Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/48—Diagnostic techniques
  • A61B6/481—Diagnostic techniques involving the use of contrast agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/46—Arrangements for interfacing with the operator or the patient
  • A61B6/461—Displaying means of special interest
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
  • A61B6/504—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of blood vessels, e.g. by angiography

Definitions

• the present invention provides a method in which a physician injects a pseudo-contrast agent into relevant blood vessels of an in-vivo organ such as a liver in clinical practice, and pseudo-displays the flow of the pseudo-injected contrast agent.
• the present invention relates to a medical image display method and apparatus for assisting a doctor in diagnosis and treatment. Background art
• medical image diagnostic apparatuses such as an X-ray imaging apparatus, an X-ray CT apparatus, and an MRI apparatus have been actively used not only for diagnosis but also for treatment.
• Patent Document 1 describes extracting a specific region of an organ based on a running state of a blood vessel in a single organ.
• Patent Document 1 Japanese Patent Application Laid-Open No. 2001-283191
• the medical image display method of the present invention includes an organ display step of displaying an image of a predetermined organ including a desired blood vessel in a medical image on a display, and an image of the predetermined organ displayed in the organ display step.
• the flow of the contrast agent in the blood vessel can be displayed in a simulated manner, which can be used for a doctor's diagnosis and treatment.
• the contrast agent may not be injected into the patient. Since the flow of the agent into the blood vessel is a burden on the patient, the pseudo-contrast mode in which the contrast agent flows into the blood vessel in a pseudo manner is also beneficial for the patient.
• the method further includes a tissue boundary calculation step of calculating a tissue boundary of a related region related to the desired blood vessel selected in the blood vessel selection step.
• the image display step in the mode the image is displayed as if a contrast agent was pseudo-flowed from the specific position to the selected blood vessel and the related area of the blood vessel based on the tissue boundary calculated in the tissue boundary calculation step. Including doing.
• the flow of the contrast agent in the related area affected by the contrast agent injected into the blood vessel can be displayed in a pseudo manner.
• the image display step in the pseudo contrast mode includes a pseudo contrast enhancement up to a related area calculated in the tissue boundary calculation step from the specific position map. Including sequentially displaying the flow of the agent.
• the blood vessel selecting step sets a region of interest when extracting the image of the predetermined organ
• the tissue boundary calculating step includes: Calculating the tissue boundary based on a region.
• the calculation target is limited to the region of interest, so that the calculation time can be shortened compared to the whole organ.
• the blood vessel selecting step includes arbitrarily setting a specific position of the desired blood vessel as a virtual contrast medium inflow start position.
• the method further includes the step of setting an end position with respect to the set injection start position, wherein the image display step in the pseudo contrast mode includes the injection start This includes sequentially displaying the flow of the simulated contrast agent from the position to the end position. Accordingly, the start position and the end position of the range of the virtual contrast agent to be observed can be arbitrarily set, so that the degree of freedom in setting the contrast agent observation range can be further increased.
• the image display step in the pseudo-contrast mode includes the pseudo-contrast up to substantially the entire relevant region of the selected and designated blood vessel. Including sequentially displaying the flow of the agent.
• the step of displaying an image in the pseudo contrast mode includes sequentially displaying a path in which the contrast agent flows in a pseudo manner. This allows the observer to identify at a glance how far the simulated contrast agent that has flowed into the sequentially displayed blood vessel to be observed flows.
• the highlighting includes filling the locus with a predetermined color or luminance. Filling here means that the contrast agent simulates circulating in the blood vessel in relation to the surroundings, so it can change the color of the surroundings, blink the already flowing part, etc. Is a concept including various display forms. This makes it clear that the observer can identify at a glance how far the pseudo-contrast agent that has flowed into the sequentially displayed observation target blood vessel has flowed.
• the image display step in the pseudo contrast mode includes a pseudo contrast agent from a predetermined position of a blood vessel selected in the blood vessel selection step to a peripheral blood vessel. Including displaying the flows sequentially.
• the state in which the contrast agent simulates circulates in the blood vessel can be sequentially observed toward the peripheral force of the position of the blood vessel to be observed.
• the medical image display device of the present invention includes an organ display means for displaying an image of a predetermined organ including a desired blood vessel in a medical image on a display, and an image of the predetermined organ displayed by the organ display means.
• a blood vessel selecting means for selecting the desired blood vessel and specifying a specific position of the desired blood vessel, and a contrast agent is simulated on the blood vessel selected by the blood vessel selecting means.
• Image display means in a pseudo-contrast mode for displaying the image as if it had flowed. In this way, the flow of the contrast agent in the blood vessel can be displayed in a simulated manner, which can be used for a doctor's diagnosis and treatment.
• FIG. 1 is a block diagram showing a hardware configuration of an entire medical image display device to which the present invention is applied.
• FIG. 2 is a diagram showing a relationship between a tomographic image and data.
• FIG. 3 is a diagram showing an example of a main flow executed by the medical image display device.
• FIG. 4 is a view showing an example of a main blood vessel displayed on a CRT display 14.
• FIG. 5 is a view showing a state after a main blood vessel is clicked.
• FIG. 6 is a diagram specifically showing a method of determining a boundary of a region controlled by a blood vessel.
• FIG. 7 is a view showing a general relationship between a blood vessel cross-sectional area and a blood flow velocity.
• FIG. 8 is a diagram showing the relationship between flowing blood flow and time.
• FIG. 9 is a diagram showing a state in which blood flow has reached the periphery of a blood vessel at time tk.
• FIG. 10 is a view showing a state in which a blood flow flows out through a capillary at time tk + 1.
• FIG. 11 is a view showing a state in which a blood flow flows out through a capillary at time tk + 2.
• FIG. 12 is a view showing a state in which a contrast agent has spread over the entire area controlled by blood vessels.
• FIG. 1 is a block diagram showing a hardware configuration of the entire medical image display device to which the present invention is applied.
• This medical image display apparatus uses, for example, an X-ray CT image obtained by performing a contrast-enhanced imaging of a liver as a processing target image, and uses a running information of a blood vessel to specify a region of the liver, and to remove the liver using the procedure. It displays the area.
• This medical image display apparatus stores a central processing unit (CPU) 10 for controlling the operation of each component, a main memory 11 storing a control program for the entire apparatus, and a plurality of tomographic image data and programs.
• CPU central processing unit
• a magnetic disk 12 a display memory 13 for temporarily storing image data for display, a CRT display 14 as a display device for displaying an image based on the image data from the display memory 13, and an on-screen display.
• Operate the soft switch It comprises a mouse 15 and its controller 16, a keyboard 17 having keys and switches for setting various parameters, a speaker 18, and a common bus 19 for connecting the above components.
• a force is shown in which only the magnetic disk 12 is connected as a storage device other than the main memory 11.
• a floppy disk drive, a hard disk drive, a CD-ROM drive, A magneto-optical disk (MO) drive, ZIP drive, PD drive, DVD drive, etc. may be connected.
• it can be connected to various communication networks such as LAN (local area network), the Internet, and telephone lines via a communication interface to exchange image data with other computers and CT equipment lb. It may be.
• the exchange of image data may be performed by connecting a medical image display device such as an X-ray CT device or an MRI device capable of collecting a tomographic image of the subject to the communication network la such as the LAN.
• FIG. 2 is a diagram showing a relationship between a tomographic image and data.
• Fig. 2 (A) multiple tomographic images 21 acquired by an image diagnostic device capable of three-dimensional measurement such as an X-ray CT device or MRI device are stacked, and a stacked tertiary image as shown in Fig. 2 (B).
• the original image 22 is used, and the image of the predetermined organ (object to be processed) is made three-dimensional.
• the stacked three-dimensional image 22 includes a liver tissue and arteries, veins, tumors, etc., and is a pseudo three-dimensional image projected and shaded on a two-dimensional projection plane (not shown). Is displayed on the CRT display 14 in FIG. 1, for example.
• FIG. 3 is a diagram showing an example of a main flowchart of a pseudo-contrast display mode executed by the medical image display device.
• the CPU 10 of FIG. 1 operates according to the main flowchart.
• the momentary state when a contrast agent is injected into a certain blood vessel in the liver will be described using an example of a screen displayed on the CRT display 14.
• details of the main flowchart will be described in the order of steps.
• the main blood vessels are extracted from the three-dimensional image.
• the extraction of the main blood vessels is performed by a conventionally known region expansion method or the like.
• the area extension method means that adjacent pixels When a condition such as a value is satisfied, the area is regarded as the same area and is sequentially taken in.
• FIG. 4 is a diagram illustrating an example of a state of the extracted main blood vessel.
• the cursor 15a of the mouse 15 is moved with respect to the main blood vessel displayed on the CRT display 14, and the contrast medium injection part is selected and clicked. As a result, as shown in FIG. 5, an injection position line 41 indicating where the color contrast agent has been injected into the main blood vessel 40 is displayed.
• step S33 is skipped.
• the injection position line 41 From the location where the contrast medium was injected, the injection position line 41, the trajectory toward the periphery of the blood vessel is highlighted. For example, in the figure, one line is filled from the injection position line 41 to the peripheral end of the blood vessel. That is, the flow rate in the blood vessel is approximated to be constant, and one line (multiple lines may be used) is added to the front line in the blood vessel based on the injection position line 41, and the state is displayed on the CRT display 14. To display.
• V02 S3 -V3 + S03 -V03
• step S36 It is determined whether or not the main vessel has been filled. If not, the process ends.If no (no), the process returns to step S34, and the line-by-line filling process is repeatedly executed, and the process is completed (yes). To the next step S36. In this way, the main blood vessel filling process is performed, and at time tk, the filling process reaches the periphery of the main blood vessel 40, and as shown in FIG. The entire area is shaded and shaded. At this point, the determination in step S35 becomes yes, and the process in the next step S36 is executed.
• This step is a process to show the progress of the blood containing the contrast medium passing through the capillaries and into the tissue, and the outermost one line of the filled main blood vessel 40 is extravascular. Add one line (or multiple lines) to the front row of, and fill.
• FIG. 10 shows a state in which the entirety of the main blood vessel 40 up to the periphery is filled, and at time tk + 1, the outside of the main blood vessel 40 is filled line by line.
• time tk + 2 the time further elapses from this state and reaches time tk + 2, as shown in FIG. 11, the portion beyond the injection position line 41 of the main blood vessel 40 is filled, and blood containing the contrast agent permeates outside the blood vessel. Is out.
• the bleeding limit is the area where the major blood vessels are relevant and does not bleed beyond that area.
• the appearance of blood gradually seeping into the tissue in this way is displayed on the CRT display 14, and finally, as shown in FIG. Are shaded, and the process ends.
• the flow of the main blood vessel and the flow of the contrast agent in the fibrous tissue related to the main blood vessel can be displayed in a pseudo manner, so that it can be used for diagnosis and treatment by a doctor. Also, the flow of the contrast agent into the blood vessel is burdensome for the patient, for example, the contrast agent may not be injected into the patient depending on the patient's constitution. It is useful.
• FIG. 2 is a diagram showing a relationship between a tomographic image and data.
• Fig. 2 (A) multiple tomographic images 21 acquired by an image diagnostic device capable of three-dimensional measurement such as an X-ray CT device or MRI device are stacked, and a stacked tertiary image as shown in Fig. 2 (B).
• the original image 22 is used, and the image of the predetermined organ (object to be processed) is made three-dimensional.
• the stacked three-dimensional image 22 includes a liver tissue and arteries, veins, tumors, etc., and is a pseudo three-dimensional image projected and shaded on a two-dimensional projection plane (not shown). Is displayed on the CRT display 14 in FIG. 1, for example.
• an MPR (multi-planner reconstruction) image that also includes a plurality of two-dimensional image forces may be used.
• FIG. 3 is a diagram showing an example of a main flowchart of a pseudo-contrast display mode executed by the medical image display device.
• the CPU 10 of FIG. 1 operates according to the main flowchart.
• the momentary state when a contrast agent is injected into a certain blood vessel in the liver will be described using an example of a screen displayed on the CRT display 14.
• details of the main flowchart will be described in the order of steps.
• the main blood vessels are extracted from the three-dimensional image.
• the extraction of the main blood vessels is performed by a conventionally known region expansion method or the like.
• the area extension method is a method in which, when adjacent pixels satisfy conditions such as a CT value, they are regarded as the same area and are sequentially captured.
• a region of interest may be set at the time of extraction of the main blood vessel, and the amount of calculation for extracting a blood vessel and extracting a related region may be reduced depending on the region of interest to speed up the extraction calculation.
• FIG. 4 is a diagram illustrating an example of a state of the extracted main blood vessel.
• the cursor 15a of the mouse 15 is moved with respect to the main blood vessel displayed on the CRT display 14, and the contrast medium injection part is selected and clicked.
• an injection position line 41 indicating where the color contrast agent has been injected into the main blood vessel 40 is displayed. Since the injection start position can be arbitrarily set, the flow of the contrast agent in the blood vessel and tissue from the arbitrarily set start point can be displayed in a pseudo manner.
• start and end portions of the range of the virtual contrast agent to be observed can be arbitrarily set, and the degree of freedom in setting the observation range of the blood flow and the pseudo-contrast agent flow is further increased. May be.
• FIG. 6 is a diagram specifically showing a method of determining a boundary of a region controlled by a blood vessel. That is, as shown in FIG. 6, the shortest distance between the blood vessel extending from the injection position line 41, which indicates the part clicked with the mouse 15, in the extracted main blood vessel 40 to the periphery, and the other branch blood vessels 42, 43, as shown in FIG. Then, the shortest distance line segment is divided by a predetermined method, and the dividing points are connected to determine a boundary of a region related to the blood vessel.
• the area boundary is determined by one of the following two methods.
• the shortest distance between the blood vessel extending from the injection position line 41 of the main blood vessel 40 to the periphery and the other branch blood vessel 42 is sequentially obtained, and the midpoint of the line segment L of the shortest distance between the blood vessels is determined.
• This is a method of finding and using that as a division point.
• FIG. 6 shows a case where the boundary between the blood vessel extending from the injection position line 41 of the main blood vessel 40 to the periphery and the branch blood vessel 42 is determined by this method, and the boundary is determined from the injection position line 41 of the main blood vessel 40 to the periphery.
• the ratio L1 of the line segment that becomes the same as the cross-sectional area ratio S1: S3 is determined by determining L3, using that as a dividing point, and connecting these dividing points.
• the limit of the region may be such that a blood flow end portion with respect to a blood flow start portion is set, and the range of the blood flow to be observed can be set arbitrarily at the start portion and the end portion.
• the region is limited to substantially the entire related region including the main blood vessel, it is possible to observe the blood flow to substantially the entire related region simply by selecting a desired blood vessel. Thereby, the blood flow of the blood vessel selected by one touch can be simulated.
• the injection position line 41 From the location where the contrast medium was injected, the injection position line 41, the trajectory toward the periphery of the blood vessel is highlighted. For example, in the figure, one line is filled from the injection position line 41 to the peripheral end of the blood vessel. That is, the flow rate in the blood vessel is approximated to be constant, and one line (multiple lines may be used) is added to the front line in the blood vessel based on the injection position line 41, and the state is displayed on the CRT display 14. To display.
• V02 S3 -V3 + S03 -V03
• S03 -V03 S4-V4 + S03 -V03
• the flow velocity in the capillary is approximated to be constant. Therefore, as shown in FIG. 4, from the time when the mouse 15 is clicked on, the filling of one line at a time in the order of tl, t2,..., Tk-1, tk proceeds.
• a shaded area that is directed from the injection position line 41 of the main blood vessel 40 toward the periphery from the time when the mouse 15 is clicked to the time t2 is shaded.
• step S36 It is determined whether or not the main vessel has been filled. If not, the process ends.If no (no), the process returns to step S34, and the line-by-line filling process is repeatedly executed, and the process is completed (yes). To the next step S36. In this way, the main blood vessel filling process is performed, and at time tk, the filling process reaches the periphery of the main blood vessel 40, and as shown in FIG. The entire area is shaded and shaded. At this point, the determination in step S35 becomes yes, and the process in the next step S36 is executed.
• This step is a process for indicating the progress of the blood containing the contrast agent passing through the capillaries and into the interior of the division boundary determined in step S33.
• Step S33 This step is a process for indicating the progress of the blood containing the contrast agent passing through the capillaries and into the interior of the division boundary determined in step S33.
• FIG. 10 shows a state in which the entirety of the main blood vessel 40 up to the periphery is filled, and at time tk + 1, the outside of the main blood vessel 40 is filled line by line. From this state, when the time further elapses and the time reaches tk + 2, as shown in FIG. The part beyond the injection position line 41 is filled, and the blood containing the contrast agent is seeping out of the blood vessel.
• the limit of the seepage is the division boundary obtained in step S33, and the seep does not seep to the partial force.
• the appearance of blood gradually seeping into the division boundary is displayed on the CRT display 14, and finally, the entire division boundary obtained in step S33 is shaded as shown in FIG. 12, and the process ends. .
• the doctor can perform the preoperative plan of organ resection as a preoperative plan.
• the simulation accuracy can be dramatically improved.
• the force is described as an example where only one contrast agent is injected.
• a plurality of positions may be designated, and the simulation may be performed simultaneously. In this case, it is possible to recognize the state with high accuracy by making each fill color different.
• the case where the contrast agent is injected has been described. However, when a blood vessel is ligated, the state of the ischemic state and the congested state from the ligated position may be shown by simulation.
• the extracted related area that is, the resected area and other non-extracted areas are made different in image density value and hue.
• the image observer will then display that particular area on the CRT display 14 so that other non-extracted areas can be easily identified.
• the thickness of the line may be made variable as going from a specific position to the peripheral portion of the blood vessel. That is, the line may be made thinner in a thick blood vessel than in the thick blood vessel. As a result, the branching of the blood vessel increases toward the distal end of the blood vessel, so that a more realistic simulation can be provided by adapting to the thickness of the blood vessel.
• the method of the present invention is applied not only to an X-ray CT apparatus but also to an image acquired by another image diagnostic apparatus such as a magnetic resonance imaging apparatus or an ultrasonic diagnostic apparatus. Can also be used.
• a target organ in addition to the liver described in the above embodiment, the present invention can be applied to many parts of the human body.
• the medical image display method or the medical image display device of the present invention can be used for a doctor's diagnosis and treatment by pseudo-displaying the flow of a contrast agent in a blood vessel.

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