JP7245226B2 - Image processing device, image processing method, calculation method and program - Google Patents

Description

The present invention relates to an image processing device, an image processing method, a calculation method and a program.

In the treatment of heart failure, biomaterials such as cells or injection materials such as biomaterials are inserted into the chamber of the heart via the femoral artery, etc., using a device such as a catheter to treat the tissue surrounding the chamber (e.g., Injection into the myocardium surrounding the left ventricle) is being considered as a treatment that is expected to have therapeutic effects such as angiogenesis and cell differentiation.

In the treatment of injecting the infusion material using a catheter as described above, the injection site where the infusion material is injected is the myocardium in the border region between the infarcted site and the normal site (hereinafter referred to as hibernating myocardium) rather than the infarcted site. is known to be more effective. Therefore, identification of hibernating myocardium is important in the above-described therapy. One of the characteristics of hibernating myocardium is that wall motion is reduced compared to normal myocardium. Japanese Patent Laid-Open No. 2002-200001 discloses a technique for detecting a site of decreased wall motion of the heart from an ultrasound image or the like.

JP 2009-106530 A

During the procedure of injecting an injection material using a catheter as described above, the operator generally performs the procedure while viewing an X-ray fluoroscopic image obtained by X-ray fluoroscopy of the heart from a predetermined direction. In fluoroscopic imaging, imaging of the atrioventricle (eg, left ventricle) allows assessment of the motion of the entire left ventricle. However, it is not possible to assess the wall motion of the local heart wall and obtain the information necessary for the identification of hibernating myocardium. Therefore, there is a possibility that a sufficient therapeutic effect cannot be obtained.

As disclosed in Patent Document 1, ultrasonic diagnostic equipment, X-ray CT (Computed Tomography) equipment, MRI (Magnetic Resonance Imaging) equipment, SPECT (Single Photon Emission Computed Tomography) equipment, PET (Positron Emission computed Tomography) It is also conceivable to evaluate wall motion based on three-dimensional data of the heart obtained by imaging the heart with an imaging device such as a device. However, the use of the imaging device described above for detecting wall motion in addition to the intraoperative X-ray fluoroscopy device results in an increase in equipment size and treatment complexity, resulting in an increase in cost. Therefore, a method for detecting the wall motion of the heart wall more easily is desired.

SUMMARY OF THE INVENTION An object of the present invention, which has been made in view of the above problems, is to provide an image processing apparatus, an image processing method, a calculation method, and a program capable of detecting wall motion of the heart wall more easily.

An image processing apparatus according to a first aspect of the present invention is an X-ray fluoroscopic image obtained by imaging from a predetermined direction an atrium of the heart in which a catheter is inserted and the tip of the catheter is in contact with the heart wall. a tip position information acquisition unit that acquires tip position information indicating the position of the part;
A wall motion of the heart wall contacted by the tip of the catheter is calculated based on the movement of the tip of the catheter in the longitudinal direction of the heart indicated by the tip position information acquired by the tip position information acquisition unit. and a wall motion calculator.

As one embodiment of the present invention, a contrast marker is provided at the tip of the catheter, and the tip position information acquisition unit acquires the tip position information based on the position of the contrast marker in the X-ray fluoroscopic image. do.

As one embodiment of the present invention, the image processing apparatus further includes an image processing unit that superimposes the wall motion of the heart wall calculated by the wall motion calculation unit on the X-ray fluoroscopic image and displays the image on a display device. Prepare.

As one embodiment of the present invention, the image processing unit converts the wall motion of the heart wall calculated by the wall motion calculation unit into a two-dimensional image of the atrioventricular chamber obtained from the three-dimensional structural data of the heart. is mapped to a format diagram and recorded.

As one embodiment of the present invention, the image processing unit performs at least a site into which the infusion material has been injected through the catheter, a site suitable for injecting the infusion material, and a site unsuitable for injecting the infusion material. Either one is mapped to the format diagram and recorded.

As one embodiment of the present invention, the image processing unit uses the recorded format diagram to generate at least one of a three-dimensional image and a bull's eye image in which the atrium of the heart is three-dimensionally displayed.

As one embodiment of the present invention, the image processing device includes an infarct site identification unit that identifies an infarct site in the heart wall of the heart, a wall motion of the heart wall calculated by the wall motion calculation unit, and the infarct a hibernating myocardium identifying unit that identifies the hibernating myocardium based on the position of the infarction site identified by the site identifying unit.

As one embodiment of the present invention, a contrast marker is provided at the tip of the catheter, and the tip position information acquisition unit acquires the tip position information based on the position of the contrast marker in the X-ray fluoroscopic image. do.

As one embodiment of the present invention, an electrode is provided at the distal end of the catheter, and the infarct site identification unit is configured to indicate, via the electrode, the cardiac potential of the heart wall with which the distal end of the catheter abuts. Electric potential information is acquired, and an infarct site is identified based on the acquired electrocardiographic information.

As one embodiment of the present invention, the infarct site identification unit acquires electrocardiographic information indicating the electrocardiographic potential of the heart wall based on an image of the heart captured by a predetermined imaging device, and The infarction site is identified based on the potential information.

As one embodiment of the present invention, the infarct site identifying unit identifies the infarct site based on a delayed enhancement phase obtained by imaging with a predetermined imaging device after administering a contrast medium to the heart.

As one embodiment of the present invention, the image processing apparatus further includes an image processing unit that superimposes the hibernating myocardium identified by the hibernating myocardium identification unit on the X-ray fluoroscopic image and displays the image on a display device.

As one embodiment of the present invention, the image processing unit converts the hibernating myocardium identified by the hibernating myocardial identification unit into a two-dimensional image of the atrioventricular chamber obtained from the three-dimensional structural data of the heart. map to and record.

As one embodiment of the present invention, the image processing unit performs at least a site into which the infusion material has been injected through the catheter, a site suitable for injecting the infusion material, and a site unsuitable for injecting the infusion material. Either one is mapped to the format diagram and recorded.

As one embodiment of the present invention, the image processing unit uses the recorded format diagram to generate at least one of a three-dimensional image and a bull's eye image in which the atrium of the heart is three-dimensionally displayed.

An image processing method according to a second aspect of the present invention is an image processing method executed by an image processing apparatus, in which a catheter is inserted and the tip of the catheter touches the heart wall at a predetermined chamber of the heart. a step of acquiring tip position information indicating the position of the tip of the catheter in an X-ray fluoroscopic image taken from a direction; calculating the wall motion of the heart wall contacted by the tip of the catheter based on the motion of .

In one embodiment of the present invention, the image processing method comprises the steps of identifying an infarcted region in the heart wall of the heart; and identifying hibernating myocardium based on the method.

A calculation method as a third aspect of the present invention is a method for calculating wall motion of the heart wall, wherein a catheter is inserted, and the tip of the catheter touches the heart wall from a predetermined direction. acquiring tip position information indicating the position of the tip of the catheter in the captured X-ray fluoroscopic image, and based on the motion of the tip of the catheter indicated by the acquired tip position information in the longitudinal direction of the heart , the wall motion of the heart wall contacted by the tip of the catheter.

A program as a fourth aspect of the present invention causes a computer to function as the above image processing apparatus.

According to the image processing apparatus, image processing method, calculation method, and program according to the present invention, wall motion of the heart wall can be detected more easily.

1 is a diagram showing a configuration example of an image processing apparatus according to an embodiment of the present invention; FIG. FIG. 1 shows an example of an X-ray fluoroscopic image of a catheterized heart chamber. FIG. 2 is a diagram for explaining calculation of wall motion of a heart wall by a wall motion calculator shown in FIG. 1; 2 is a diagram showing an example of display on a display device by the image processing unit shown in FIG. 1; FIG. 3 is a diagram showing another example of display on the display device by the image processing unit shown in FIG. 1; FIG. 2 is a diagram showing an example of display on a display device according to the cardiac potential and wall motion of the heart wall by the image processing unit shown in FIG. 1; FIG. 2 is a diagram showing an example of mapping of a hibernating myocardium, an injection site, and a site unsuitable for injection of an injection material to a format diagram by the image processing unit shown in FIG. 1; FIG. 2 is a flow chart showing an example of the operation of the image processing apparatus shown in FIG. 1; FIG. 4 is a view showing the vicinity of the distal end of the catheter; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8; FIG. 9 is a diagram for explaining how the contrast marker looks when the distal end of the catheter is viewed in the direction of the hollow arrow P1 shown in FIG. 8;

EMBODIMENT OF THE INVENTION Hereinafter, the form for implementing this invention is demonstrated, referring drawings. In each figure, the same reference numerals indicate the same or equivalent components.

FIG. 1 is a diagram showing a configuration example of an image processing apparatus 10 according to one embodiment of the present invention. The image processing apparatus 10 according to the present embodiment detects the wall motion of the atrioventricular heart wall in a procedure of inserting a catheter into the atrium of the heart and injecting an injection material into the atrium of the heart, thereby preventing hibernating myocardium. to identify.

The image processing apparatus 10 shown in FIG. 1 includes a tip position information acquisition unit 11 , a wall motion calculation unit 12 , an infarction site identification unit 13 , a hibernating myocardium identification unit 14 , and an image processing unit 15 .

The tip position information acquiring unit 11 acquires tip position information indicating the position of the tip of the catheter during the procedure of inserting the catheter into the chamber of the heart of the subject and injecting the injection material. More specifically, the tip position information acquiring unit 11 obtains the tip position of the catheter in an X-ray fluoroscopic image of the atrium of the heart in which the catheter is inserted and the tip of the catheter is in contact with the heart wall. Acquire the tip position information indicating the position. In this embodiment, information indicating the position of the tip of the tip of the catheter is acquired as the tip position information.

The tip position information acquisition unit 11 acquires, as tip position information, an input regarding the position of the heart wall with which the tip of the catheter contacts, which is determined by, for example, an operator who inserts the catheter into the heart. Further, as described above, during the procedure of injecting the injection material into the atrium of the heart using a catheter, an X-ray fluoroscopic image of the heart captured from a predetermined direction is displayed so as to be visible to the operator. Displayed on device 20 . The tip position information acquisition unit 11 may acquire the X-ray fluoroscopic image, identify the position of the tip of the catheter by image analysis of the acquired X-ray fluoroscopic image, and acquire the tip position information.

FIG. 2 is an example of diastolic and systolic fluoroscopic images of the left ventricle during a procedure of injecting an injectate into the left ventricle of the heart using a catheter.

As shown in FIG. 2, by providing a contrast marker at the distal end of the catheter, the distal end position information acquiring unit 11 identifies the position of the distal end of the catheter based on the position of the contrast marker in the X-ray fluoroscopic image, Location information can be acquired. In this embodiment, contrast markers are provided at positions including the tip of the catheter. Therefore, information indicating the position of the distal end of the distal end portion of the catheter can be acquired as the distal end position information. In order to identify the distal end of the catheter, for example, the distal end of the catheter may be provided with a contrast marker that is larger than the other portion of the catheter, and is contrasted more densely in the X-ray fluoroscopic image than the other portion of the catheter. It is conceivable to provide a contrast marker, a contrast marker with a special shape, or the like. From the X-ray fluoroscopic image, it can be determined whether the distal end of the catheter is in contact with the heart wall on the front side or the heart wall on the far side when viewed from the imaging direction of the X-ray fluoroscopic image. It may not be possible to determine However, by providing a specific-shaped contrast marker on the catheter, it is possible to determine from the X-ray fluoroscopic image whether the tip of the catheter is in contact with the heart wall on the front side or the heart wall on the back side. can be determined. The details of the shape of such a contrast marker will be described later.

Referring to FIG. 1 again, the tip position information acquisition unit 11 outputs the acquired tip position information to the wall motion calculation unit 12 .

Based on the tip position information output from the tip position information acquisition unit 11, the wall motion calculation unit 12 calculates the wall motion of the heart wall with which the tip of the catheter that is indicated by the tip position information is in contact. More specifically, the wall motion calculator 12 calculates (detects) the wall motion of the heart wall in contact with the catheter based on the movement of the tip of the catheter indicated by the tip position information in the longitudinal direction of the heart. .

It is known that myocardial fibers are composed of three layers of muscle, ie, internal oblique muscle, circular muscle, and external oblique muscle, from the endocardial side to the epicardial side. The contraction and relaxation of the myocardial fibers are oriented in the longitudinal direction (direction from the base to the apex), the centroid direction (the direction perpendicular to the epicardium on the short axis cross-section perpendicular to the long axis), and the circumferential direction ( It is formed from three components in the direction perpendicular to the center of gravity direction on the short axis cross section perpendicular to the long axis.

In general, myocardial damage often appears from the endocardial side. This is because myocardial fibers on the intimal surface consume a large amount of myocardial oxygen, and are the furthest from the coronary arteries running on the epicardium, and are easily exposed to ischemia. Since the myocardial fibers of the intimal surface extend in the longitudinal direction of the heart, infarction is most sensitive to longitudinal wall motion. Therefore, the wall motion calculation unit 12 calculates the wall motion of the heart wall contacted by the catheter based on the movement of the distal end of the catheter in the longitudinal direction of the heart.

FIG. 3 is a diagram for explaining the calculation of the wall motion of the heart wall by the wall motion calculator 12. As shown in FIG.

The wall motion calculator 12 calculates the distance from the zero point to the distal end of the catheter from the diastolic and systolic X-ray fluoroscopic images of the heart, using the zero point as a reference. As the zero point, the apex, the aortic valve, the mitral valve, or their proximal points can be used. Also, the distance from the zero point to the tip of the catheter can be the distance from the zero point to a predetermined point, such as the tip, at the tip of the catheter. In this embodiment, the distance from the zero point to the tip of the catheter is calculated. Assume that the distance from the zero point to the tip of the catheter is x during diastole of the heart and x-dx during systole of the heart, as shown in FIG. That is, it is assumed that the distance from the zero point to the tip of the catheter changes by dx between the diastole and systole of the heart.

The wall motion calculator 12 calculates, as the wall motion of the heart wall, a strain ε indicating the degree of strain, a strain rate S indicating the rate of strain, and the like. Specifically, the wall motion calculator 12 calculates the strain ε according to the following equation (1). Also, the wall motion calculator 12 calculates the strain rate S according to the following equation (2).
ε=dx/x (1)
S=dε/dt=d(dx/x)/dt=(dx/dt)/x=dv/x (2)

Referring to FIG. 1 again, the wall motion calculation unit 12 outputs the calculation result of the wall motion of the heart wall (strain ε, strain rate S, etc.) to the hibernating myocardium identification unit 14 . The wall motion calculation unit 12 may also output the calculation result of the wall motion of the heart wall to the image processing unit 15 .

The infarction site identification unit 13 identifies the infarction site in the cardiac wall of the subject's heart. The infarct site can be identified, for example, based on electrocardiographic information indicating the electrocardiographic potential of the heart wall. Generally, it is known that the cardiac potential is less than 7.0 mV in the infarct site, and 7.0 mV or more in the normal site and the hibernating myocardium. Therefore, sites where the cardiac potential is below a predetermined threshold (eg, below 7.0 mV) can be identified as infarct sites.

There are various methods for acquiring electrocardiographic information. For example, as a method of acquiring electrocardiographic information, there is a method of acquiring electrocardiographic information by providing an electrode at the distal end of a catheter and bringing the electrode at the distal end of the catheter into contact with the heart wall of the heart. Another method is to use a captured image of the heart captured by a predetermined imaging device such as an ultrasonic diagnostic device, an X-ray CT device, or an MRI device. This method utilizes the fact that the electrical excitation of the myocardium and the contraction of the myocardium are linked, and acquires electrocardiographic information based on the captured image of the heart captured by a predetermined imaging device (various imaging devices described above). . Specifically, electrocardiographic information can be acquired from the contraction propagation pattern due to wall motion observed in the captured image.

In addition, the infarction site identification unit 13 uses a delayed contrast enhancement phase obtained by imaging the heart with a predetermined imaging device such as an ultrasonic diagnostic device, an X-ray CT device, or an MRI device after administering a contrast medium to the heart. Infarct sites can be identified. Early in contrast agent administration, the agent distributes to the myocardial vascular bed and then leaks into the interstitium to fill the extracellular space. Early poor enhancement is thought to reflect vascular bed depletion, and late enhancement reflects enlargement of the extracellular space and interstitial accumulation of contrast agent (delayed contrast washout). Contrast agents do not pass through normal myocardial cell membranes, but when cell membranes are disrupted, such as in acute myocardial infarction, contrast agents passively diffuse into intracellular spaces. Therefore, delayed contrast enhancement is recommended in acute myocardial infarction and myocarditis due to myocardial cell membrane rupture and edema-induced stroma enlargement, and in old myocardial infarction and cardiomyopathy due to stroma enlargement due to fibrosis. supposed to appear. Thus, infarcted areas can be identified as areas that are enhanced by the delayed enhancement phase, and normal areas and hibernating myocardium can be identified as areas that are not enhanced by the delayed enhancement phase.

The infarction site identification unit 13 outputs the identification result of the infarction site (position of the identified infarction site) to the hibernating myocardium identification unit 14 .

The hibernating myocardium identifying unit 14 identifies the hibernating myocardium based on the calculation result of the wall motion of the heart wall output from the wall motion calculating unit 12 and the position of the infarct site identified by the infarct site identifying unit 13 . Wall motion is reduced in infarcted areas and abnormal areas such as hibernating myocardium where the amount of motility is reduced due to chronic ischemia. Here, the reduction in wall motion in the infarcted area is irreversible. On the other hand, the reduction in wall motion in hibernating myocardium is reversible. The hibernating myocardial muscle identification unit 14 hibernates a portion of the region whose wall motion is equal to or less than a predetermined threshold, excluding the region identified by the infarction region identification unit 13 that is not enhanced by the delayed enhancement phase or the region that is enhanced by the delayed enhancement phase. Identify as myocardium. Alternatively, the hibernating myocardial muscle identification unit 14 may identify the hibernating myocardial muscle by excluding a region where the cardiac potential is equal to or greater than the predetermined threshold or a region where the cardiac potential is less than the predetermined threshold among the regions where the wall motion is equal to or less than the predetermined threshold. identified as

The hibernating myocardial muscle identification unit 14 outputs hibernating myocardial muscle position information indicating the position of the identified hibernating myocardium to the image processing unit 15 .

The image processing unit 15 displays and records the wall motion calculation results, hibernating myocardium identification results, and the like on the display device 20 . For example, the image processor 15 may superimpose the wall motion of the heart wall calculated by the wall motion calculator 12 on the X-ray fluoroscopic image of the heart and display it on the display device 20 . The image processing unit 15 may superimpose the hibernating myocardium identified by the hibernating myocardium identifying unit 14 on the X-ray fluoroscopic image of the heart and display it on the display device 20 .

For example, when electrocardiographic information is acquired, the image processing unit 15 converts the electrocardiographic potential and wall motion of the heart wall in contact with the distal end of the catheter into an X-ray image of the heart, as shown in FIG. 4A. It may be displayed on the display device 20 by being superimposed on the fluoroscopic image. In addition, the image processing unit 15 determines that, for example, as shown in FIG. 4B, the electrocardiographic potential and wall motion of the heart wall with which the distal end of the catheter is in contact satisfy predetermined conditions for identifying, for example, hibernating myocardium. A symbol (for example, a “circle” and a “cross”) indicating whether or not the patient has a heart may be superimposed on the X-ray fluoroscopic image of the heart and displayed on the display device 20 . In addition, the image processing unit 15 determines whether the tip of the catheter is in contact with the heart wall on the front side or the heart wall on the back side from the contrast marker, shape, etc. of the tip of the catheter. If possible, information indicating whether the heart wall with which the catheter is in contact is the front wall or the back wall is superimposed on the X-ray fluoroscopic image of the heart and displayed on the display device 20. You may

Further, the image processing unit 15 displays images of different patterns on the display device 20 depending on whether the cardiac potential of the heart wall is equal to or higher than a predetermined threshold or whether the wall motion of the heart wall is equal to or higher than a predetermined threshold. may be displayed. For example, when the electrocardiographic information has been acquired, the image processing unit 15 determines whether the electrocardiographic potential of the heart wall is above a predetermined threshold and whether the wall motion of the heart wall is above a predetermined threshold. Accordingly, as shown in FIG. 5, the display device 20 may change the state of an image composed of three circular portions arranged in a horizontal line and display the image. In this example, the image processing unit 15, for example, when the potential and wall motion of the heart wall are equal to or higher than a predetermined threshold value (when the site is normal), the image processing unit 15 makes the right circular portion light up. When the electrocardiographic potential of the heart wall is equal to or greater than a predetermined threshold and the wall motion is less than the predetermined threshold (in the case of hibernating myocardium), the image processing unit 15 performs state. Further, when the potential and wall motion of the heart wall are less than a predetermined threshold value (infarct site), the image processing unit 15 makes the central circular part light up. In addition, the image processing unit 15 detects when the cardiac potential of the heart wall is less than a predetermined threshold and the wall motion is above the predetermined threshold (normally not assumed), and when the values of the heart wall potential and the wall motion are If not obtained (when the tip of the catheter is not in contact with the heart wall), it is assumed that both circles are extinguished.

Further, the image processing unit 15 maps and records the wall motion of the heart wall calculated by the wall motion calculating unit 12 on a format diagram, which is a two-dimensional image of the atrioventricular chamber obtained from the three-dimensional structural data of the heart. may For example, the image processing unit 15 generates, as a format diagram, a two-dimensional image obtained by extracting the outline of the atrium of the heart when the heart shown in the three-dimensional structural data is viewed from a predetermined direction. The image processing unit 15 may map the hibernating myocardium identified by the hibernating myocardium identifying unit 14 to a format diagram as shown in FIG. 6 and record it. In addition, as shown in FIG. 6, the image processing unit 15 performs at least one of a site into which the infusion material has been injected via the catheter, a site suitable for injecting the infusion material, and a site unsuitable for injecting the infusion material. Information indicating a site may be acquired, and the site indicated by the acquired information may be mapped to a format diagram and recorded. FIG. 6 shows an example of mapping a site into which an infusion material is injected via a catheter and a site unsuitable for injection of the infusion material. Information indicating the site where the injection material is injected through the catheter is determined by, for example, the operator and is input to the image processing device 10 . The information indicating the site where the injection material is injected via the catheter may be acquired by the image processing unit 15 analyzing the intraoperative X-ray fluoroscopic image. In addition, information indicating sites suitable for injection of the injection material and sites not suitable for injection of the injection material is specified by the operator, for example, based on three-dimensional structural data obtained in advance, and subjected to image processing. Input to the device 10 .

The three-dimensional structural data can be acquired in advance using an imaging device such as an ultrasonic diagnostic device, an X-ray CT device, an MRI device, a SPECT device, or a PET device. By using the three-dimensional structure data acquired by these imaging devices, a more accurate format diagram can be created.

As described above, it is possible to determine whether the tip of the catheter is in contact with the heart wall on the front side or the heart wall on the back side by using the contrast marker or the like provided at the tip of the catheter. can. In addition, the operator can determine whether the tip of the catheter is in contact with the heart wall on the front side or the heart wall on the back side during the procedure. Therefore, the image processing unit 15 determines whether the heart wall for which the wall motion has been calculated, the site into which the injection material is injected via the catheter, and the site unsuitable for injection of the injection material are the heart wall on the front side. information indicating whether the heart wall is the heart wall, that is, information in the depth direction can also be included in the format diagram and recorded. In addition, the image processing unit 15 may generate a three-dimensional image, such as a three-dimensional representation of the atrium of the heart, a bull's eye image, etc., using a format diagram including information in the depth direction, and display them on the display device 20. good.

Next, an image processing method executed by the image processing apparatus 10 according to this embodiment will be described with reference to FIG. FIG. 7 is a flow chart showing an example of the operation of the image processing apparatus 10. As shown in FIG.

First, the tip position information acquisition unit 11 indicates the position of the tip of the catheter in an X-ray fluoroscopic image of the atrium of the heart in which the catheter is inserted and the tip of the catheter abuts against the heart wall. Tip position information is acquired (step S11). As described above, the tip position information acquisition unit 11 may acquire tip position information by receiving an input from an operator or the like, or acquire tip position information by analyzing an X-ray fluoroscopic image. good too.

Next, the wall motion calculation unit 12 determines the motion of the tip of the catheter indicated by the tip position information acquired by the tip position information acquisition unit 11 in the longitudinal direction of the heart. Calculate the wall motion of the wall (step S12).

Next, the infarct site identifying unit 13 identifies an infarct site in the heart wall (step S13). The infarct site identification unit 13 identifies the infarct site, for example, based on the electrocardiographic information. In addition, the infarct site identification unit 13 identifies the infarct site, for example, based on the delayed enhancement phase obtained by imaging with a predetermined imaging device after administering a contrast medium to the heart. Cardiac potential information can be acquired, for example, using a catheter having electrodes at its tip. Also, the electrocardiographic information can be acquired based on, for example, an image of the heart captured by a predetermined imaging device.

Next, the hibernating myocardium identifying unit 14 identifies hibernating myocardium based on the wall motion of the heart wall calculated by the wall motion calculating unit 12 and the position of the infarcted site identified by the infarcted site identifying unit 13 (step S14).

In FIG. 7, wall motion is calculated to identify hibernating myocardium, but wall motion is necessary not only for identifying hibernating myocardium but also for various examinations and treatments. Therefore, the image processing apparatus 10 need only have the function of calculating the wall motion and not have the function of identifying the hibernating myocardium. In this case, the infarct site identification unit 13 and the hibernating myocardium identification unit 14 are not essential components. When the image processing apparatus 10 does not need to identify hibernating myocardium, the image processing apparatus 10 performs the processes of steps S11 and S12 shown in FIG. 7 to calculate the wall motion of the heart wall.

Next, in order to determine from the X-ray fluoroscopic image whether the tip of the catheter is in contact with the heart wall on the front side or the heart wall on the back side, a contrast marker is provided at the tip of the catheter. will be described.

FIG. 8 is a diagram showing the vicinity of the distal end portion 2a of the catheter 2, which enables determination of whether the distal end portion is in contact with the heart wall on the near side or the heart wall on the far side. is. As shown in FIG. 8, the contrast marker 3 of the catheter 2 has an asymmetrical shape with respect to an arbitrary imaginary plane that includes the central axis O of the catheter 2 and is parallel to the central axis O. As shown in FIG. Specifically, FIG. 8 shows two virtual planes Y1 and Y2 as examples of virtual planes that include and are parallel to the central axis O of the catheter 2 . As shown in FIG. 8, the contrast marker 3 has an asymmetrical shape with respect to each of the virtual planes Y1 and Y2. In other words, the contrast marker 3 has a shape that is not symmetrical with respect to all imaginary planes that include the central axis O of the catheter 2 and are parallel to the central axis O. As shown in FIG. Hereinafter, for convenience of explanation, an arbitrary virtual plane that includes the central axis O of the catheter 2 and is parallel to the central axis O is simply referred to as "virtual plane Y".

By configuring the contrast marker 3 in such a manner, depending on the appearance of the contrast marker 3 in the X-ray fluoroscopic image, the front-back direction perpendicular to the projection plane in the X-ray fluoroscopic image (hereinafter simply referred to as the "back-front direction A") ) can be identified.

As shown in FIG. 8 , the contrast marker 3 of this embodiment includes a first contrast marker section 4 and a second contrast marker section 5 . The first contrast marker part 4 has an asymmetrical shape with respect to a first intermediate virtual plane in the virtual plane Y that passes through the intermediate position of the second contrast marker part 5 in the circumferential direction B. As shown in FIG. In addition, the second contrast marker part 5 has an asymmetrical shape with respect to a second intermediate virtual plane in the virtual plane Y that passes through the intermediate position of the first contrast marker part 4 in the circumferential direction B. As shown in FIG. The "first intermediate virtual plane" in this embodiment is the virtual plane Y1 shown in FIG. Also, the "second intermediate virtual plane" in this embodiment is the virtual plane Y2 shown in FIG.

The first contrast marker part 4 of the present embodiment is formed over at least a partial area in the circumferential direction B of the catheter 2 . More specifically, the first contrast marker part 4 of the present embodiment linearly extends in the circumferential direction B. As shown in FIG. Also, the first contrast marker part 4 of the present embodiment is provided at the distal end part 2 a of the catheter 2 . More specifically, the first contrast marker part 4 of the present embodiment is linearly formed in the circumferential direction B on the distal end surface of the catheter 2 .

The second contrast marker part 5 of the present embodiment linearly extends along the central axis direction C parallel to the central axis O. As shown in FIG.

An identification method for identifying movement of the catheter 2 in the back-front direction A based on how the contrast markers 3 appear as shown in FIG. 8 will be described below. 9A to 9F show the case where the distal end portion 2a of the catheter 2 is viewed in the direction of the white arrow P1 shown in FIG. 8 (hereinafter simply referred to as "viewed from the point of view of the arrow P1"). is a diagram showing how the contrast marker 3 of .

9A shows a state in which the distal end portion 2a of the catheter 2 is not deformed in the back-front direction A when viewed from the viewpoint of the arrow P1, that is, the distal end portion 2a of the catheter 2 is deformed in a direction perpendicular to the direction of the arrow P1. extended state. The distal end portion 2a of the catheter 2 in the state shown in FIG. 9A appears in the state of FIG. 9B when viewed from the viewpoint of the arrow P1. As shown in FIG. 9B, when viewed from the viewpoint of arrow P1, the first contrast marker portion 4 of the contrast marker 3 has a shape extending linearly along the radial direction D orthogonal to the central axis direction C. looks like Further, as shown in FIG. 9B, when viewed from the viewpoint of arrow P1, the second contrast marker portion 5 of the contrast marker 3 appears to have a shape extending linearly along the central axis direction C. As shown in FIG.

9C shows that when viewed from the viewpoint of arrow P1, the distal end portion 2a of the catheter 2 is in the front direction A2 (downward in FIG. 9C) compared to the state shown in FIG. 9A. It shows a deformed state in the direction approaching the point of view when viewed from the point of view P1. The distal end portion 2a of the catheter 2 in the state shown in FIG. 9C appears in the state of FIG. 9D when viewed from the viewpoint of arrow P1. As shown in FIG. 9D, when viewed from the viewpoint of arrow P1, the first contrast marker portion 4 of the contrast marker 3 appears to have an arc shape that is convex toward the base end side in the direction C of the center axis. As shown in FIG. 9D, the second contrast marker part 5 of the contrast marker 3 looks like a shape extending linearly along the central axis direction C when viewed from the viewpoint of the arrow P1. The position of the second contrast marker part 5 in the radial direction D orthogonal to the central axis direction C in FIG. 9D is the same as the position of the second contrast marker part 5 in the radial direction D in FIG. 9B. Thus, the shape of the first contrast marker part 4 in FIG. 9D differs from the shape of the first contrast marker part 4 in FIG. 9B. On the other hand, the position and shape of the second contrast marker part 5 in FIG. 9D appear to be the same as the position and shape of the second contrast marker part 5 in FIG. 9B.

9E shows that when viewed from the viewpoint of arrow P1, the distal end portion 2a of the catheter 2 is in the depth direction A1 (upward in FIG. 9E) compared to the state shown in FIG. 9A. It shows a deformed state in the direction away from the viewpoint when viewed from the viewpoint P1. The distal end portion 2a of the catheter 2 in the state shown in FIG. 9E appears in the state of FIG. 9F when viewed from the viewpoint of the arrow P1. As shown in FIG. 9F , when viewed from the viewpoint of arrow P1, the first contrast marker portion 4 of the contrast marker 3 appears to have an arc shape that is convex toward the distal end side in the central axis direction C. As shown in FIG. As shown in FIG. 9F , the second contrast marker part 5 of the contrast marker 3 looks like a shape extending linearly along the central axis direction C when viewed from the viewpoint of the arrow P1. The position of the second contrast marker part 5 in the radial direction D perpendicular to the central axis direction C in FIG. 9F is the same as the position of the second contrast marker part 5 in the radial direction D in FIGS. 9B and 9D. That is, the shape of the first contrast marker part 4 in FIG. 9F is different from the shape of the first contrast marker part 4 in FIGS. 9B and 9D. On the other hand, the position and shape of the second contrast marker part 5 in FIG. 9F are the same as the position and shape of the second contrast marker part 5 in FIGS. 9B and 9D.

Therefore, in the X-ray fluoroscopic image obtained by fluoroscopy from the direction of arrow P1 shown in FIG. Movement in the near direction A can be discerned. More specifically, in this embodiment, when the shape of the first contrast marker part 4 looks like an arc that is convex toward the base end side in the direction C of the central axis, it moves in the front direction A2 of the back-front direction A. It is possible to identify the presence or movement (see FIGS. 9C and 9D). In addition, in the present embodiment, when the shape of the first contrast marker part 4 looks like an arc that is convex toward the tip side in the central axis direction C, it means that the first contrast marker part 4 is moving in the depth direction A1 of the back-front direction A. Alternatively, movement can be identified (see FIGS. 9E and 9F).

When the distal end portion 2a of the catheter 2 is viewed in the direction of the outline arrow P2 shown in FIG. 8, when the distal end portion 2a of the catheter 2 is viewed in the direction of the outline arrow P3 shown in FIG. 8, and Similarly, when the distal end portion 2a of the catheter 2 is viewed in the direction of the outline arrow P4 shown in FIG. In the fluoroscopic image, by observing the change in the shape of the first contrast marker part 4 and the positional relationship between the first contrast marker part 4 and the second contrast marker part 5, the distal end portion 2a of the catheter 2 can be seen in the front and back direction. Motion in A can be identified.

As described above, according to the present embodiment, the image processing apparatus 10 captures an X-ray fluoroscopic image of the atrium of the heart in which the catheter 2 is inserted and the tip portion 2a of the catheter 2 is in contact with the heart wall from a predetermined direction. a tip position information acquisition unit 11 that acquires tip position information indicating the position of the tip 2a of the catheter 2 in the heart a wall motion calculator 12 for calculating the wall motion of the heart wall with which the distal end portion 2a of the catheter 2 is in contact, based on the longitudinal motion of the .

In the X-ray fluoroscopic image, the position of the tip 2a of the catheter 2 inserted into the atrium of the heart is specified, and based on the movement of the tip 2a of the catheter 2 in the longitudinal direction of the heart, the wall motion of the heart wall is determined. can be calculated (detected). Therefore, wall motion of the heart wall can be detected more easily without using an imaging device other than an X-ray fluoroscope.

Further, according to the present embodiment, the image processing apparatus 10 includes the infarct site identification unit 13 that identifies the infarct site in the heart wall of the heart, the wall motion of the heart wall calculated by the wall motion calculation unit 12, the infarct site A hibernating myocardium identifying unit 14 for identifying the hibernating myocardium based on the position of the infarction site identified by the identifying unit 13 is further provided.

In the X-ray fluoroscopic image, the position of the tip 2a of the catheter 2 inserted into the atrium of the heart is specified, and based on the movement of the tip 2a of the catheter 2 in the longitudinal direction of the heart, the wall motion of the heart wall is determined. can be calculated (detected). Therefore, it is possible to more easily detect wall motion of the heart wall and identify hibernating myocardium without using an imaging device other than an X-ray fluoroscope.

Although not specifically mentioned in the embodiment, the image processing apparatus 10 can also be realized by a computer and a program. Also, the program may be recorded on a computer-readable medium. It can be installed on a computer using a computer readable medium. Here, the computer-readable medium on which the program is recorded may be a non-transitory recording medium. The non-transitory recording medium is not particularly limited, but may be, for example, a recording medium such as CD-ROM and DVD-ROM. Also, the program can be provided via a network.

The present invention is not limited to the configurations specified in the above-described embodiments, and various modifications are possible without departing from the gist of the invention described in the claims. For example, the functions included in each component and each step can be reconfigured so as not to be logically inconsistent, and multiple components or steps can be combined into one or divided. is.

2 Catheter 2a Catheter Tip 3 Contrast Marker 4 First Contrast Marker Section 5 Second Contrast Marker Section 10 Image Processing Apparatus 11 Tip Position Information Acquisition Section 12 Wall Motion Calculation Section 13 Infarction Site Identification Section 14 Hibernating Myocardium Identification Section 15 Image Processing Part 20 Display device

Claims (13)

Tip position information for acquiring tip position information indicating the position of the tip of the catheter in an X-ray fluoroscopic image obtained by imaging from a predetermined direction the atrium of the heart in which the tip of the catheter is in contact with the heart wall. an acquisition unit;
A wall motion of the heart wall contacted by the tip of the catheter is calculated based on the movement of the tip of the catheter in the longitudinal direction of the heart indicated by the tip position information acquired by the tip position information acquisition unit. a wall motion calculator;
an infarction site identification unit that identifies an infarction site in the heart wall of the heart;
an image processing apparatus comprising: a hibernating myocardium identifying unit that identifies hibernating myocardium based on the wall motion of the heart wall calculated by the wall motion calculating unit and the position of the infarct site identified by the infarct site identifying unit. The image processing device according to claim 1,
A contrast marker is provided at the distal end of the catheter,
The image processing device, wherein the tip position information acquisition unit acquires the tip position information based on the position of the contrast marker in the X-ray fluoroscopic image. The image processing device according to claim 1 or 2,
An image processing apparatus, further comprising an image processing unit that superimposes the wall motion of the heart wall calculated by the wall motion calculation unit on the X-ray fluoroscopic image and displays the image on a display device. In the image processing device according to claim 3,
The image processing unit maps and records the wall motion of the heart wall calculated by the wall motion calculation unit on a format diagram that is a two-dimensional image of the atrioventricular chamber obtained from the three-dimensional structural data of the heart. image processing device. In the image processing device according to claim 4,
The image processing unit maps at least one of a site into which the injection material is injected through the catheter, a site suitable for injection of the injection material, and a site unsuitable for injection of the injection material onto the format drawing. image processing device for recording. The image processing device according to claim 4 or 5,
The image processing unit uses the recorded format diagram to generate at least one of a three-dimensional image and a bull's eye image in which the chambers of the heart are three-dimensionally displayed. In the image processing device according to any one of claims 1 to 6 ,
An electrode is provided at the tip of the catheter,
The infarction site identification unit acquires, via the electrode, electrocardiographic information indicating the electrocardiographic potential of the heart wall with which the tip of the catheter abuts, and identifies the infarct site based on the acquired electrocardiographic information. Image processing device. In the image processing device according to any one of claims 1 to 6 ,
The infarct site identification unit acquires electrocardiographic information indicating the electrocardiographic potential of the heart wall based on the captured image of the heart captured by a predetermined imaging device, and identifies the infarct site based on the acquired electrocardiographic information. image processing device. In the image processing device according to any one of claims 1 to 6 ,
The image processing device, wherein the infarct site identification unit identifies the infarct site based on a delayed contrast enhancement phase obtained by imaging with a predetermined imaging device after administering a contrast medium to the heart. In the image processing device according to any one of claims 1 to 9 ,
The image processing apparatus further comprising an image processing unit that superimposes the hibernating myocardium identified by the hibernating myocardium identification unit on the X-ray fluoroscopic image and displays the image on a display device. In the image processing device according to claim 10 ,
The image processing unit maps and records the hibernating myocardium identified by the hibernating myocardium identification unit on a format diagram that is a two-dimensional image of the atrioventricular chamber obtained from the three-dimensional structural data of the heart. Device. An image processing method executed by an image processing device,
a step of acquiring tip position information indicating the position of the tip of the catheter in an X-ray fluoroscopic image obtained by imaging from a predetermined direction the atrium of the heart in which the tip of the catheter is in contact with the heart wall;
calculating the wall motion of the heart wall contacted by the tip of the catheter based on the movement of the tip of the catheter in the longitudinal direction of the heart indicated by the acquired tip position information;
identifying a site of infarction in the wall of the heart;
and identifying hibernating myocardium based on the calculated wall motion of the heart wall and the location of the identified infarcted region. A program that causes a computer to function as the image processing apparatus according to any one of claims 1 to 11 .

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