain the resulting image shown in FIG.

A binarization processing module is further provided inside the image processing module 135 to perform binarization processing on the image to obtain a three-dimensional coronary artery model.

The present application will be specifically described below together with specific examples.

Example 1
As shown in FIG. 19, this is two postural coronary angiographic images taken of a patient. , and the right figure is a contrast-enhanced image when the body posture angle is right anterior oblique RAO: 3° and head direction CRA: 30°.

A pressure guidewire sensor is placed in the patient's distal coronary artery (distance >5 cm from the guiding catheter opening), the vessel is infused with a dilator, and the vessel is reached and held in maximal dilatation (before and after infusion of the dilator). ensure the pressure guidewire sensor is in the same position), measured by pressure guidewire, P _a =87 Hg, P _d =86 mm Hg.

The vessel length of the coronary artery three-dimensional vessel model is L value=120 mm, the generated coronary artery _three -dimensional vessel model is shown in FIG. ₁ / _fps1 =14/15=0.93 s, T2 _{= N2} / _{fps2 =} 17/15=1.13 s, Ta=(1.13+0.93)/2=1.03, in extended state V=L/( _Nmax /fps)=120/(2/15)=900mm/s,
_Tmax = 120/900 = 0.13s,
CFR=Ta/ _{Tmax =} 1.03/0.13=7.90,
Therefore, IMR = 86 x 0.13 = 9.46,
FFR=86/87=0.99,
is.

Comparative example 1
Similar to the patient of Example 1, both Comparative Example 1 and Example 1 are the same coronary angiography images of the same patient.

A pressure guidewire sensor was placed in the patient's distal coronary artery (distance >5 cm from the guiding catheter opening), 3 ml of saline was injected into the vessel through the catheter, and blood temperature was detected to return to normal. Then, 3 ml of physiological saline was injected into the blood vessel again through the catheter, and the above process was repeated three times. After that, T ₁ and T ₁ were recorded as 0.83 s, a dilating drug was put into the blood vessel, and the blood vessel was in the state of maximum dilation. (ensuring that the pressure guidewire sensor is in the same position before and after the dilator is inserted), injecting 3 ml of saline into the vessel through the catheter, and the blood temperature is restored to normal is detected, ₃ ml of physiological saline is injected into the blood vessel again through the catheter, and the above process is repeated _three times. P _d =84 mm Hg, coronary inlet pressure P _a =85 mm Hg,
CFR=0.83/0.11=7.54,
IMR = _Pd x T2 ₌ 84 x 0.11 = 9.24,
FFR = 84/85 = 0.988,
is.

By comparing Example 1 and Comparative Example 1, it was found that the difference was about 0.5 and the IMR measurement results were basically the same, so the measurement results of Example 1 were accurate. Also, the embodiments of the present application measure distal pressure with a pressure guide wire without using saline, and T ₁ and T ₂ are measured with a three-dimensional blood vessel model. In addition, the contrast-enhanced image can be used to measure IMR, filling a gap in the industry, the operation is simpler, and the FFR measurement can also be achieved, and there is no need to use saline, and the pressure guide wire sensor can be used. The impact of saline can eliminate the problem of difficult to control the position of the pressure guide wire and the problem of inaccurate distal pressure measurement, and the process is simple without the need for multiple injections of saline. ,quick.

The present application provides a coronary artery analysis system that includes a measurement device that simply measures the coronary artery vascular assessment parameters described above.

The present application provides a computer storage medium embodying a method of simply measuring the above coronary artery vessel assessment parameters when the computer program is executed by a processor.

As those skilled in the art will recognize, each aspect of the invention can be implemented as a system, method or computer program product. Accordingly, each aspect of the present invention can be specifically embodied in the following forms. That is, an entirely hardware embodiment, an entirely software embodiment (including firmware, resident software, microcode, etc.), or an embodiment combining hardware and software aspects, collectively referred to herein as "circuitry." , a "module" or a "system". Additionally, in some embodiments, each aspect of the invention can also be embodied in the form of a computer program product on one or more computer-readable media, on which computer programs are stored. Contains readable program code. Embodiments of methods and/or systems according to embodiments of the present invention may involve performing or completing selected tasks manually, automatically, or a combination thereof.

For example, hardware could be implemented as a chip or a circuit for performing selected tasks in accordance with embodiments of the invention. As software, selected tasks in accordance with embodiments of the invention can be implemented as a plurality of software commands executed by a computer using any suitable operating system. In an exemplary embodiment of the invention, a data processor can perform one or more tasks according to an exemplary embodiment of the method and/or system herein. For example, a computing platform for executing multiple commands. Optionally, the data processor includes volatile memory for storing commands and/or data and/or non-volatile memory for storing commands and/or data. For example, magnetic hard disks and/or removable media. Optionally, network connectivity is also provided. Optionally, a display and/or user input devices such as keyboard and mouse are also provided.

Any computer readable combination of one or more may be used. A computer readable medium may be a computer readable signal medium or a computer readable storage medium. A computer-readable storage medium can be, for example, but not limited to, an electrical, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus or device, or any combination thereof. Further specific examples (non-exhaustive) of computer-readable storage media include:

Electrical connections with single or multiple conductors, portable computer disks, hard disks, random access memory (RAM), read-only memory (ROM), rewritable read-only memory (EPROM or flash memory), optical fibers, compact discs read-only Memory (CD-ROM), optical storage, magnetic storage, or any suitable combination of the above. As used herein, a computer-readable storage medium can be any tangible medium that contains or stores a program that can be used by or in combination with a command execution system, apparatus, or device. can.

A computer readable signal medium can be a data signal in baseband or propagating as part of a carrier wave and can carry computer readable program code. The data signals so propagated may take multiple forms, including, but not limited to, electromagnetic signals, optical signals, or any suitable combination of the foregoing. A computer-readable signal medium can also be any computer-readable medium other than a computer-readable storage medium, which is used by or used by a command execution system, apparatus, or device. may transmit, propagate or transmit a program for use in conjunction with

Program code contained on computer readable media may be transmitted using any suitable medium including, but not limited to, wireless, wire, optical cable, RF, etc., or any suitable combination of the above. do not have).

For example, computer program code for performing the operations employed in aspects of the invention can be programmed in any combination of one or more programming languages, such as Java, Smalltalk, C++, etc. targets. Type programming languages and normal process programming languages, such as the "C" programming language or similar programming languages. The program code can run entirely on the user computer, partly on the user computer, as a separate software package, partly on the user computer and partly on the user computer. It can run on a remote computer, or can run entirely on a remote computer or server. In the case of a remote computer, the remote computer can be connected to the user computer by any type of network, including a local area network (LAN) or wide area network (WAN), or can be connected to an external computer (e.g., by an Internet service provider). connected through the Internet).

It is to be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program commands. These computer program commands may be provided to a processor of a general purpose computer, special purpose computer or other programmable data processing apparatus and produced as a piece of equipment whereby these computer program commands may be executed by a computer or other programmable processor. It may be any apparatus capable of implementing the functions/acts specified in one or more of the blocks in the flowcharts and/or block diagrams when executed by a processor of the data processing apparatus.

These computer program commands can also be stored on a computer readable medium, where they cause a computer, other programmable data processing device, or other equipment to operate in a specified manner and which are computer readable. The commands stored on such media may be an article of manufacture containing commands capable of performing the functions/operations defined in one or more blocks in the flowcharts and/or block diagrams.

Further, computer program commands to a computer (e.g., a coronary artery analysis system) or other programmable data processing equipment to cause the computer, other programmable data processing equipment or other equipment to perform a series of operational steps. may be loaded so that commands executed by a computer, other programmable device, or other facility may perform the functions/operations specified in the flowcharts and/or blocks of one or more block diagrams. A computer-executed process can be generated to provide the process for implementation.

The above specific examples of the present invention have explained the purpose, technical solution and beneficial effects of the present invention in more detail. The above are only specific embodiments of the present invention, and are not used to limit the present invention, and any modifications, equivalent substitutions, improvements, etc. It should be understood that all are included in the protection scope of the present invention.

pressure guidewire measurement unit 110
coronary angiography extraction unit 120
3D modeling unit 130
Image reading module 131
Split module 132
Vessel length measurement module 133
3D modeling module 134
Image processing module 135
Image noise removal module 1350
Catheter feature point extraction module 1351
Coronary Artery Extraction Module 1352
Coronary centerline extraction module 136
Vessel diameter measurement module 137
Parameter measurement unit 140
Coronary Flow Reserve Module 141
Microvascular resistance coefficient module 142
Coronary Blood Flow Reserve Ratio Module 143

Claims (13)

measuring the pressure P _d distal to the coronary artery stenosis and/or the coronary inlet pressure P _a with a pressure guidewire;
performing coronary angiography on the measurement vessel;
selecting a first postural contrast image and a second postural contrast image of the measured blood vessel;
A section of the blood vessel from the proximal to the distal coronary artery is selected and divided, and three-dimensional modeling is performed based on the first and second postural angiographic images to obtain a three-dimensional coronary artery model. a step;
injecting a contrast agent and obtaining an average time T _a during which the contrast agent passes from the entrance to the exit of the vessel stage based on the three-dimensional coronary artery model;
obtaining the time T _max during which the contrast medium passes from the entrance to the exit of the vessel stage in the maximum expansion state based on the three-dimensional coronary artery model and the hydrodynamic equation;
obtaining a coronary vessel assessment parameter based on said T _a , T _max and/or P _d and/or P _a ;
including,
A method for simply measuring a coronary artery vascular rating parameter, characterized by: The coronary vascular rating parameters include coronary blood flow reserve CFR, microvascular resistance coefficient IMR when coronary artery blood flow increases from resting to hyperemic.
The method for simply measuring coronary artery vascular assessment parameters according to claim 1, characterized in that: said CFR is CFR=T _a /T _max ;
and/or
the IMR is IMR = _Pd x _Tmax ;
The method for simply measuring coronary artery vascular assessment parameters according to claim 2, characterized in that: The step of obtaining an average time T _a for the contrast agent to pass from the vessel stage entrance to the exit,
Acquiring the time T1 during which the contrast agent in the _first unitary contrast image passes from the entrance to the exit of the blood vessel stage,
Obtaining a time T2 during which the contrast agent in the _second postural contrast image passes from the entrance to the exit of the blood vessel stage,

is
including
A method for simply measuring a coronary artery vessel assessment parameter according to any one of claims 1 to 3, characterized in that: The times T ₁ and T ₂ are calculated based on the ratio of the number of frames of sub-segment images in which the cardiac cycle segment is divided to the number of transmission frames per second.
The method for simply measuring coronary artery vascular assessment parameters according to claim 4, characterized in that: The step of obtaining the time T _max during which the contrast medium passes from the entrance to the exit of the vessel stage in the maximum expansion state,
measuring the length L of the segmented vessel;
estimating the blood flow velocity V in the dilated state based on the three-dimensional coronary artery model, P _a , P _d , by a fluid dynamics calculation method;
obtaining the time T _max for the contrast agent to pass from the vessel stage entrance to the exit in the maximally dilated state according to the equation T _max =L/V;
including,
A method for simply measuring a coronary artery vessel assessment parameter according to any one of claims 1 to 3, characterized in that: The step of estimating the blood flow velocity V in the dilated state by a hydrodynamic calculation method based on the three-dimensional coronary artery model, Pa, Pd,
obtaining the vessel stage diameter D _t once every t hours;
once every t hours, the pressure guidewire distal to the coronary artery stenosis P _d and the coronary ostial pressure P _a are obtained;
calculating one FFR _t value every t time based on D _t , P _a , and P _d , and inversely estimating and solving based on the FFR definition to obtain the blood flow velocity V _t value;
Injecting a dilating drug, measuring the FFR value in the dilated state, comparing the FFR value in the dilated state with the real-time FFR _t value, and correspondingly determining the blood flow velocity V _t value, i.e. blood flow in the dilated state obtaining a velocity V value;
including,
The method for simply measuring coronary artery vascular assessment parameters according to claim 6, characterized in that: The included angle between the first posture and the second posture is greater than 30°,
A method for simply measuring a coronary artery vessel assessment parameter according to any one of claims 1 to 3, characterized in that: The step of obtaining a coronary artery three-dimensional vessel model based on the three-dimensional modeling of the first postural angiographic image and the second postural angiographic image,
removing interfering blood vessels in the first postural contrast image and the second postural contrast image to obtain a resulting image;
extracting the coronary artery centerline and diameter of each of the resulting images along the extending direction of the coronary artery;
projecting the centerline and diameter of each coronary artery into a three-dimensional space for three-dimensional modeling to obtain a three-dimensional coronary artery model;
including,
A method for simply measuring a coronary artery vessel assessment parameter according to any one of claims 1 to 3, characterized in that: comprising a pressure guidewire measurement unit, a coronary angiography extraction unit, a three-dimensional modeling unit and a parameter measurement unit;
the coronary angiography extraction unit is connected to a three-dimensional modeling unit;
the parameter measurement unit is connected to the pressure guide wire measurement unit and the three-dimensional modeling unit;
the pressure guidewire measuring unit is for measuring the pressure P _d distal to the coronary artery stenosis and the coronary inlet pressure P _a by means of a pressure guidewire;
wherein the coronary angiography extraction unit is for selecting a first and a second postural angiographic image of the blood vessel to be measured;
The three-dimensional modeling unit is for receiving the first postural contrast image and the second postural contrast image transmitted by the coronary angiography extraction unit, and obtaining a coronary artery three-dimensional blood vessel model by three-dimensional modeling. ,
The parameter measurement unit receives the coronary artery three-dimensional blood vessel model transmitted by the three-dimensional modeling unit, obtains an average time T _a during which the contrast agent passes from the blood vessel stage entrance to the blood vessel stage exit, and calculates the coronary artery three-dimensional blood vessel model. and based on the fluid dynamics formula, obtain the time T _max during which the contrast agent passes from the entrance to the exit of the vessel stage in the maximum expansion state, and based on the _Ta , T _max and/or P _d and/or _Pa , the coronary artery for obtaining vascular rating parameters,
A measuring device for simply measuring a coronary artery vessel rating parameter used in the method for simply measuring a coronary artery vessel rating parameter according to any one of claims 1 to 9. the parameter measurement unit comprises a coronary flow reserve module, a microvascular resistance coefficient module, and/or a coronary flow reserve ratio module;
the coronary flow reserve module and the microvascular resistance coefficient module are both connected to the three-dimensional modeling unit;
both the microvascular resistance coefficient module and the coronary blood flow reserve ratio module are connected to the pressure guidewire measurement unit;
the coronary blood flow reserve module is for measuring coronary blood flow reserve CFR when coronary artery blood flow increases from a resting state to a hyperemic state, wherein the CFR is CFR=T _a /T _max ;
said microvascular resistance coefficient module is for measuring a microvascular resistance coefficient IMR, said IMR is IMR = _Pd x _Tmax ;
wherein said fractional coronary flow reserve module is for measuring fractional coronary flow reserve FFR, said FFR being FFR=P _d /P _a ;
The measuring device for simply measuring coronary artery vessel assessment parameters according to claim 10, characterized in that: comprising a measuring device for simply measuring a coronary vessel assessment parameter according to claim 10 or 11,
A coronary artery analysis system characterized by: realizing a method for simply measuring a coronary artery vessel assessment parameter according to any one of claims 1 to 9 when a computer program is executed by a processor,
A computer storage medium characterized by:

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