US20070038081A1 - Device and method for displaying ultrasound images of a vessel - Google Patents

Device and method for displaying ultrasound images of a vessel Download PDF

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Publication number
US20070038081A1
US20070038081A1 US10/570,235 US57023504A US2007038081A1 US 20070038081 A1 US20070038081 A1 US 20070038081A1 US 57023504 A US57023504 A US 57023504A US 2007038081 A1 US2007038081 A1 US 2007038081A1
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United States
Prior art keywords
vessel
images
parameter
image
memory
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Abandoned
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US10/570,235
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English (en)
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Kai Eck
Barbara Martin-Leung
Jorg Bredno
Jurgen Weese
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Koninklijke Philips NV
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Koninklijke Philips Electronics NV
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Assigned to KONINKLIJKE PHILIPS ELECTRONICS, N.V. reassignment KONINKLIJKE PHILIPS ELECTRONICS, N.V. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: WEESE, JURGEN, BREDNO, JORG, ECK, KAI, MARTIN-LEUNG, BARBARA
Publication of US20070038081A1 publication Critical patent/US20070038081A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4416—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/12—Devices for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5247—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters

Definitions

  • the invention relates to a device and a method for displaying a vessel with the aid of ultrasound images, the vessel being subject to a cyclic intrinsic movement.
  • angiograms of the vascular system may than be of assistance, for example, in locating the site of a lesion that is to be treated, or else they may be used as (static) road maps for navigating a catheter during a subsequent medical intervention.
  • IVUS probes intravascular ultrasound probes
  • a catheter can guide ultrasound section images transversely to the vessel axis.
  • Ultrasound images are often generated in a so-called pullback sequence using an IVUS probe.
  • the IVUS probe is pulled back through the vessel at a defined speed while at the same time recording a series of ultrasound images.
  • the IVUS images provide useful additional information about the vessel or a vessel lesion, for example the length of a vessel section affected by a disease, the minimum/maximum thickness of a vessel, the type of a deposit and the like.
  • U.S. Pat. No. 6,148,095 discloses a method of reconstructing three-dimensionally winding vessels such as, for example, the coronary vessels, in which firstly the three-dimensional course of the vessel is reconstructed from biplanar angiographs, and this is then combined with the two-dimensional section images of an IVUS pullback sequence.
  • the result is a static representation of the vascular tree, in which intrinsic movements and deformations on account of the heartbeat and/or breathing cannot be seen.
  • the treating physician When navigating a catheter with an intervention device such as, for example, a stent or a balloon toward a lesion during a medical intervention, the treating physician therefore has to correlate the current fluoroscopic images of the catheter with the static three-dimensional vessel model in order to be able to use the information contained in the IVUS images.
  • an intervention device such as, for example, a stent or a balloon toward a lesion during a medical intervention
  • the device which is used to display a vessel or a section of a vascular system, comprises the following components:
  • Said ultrasound images may have been generated, for example, with the aid of an intravascular ultrasound probe.
  • the images may come from an IVUS pullback sequence, wherein as the IVUS probe is being pulled back, the respective stopping location of the IVUS probe in the vessel is determined in parallel by means of further imaging. The latter may moreover be estimated from existing images of the vascular system (angiographs).
  • a data input for information which describes (at least) a current location in the vessel a pointer (mouse, etc.) could be connected to this input, by means of which pointer a user indicates, on a road map, a current location of interest to him in the vessel, or else a locating device could be connected to said input, which locating device detects, for example by means of magnetic fields, the current stopping location of an intervention device on a catheter.
  • a pointer mouse, etc.
  • a locating device could be connected to said input, which locating device detects, for example by means of magnetic fields, the current stopping location of an intervention device on a catheter.
  • a display unit such as, for example, a monitor for displaying images of the vessel.
  • the device comprising the described components is furthermore designed to select from said memory at least one ultrasound image and to display it on the display unit, wherein the ultrasound image corresponds to the current location in the vessel indicated at the data input.
  • an ultrasound image whose associated recording location is identical to the current location or is no more than a predefined distance from the latter may be selected from the memory.
  • the selection function may be implemented in the device for example by means of a suitably programmed microprocessor.
  • the invention comprises a device for displaying a vessel or a section of a vascular system which is subject to a cyclic intrinsic movement.
  • the most important typical causes of such an intrinsic movement are the heartbeat and breathing.
  • the most important typical causes of a change in the vessel cross section is pathological constriction.
  • the cyclic intrinsic movement is to be characterized by a (single-component or multicomponent) parameter.
  • this parameter is for example the electrical heartbeat phase that can be quantitatively described by the electrocardiogram (ECG).
  • ECG electrocardiogram
  • Said ultrasound images may have been generated, for example, with the aid of an intravascular ultrasound probe.
  • the images may come from an IVUS pullback sequence, wherein as the IVUS probe is being pulled back, the parameter of the intrinsic movement (for example the ECG) is recorded in parallel, as is preferably also the respective stopping location of the IVUS probe in the vessel, using methods of the type mentioned above.
  • the latter may moreover be estimated from existing images of the vascular system (angiographs).
  • a display unit such as, for example, a monitor for displaying images of the vessel.
  • the device comprising the described components is furthermore designed to select from said memory at least one ultrasound image and to display it on the display unit, wherein the selected ultrasound image corresponds to the current value of the parameter of the intrinsic movement at the data input.
  • an ultrasound image whose associated ECG phase is identical to the current ECG phase or deviates from the latter by no more than a predefined amount may be selected from the memory.
  • the selection function may be implemented in the device for example by means of a suitably programmed microprocessor.
  • the device may moreover also have the features of a device according to the first aspect of the invention, that is to say an additional indexing of the ultrasound images by their recording location, a data input for a current location and also a selection function that is additionally based on the location.
  • special refinements of the invention are hereinbelow described in parallel for the “device according to the first and/or second aspect of the invention”.
  • the described devices according to the first and/or second aspect of the invention allow, in real time during a medical intervention, optimal use of information contained in IVUS images of a vessel or vessel lesion. This is made possible in that the device determines and displays on the display unit the IVUS image(s) corresponding to a current location in the vessel and/or to the current phase of the cyclic intrinsic movement. The physician therefore need not be satisfied with a possibly misleading static display of IVUS images, but rather sees at all times the images corresponding to the actual state. This makes it much easier for him to navigate a catheter to the desired target position such as, for example, a stenosis.
  • the device therefore preferably comprises an electrocardiograph for recording a (electrical) parameter that characterizes the heart phase and/or a breathing sensor for recording a parameter that characterizes the breathing phase.
  • the device according to the first and/or second aspect of the invention furthermore preferably comprises an intravascular ultrasound probe (IVUS probe), by means of which the ultrasound images stored in said memory can be generated.
  • IVUS probe intravascular ultrasound probe
  • Such IVUS images contain useful additional information for assessing the condition of a vessel.
  • the device according to the first and/or second aspect of the invention may furthermore comprise an X-ray device for generating X-ray projection images of the vessel.
  • the X-ray device may in particular be coupled to a data input of the device in order to provide a current image of the vessel in the form of an X-ray projection image.
  • the X-ray projections may also be used during generation of a (pullback) sequence of IVUS images, in order to determine the respective stopping location of the IVUS probe.
  • the device according to the first and/or second aspect of the invention comprises a device for injecting contrast agent into the vessel.
  • contrast agent injections it is possible to considerably improve the representation of the vessel on (X-ray) images.
  • angiograms can be produced using a contrast agent and an X-ray device.
  • the device may comprise a further memory in which angiograms of the vessel are stored, these being indexed with the respective values of the parameter of the cyclic intrinsic movement belonging to their recording time according to the second aspect of the invention.
  • the device is in this case furthermore designed to select from said further memory and display on the display unit at least one angiogram corresponding to the current value of the parameter of the intrinsic movement.
  • the angiograms which clearly show the course of the vessel, are thus displayed on the display unit in real time in a manner corresponding to the actual state of the intrinsic movement (for example heartbeat phase or breathing phase).
  • the ultrasound images and the angiograms are preferably stored in the same physical memory at different storage locations.
  • said device has a data input for data of a current image of the vessel.
  • This current image may be, for example, an X-ray image or an NMR image of the vessel.
  • the device is designed to determine from a current image of the vessel the position of an object of interest (e.g. a specific anatomical structure or a catheter in the vessel) and use it as “current location” to select a corresponding ultrasound image from the memory.
  • an object of interest e.g. a specific anatomical structure or a catheter in the vessel
  • the physician thus obtains a display of ultrasound images that is updated in real time and corresponds to the position of an object of interest, so that he can make optimal use of the information contained therein. Furthermore, the current image present in each case at the data input is preferably also displayed on the display unit together with the intravascular ultrasound images, and this allows the physician to observe a medical intervention in an optimal manner.
  • the device may furthermore be designed to display an (any) image of the vessel on the display unit and to show with reference to this image the geometric position of an ultrasound image that is likewise displayed on the display unit.
  • the image of the vessel may for example be a current image or a stored angiogram of the vessel. Since, in respect of each ultrasound image, it is known at which position of the vessel it was generated, this position of the ultrasound image can be marked, for example by means of an arrow or a cross, on the image of the vessel that is displayed. The user can then see at a glance to which location a displayed ultrasound image belongs.
  • the invention furthermore relates to a method of displaying a vessel, said method comprising the following steps:
  • the invention moreover also relates to a method of displaying a vessel which is subject to a cyclic intrinsic movement that can be characterized by a parameter.
  • the method may in particular be combined with a method of the type mentioned above and comprises the following steps:
  • the single figure schematically shows the components of a device according to the invention for displaying a vessel.
  • the left-hand part of the figure shows a vessel (segment) 2 within the body of a patient 1 , wherein said vessel may be, for example, a coronary vessel.
  • X-ray projection images A of the vessel 2 may be generated by means of an X-ray radiation source 3 and an X-ray detector 7 , and forwarded to a data processing device 8 (workstation, etc.).
  • an IVUS probe 5 for generating intravascular ultrasound images I is arranged at the tip of a catheter 6 .
  • a so-called pullback sequence (see dashed lines) can be generated when the probe 5 is pulled back through the vessel at a defined speed and in the process generates ultrasound section images I at regular time intervals, said ultrasound section images being transmitted to the data processing device 8 .
  • the position of the IVUS probe 5 during an image I generated by the latter, which position can be described by a coordinate x, may be determined in various ways. For instance, by way of example it is possible during the ultrasound recordings for X-ray projections to be produced at the same time, from which the associated position of the IVUS probe 5 can be determined.
  • an electrocardiograph 4 is also shown in the left-hand part of the figure, by means of which the electrical heart activity E (electrocardiogram) can be recorded and fed to the data processing device 8 .
  • the ECG represents a parameter E for characterizing the heartbeat phase, which has a dominating effect on the location and the shape of the vessel 2 .
  • the data processing device 8 comprises a central processor 9 (CPU) which receives the abovementioned information (ECG E, IVUS images I, X-ray projections A) and further processes it.
  • the processor 9 is connected to two memories or memory areas 10 and 11 (RAM, hard disk, etc.) and also to a display unit 12 (monitor).
  • IVUS images I Stored in the first memory area 10 are the IVUS images I which have been generated in a pullback sequence of the IVUS probe 5 .
  • the ECG E was recorded in parallel.
  • the sensory detection of the breathing cycle and the indexing of the ultrasound images I with a corresponding parameter is not shown in the figure for reasons of clarity. However, it is preferably likewise carried out and dealt with in a manner similar to the characterizing by the ECG E.
  • the second memory area 11 comprises a sequence of angiograms A*. These are X-ray projections of the vessel 2 which have been recorded with administration of contrast agent. By virtue of a parallel recording of the ECG E, the angiograms A* can once again be indexed by the associated heartbeat phase (and in accordance with what has been stated above also by a breathing cycle).
  • the generation of the ultrasound images I(E,x) of the memory area 10 and where appropriate of the angiograms A*(E) of the memory area 11 takes place in the run-up to a medical intervention.
  • a medical intervention e.g. the placing of a stent with the aid of a catheter 13
  • the catheter must be pushed as precisely as possible up to the actual stenosis with continual X-ray-fluoroscopic observation (but without contrast agent in order to minimize the exposure of the patient).
  • the precise placing of the stent in this case has a decisive effect on the success of the intervention or the risk of subsequent restenosis.
  • the data processing device 8 is designed, by means of corresponding programs for the processor 9 , etc., to carry out the steps explained below.
  • the catheter 13 is pushed up to the lesion under continual fluoroscopic observation.
  • the instantaneous stopping location of the catheter 13 is located by the data processing device 8 , and the X-ray image A t is displayed on the display unit 12 .
  • the angiographic image A*(E) that best corresponds to the current fluoroscopic image A t in terms of the ECG phase can be selected from the memory area 11 , and displayed for example on the display unit 12 next to the image A t or superposed on the latter. Details of such a combination of current fluoroscopic images and static “road maps” are known and therefore do not have to be discussed in any more detail in the present text.
  • one or more IVUS images I(E,x) are selected from the memory area 10 by the data processing device 8 in a manner corresponding to the ECG phase E of the current image A t .
  • three IVUS images I 1 , I 2 , I 3 have been determined in this way and displayed on the display unit 12 next to the picture of the current image A t .
  • the choice of IVUS images I 1 , I 2 , I 3 corresponding to the heartbeat phase of the current image A t ensures that the physician is shown on the monitor 12 at all times X-ray information and intravascular ultrasound information from the same current heartbeat phase. In this way he can make optimal use of the important information contained in the IVUS images.
  • the IVUS images I 1 , I 2 , I 3 displayed on the monitor 12 belong to various known positions x along the vessel 2 . As shown in the figure, in this respect the physician is shown the respective location of the IVUS images I 1 , I 2 , I 3 for example by connecting lines on the current image A t .
  • the processor 9 selects, among the IVUS images I(E,x) from the memory area 10 , only one (or a few) which have been generated at least approximately at the current stopping location of the catheter 13 . In a modification of the figure, therefore, only the IVUS image I 2 which corresponds to the current stopping location of the catheter tip 13 would be displayed on the monitor 12 . The physician then sees, next to the current fluoroscopic image A t , at all times the associated vessel cross section at the location of the catheter tip. In this connection, it may be useful or necessary to carry out a weighting of the selection criteria “corresponding to the stopping location of the object” and “corresponding to the ECG phase”.
US10/570,235 2003-09-04 2004-08-23 Device and method for displaying ultrasound images of a vessel Abandoned US20070038081A1 (en)

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PCT/IB2004/051525 WO2005024729A1 (fr) 2003-09-04 2004-08-23 Dispositif et procede d'affichage d'images ultrasonores d'un vaisseau

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