WO2020057323A2 - Procédé de mesure de l'indice de résistance microcirculatoire - Google Patents

Procédé de mesure de l'indice de résistance microcirculatoire Download PDF

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WO2020057323A2
WO2020057323A2 PCT/CN2019/102251 CN2019102251W WO2020057323A2 WO 2020057323 A2 WO2020057323 A2 WO 2020057323A2 CN 2019102251 W CN2019102251 W CN 2019102251W WO 2020057323 A2 WO2020057323 A2 WO 2020057323A2
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image
coronary
coronary artery
measuring
microcirculation
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PCT/CN2019/102251
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English (en)
Chinese (zh)
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刘广志
王之元
吴心娱
徐磊
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苏州润迈德医疗科技有限公司
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Priority claimed from CN201811093192.XA external-priority patent/CN109363651A/zh
Priority claimed from CN201910206541.2A external-priority patent/CN109770888A/zh
Application filed by 苏州润迈德医疗科技有限公司 filed Critical 苏州润迈德医疗科技有限公司
Publication of WO2020057323A2 publication Critical patent/WO2020057323A2/fr

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Definitions

  • the invention relates to the technical field of coronary artery medicine, in particular to a method for measuring a microcirculation resistance index.
  • the impact of coronary microcirculatory dysfunction on myocardial ischemia has gradually attracted attention.
  • the coronary system is composed of epicardial coronary and microcirculation.
  • the degree of epicardial coronary stenosis greater than or equal to 50% can lead to insufficient blood supply to the myocardium, and the clinical diagnosis is coronary heart disease.
  • clinical studies have shown that abnormal coronary microcirculation may also lead to insufficient myocardial blood supply.
  • Coronary microcirculation refers to the blood circulation between the arterioles and venules, and is the place where blood exchanges with tissue cells. Studies have shown that although coronary blood flow reaches TIMI grade 3 after successful percutaneous coronary intervention, almost 30% of patients have abnormal microvascular function, leading to poor prognosis. Therefore, with the continuous research, people have gradually realized that coronary microvascular dysfunction is an important mechanism of the pathophysiology of many heart diseases. It is necessary to accurately evaluate the functional status of coronary microcirculation.
  • Coronary microcirculation resistance index (index of microcirculatory resistance IMR) is an index to evaluate the status of coronary microcirculation function.
  • the existing IMR measurement method is to simultaneously record the coronary pressure and temperature through a soft pressure guide wire.
  • the two temperature sensors on the guide wire rod can detect the time difference between temperature changes to know that the saline has run from the guide catheter to the temperature sensor on the tip of the guide wire.
  • the average conduction time (Tmn) according to the definition of the product of the pressure Pd and Tmn at the distal coronary artery, can obtain the IMR value.
  • the invention provides a method for measuring the resistance index of the microcirculation to solve the problems that the pressure guide wire needs to pass the pressure guide wire through the distal end of the coronary artery stenosis in the prior art to measure the IMR, which increases the difficulty and risk of surgery.
  • the present invention provides a method for measuring a microcirculation resistance index, including:
  • the pressure drop ⁇ P i and blood flow velocity V h from the coronary artery entrance to the distal end of the coronary stenosis are measured to obtain the microcirculation resistance coefficient IMR, which is calculated as follows:
  • IMR (Pa- ⁇ P i ) ⁇ L / V h .
  • the measuring the pressure drop ⁇ P i from the entrance of the coronary artery to the distal end of the coronary stenosis includes:
  • the three-dimensional structure of the coronary arteries is meshed, and the center line of the coronary artery is used as the vertical axis.
  • the grid is divided into m points along the center line of the coronary artery, and the cross section corresponding to each point of the center line of the coronary artery is divided into n nodes, ⁇ P i represents the average pressure of all nodes in the cross section of the i-th point on the centerline of the coronary artery, that is, the pressure drop from the entrance of the coronary artery to the distal end of the coronary stenosis;
  • the pressure drop ⁇ P i is calculated using the following formula:
  • P 1 represents the pressure value of the first node on the cross section of the i-th point in the three-dimensional structure grid
  • P 2 represents the pressure value of the second node on the cross section of the i-th point in the three-dimensional structure grid
  • P n represents the pressure value of the n-th node on the cross-section of the i-th point
  • m and n are positive integers
  • the pressure value of each said node is calculated using the Navier-Stokes equation.
  • the above method for measuring a microcirculation resistance index said Said Means measuring the average blood flow velocity in the heartbeat cycle area, a means a constant with a value ranging from 1 to 3, and b means a constant with a value ranging from 50 to 300.
  • the method measures the average blood flow velocity in the heartbeat cycle area.
  • the measurement method uses a contrast agent transit time algorithm and includes: dividing the heartbeat cycle region into N partial region images;
  • L represents the length of the blood vessel
  • N represents the number of frames of the local area image into which the heartbeat period region is divided
  • fps represents the interval time between switching between two adjacent frames of the image.
  • the method for measuring the microcirculation resistance index and the method for measuring the blood flow velocity include: a contrast agent traversal distance algorithm, a Stewart-Hamilton algorithm, a first-pass distribution analysis method, an optical flow method, or a fluid continuous method.
  • the method of performing three-dimensional modeling on a contrast image to obtain a three-dimensional structure of a coronary artery includes:
  • the centerline and diameter of each coronary artery were projected on a three-dimensional space for three-dimensional modeling to obtain a three-dimensional structure of the coronary artery.
  • the method further includes:
  • Denoising the coronary angiography image includes static noise and dynamic noise.
  • the method of removing the interfering blood vessels of the coronary angiography image to obtain the resulting image includes:
  • segmented image in the first frame with a catheter as a reference image
  • segmented image in the k-th frame with a complete coronary artery as a target image, where k is a positive integer greater than 1;
  • the area image is dynamically grown using the characteristic points of the catheter as seed points to obtain the resulting image.
  • the method of subtracting the target image from the reference image and extracting a characteristic point O of the catheter includes:
  • Denoising including: static noise and dynamic noise
  • the method of subtracting the reference image from the target image and extracting an image of a region where the coronary artery is located includes:
  • Denoising including: static noise and dynamic noise
  • the region of the coronary artery is determined and extracted, that is, the region image where the coronary artery is located.
  • the area image is dynamically grown using the characteristic point of the catheter as a seed point, and a method for obtaining the result image includes:
  • the method of projecting the centerline and diameter of each coronary artery on a three-dimensional space for three-dimensional modeling, and obtaining a three-dimensional structure of a coronary artery includes:
  • the three-dimensional structure of the coronary arteries is generated by projecting each of the coronary centerlines in combination with the position shooting angle on a three-dimensional space.
  • the method for measuring the resistance index of the microcirculation further includes: measuring the three-dimensional coronary structure during the non-wave period, and measuring the pressure drop ⁇ P of the coronary artery entrance to the distal end of the coronary stenosis during the non-wave period during the diastolic phase.
  • i and measure the diastolic blood flow velocity V f , read the length L of the blood vessel and the coronary artery inlet pressure Pa during diastole without waveform, calculate the instantaneous waveform-free microcirculation resistance index iFMR, and the calculation formula is as follows:
  • iFMR (Pa'- ⁇ P i ') ⁇ L / V f ;
  • L represents the length of the blood vessel
  • N represents the number of frames of the local area image into which the coronary angiography image is divided
  • fps' represents the interval time between switching between adjacent two frames during the diastolic period without a waveform.
  • This application does not require dilation drugs or pressure guide wire measurement time, only needs to measure the pressure at the entrance of the coronary artery, does not need to pass through the distal end of the coronary artery stenosis, which reduces the difficulty and risk of the operation; The blank in the industry, the operation is simpler.
  • FIG. 1 is a flowchart of an embodiment of a method for measuring a microcirculation resistance index of the present application
  • FIG. 2 is a flowchart of S10 of the present application.
  • FIG. 3 is a flowchart of another embodiment of a method for measuring a microcirculation resistance index of the present application
  • FIG. 4 is a flowchart of S12 of the present application.
  • FIG. 5 is a flowchart of S122 of the present application.
  • FIG. 6 is a flowchart of S123 of the present application.
  • FIG. 7 is a flowchart of S124 of the present application.
  • FIG. 8 is a flowchart of S14 of the present application.
  • FIG. 9 is a reference image
  • FIG. 10 is a target image to be segmented
  • FIG. 11 is another target image to be segmented
  • Figure 12 is an enhanced catheter image
  • 13 is a binarized image of a characteristic point of a catheter
  • FIG. 14 is an enhanced target image
  • 15 is an image of a region where a coronary artery is located
  • Figure 16 is the resulting image
  • Figure 17 is a screenshot of a cross-section
  • Figure 18 is a screenshot of the longitudinal section
  • Figure 19 is two body radiography images
  • the left diagram of FIG. 20 is a graph of blood vessel length and blood vessel diameter
  • FIG. 21 is a three-dimensional structural diagram of a coronary artery generated by combining the posture angle and the center line of the coronary artery of FIG. 20; FIG.
  • FIG. 22 is a diagram showing the number of frames of a segmented image
  • FIG. 23 is a test chart of coronary artery inlet pressure
  • Figure 24 is an IMR test chart
  • Figure 25 is an iFMR test chart.
  • this application provides a method for measuring a microcirculation resistance index, including:
  • S20 Select a heartbeat cycle area of the three-dimensional structure of the coronary artery, and measure the length L of the blood vessel and the coronary portal pressure Pa in the heartbeat cycle area;
  • the coronary inlet pressure Pa is measured by an invasive blood pressure sensor, and the specific method is as follows:
  • the invasive blood pressure sensor includes a pressure sensing chip and a peristaltic pump head.
  • a hose is built into the peristaltic pump head. One end of the hose is connected to the pressure sensing chip and the other end is connected to the saline bag through an infusion tube.
  • the invasive blood pressure sensor is connected to the patient's aorta through a hose, and the middle is filled with physiological saline so that it can form a pathway with the aorta.
  • the invasive blood pressure sensor has a pressure sensing chip inside it, which measures the coronary inlet pressure Pa without passing through the coronary
  • the distal end of arterial stenosis reduces the difficulty and risk of surgery;
  • IMR (Pa- ⁇ P i ) ⁇ L / V h (1);
  • This application implements three-dimensional modeling by reading contrast images to obtain the three-dimensional structure of coronary angiography.
  • the blood vessel length L of the three-dimensional structure of the coronary artery is measured according to step S142, and the coronary inlet pressure Pa measured at S20 is measured, and the measurement is performed under the maximum congestion state
  • This application does not require dilation drugs or pressure guidewires, only needs to measure the pressure at the entrance of the coronary artery, does not need to pass through the distal end of the coronary artery stenosis, which reduces the difficulty and risk of surgery; and realizes the measurement of IMR by contrast images, which makes up the industry The blank inside makes the operation easier.
  • the method for measuring the pressure drop ⁇ P from the coronary portal to the distal end of coronary stenosis in S30 includes:
  • the three-dimensional structure of the coronary arteries is meshed, as shown in FIG. 17 and FIG. 18.
  • an embodiment of the present application uses a standard sweep method to perform mesh division to generate a structural three-dimensional hexahedron
  • the present application may also use other methods (eg, segmentation method, hybrid method) for mesh division to generate a structural three-dimensional hexahedral mesh.
  • the grid is divided into m points along the coronary centerline, and the cross section corresponding to each point of the coronary centerline is divided into n nodes, ⁇ P i represents the coronary
  • the average value of the pressure at all nodes in the cross section of the i-th point on the centerline of the vein is the pressure drop from the entrance of the coronary artery to the distal end of the coronary stenosis;
  • the pressure drop ⁇ P i is calculated using the following formula:
  • P 1 represents the pressure value of the first node on the cross section of the i-th point in the three-dimensional structure grid
  • P 2 represents the pressure value of the second node on the cross section of the i-th point in the three-dimensional structure grid
  • P n represents the pressure value of the n-th node on the cross-section of the i-th point
  • m and n are positive integers
  • the pressure value of each said node is calculated using the Navier-Stokes equation.
  • each three-dimensional structure node is substituted into the formula (2) to obtain the pressure drop ⁇ P from the entrance of the coronary artery to the distal end of the coronary stenosis.
  • the measurement method uses a contrast agent transit time algorithm and includes: dividing the heartbeat cycle region into N partial region images;
  • L represents the length of the blood vessel
  • N represents the number of frames of the local area image into which the heartbeat period region is divided
  • fps represents the interval time between switching between two adjacent frames of the image.
  • the measurement The method also includes: contrast agent traversal distance algorithm, Stewart-Hamilton algorithm, First-pass distribution analysis method, optical flow method or fluid continuous method.
  • a three-dimensional modeling is performed on a contrast image to obtain a three-dimensional structure of a coronary artery, including:
  • interference blood vessels of the coronary angiography images are removed in S12 to obtain a result image shown in FIG. 16, and include:
  • Static noise is noise that does not change over time, such as ribs in the chest.
  • Dynamic noise is noise that changes over time, such as part of the lung tissue and part of the heart tissue.
  • a method of removing interference vessels of a coronary angiography image to obtain a result image shown in FIG. 16 includes:
  • the first segmented image with a catheter is defined as a reference image as shown in FIG. 9, and the kth segmented image with a complete coronary artery is defined as a target image as shown in FIG. 10 and FIG. A positive integer greater than 1;
  • S122 Subtract the reference image shown in FIG. 9 from the target image shown in FIG. 10 and FIG. 11 to extract the characteristic point O of the catheter; preferably, remove some static noise; further, use average filtering to remove some dynamics Noise; and gray-scale histogram analysis, using thresholds to further denoise;
  • the region image is dynamically grown using the characteristic points of the catheter as seed points to obtain a result image as shown in FIG. 16.
  • a method of subtracting a target image from a reference image and extracting a feature point O of a catheter in S122 includes:
  • S1222 denoising, including: static noise and dynamic noise;
  • part of the static noise is removed; further, mean filtering is used to remove part of the dynamic noise; and gray level histogram analysis is used to further denoise using a threshold value;
  • this application uses a multi-scale Hessian matrix to enhance the image
  • S1224 Binarize the enhanced catheter image shown in FIG. 12 to obtain a binarized image with a set of catheter characteristic points O as shown in FIG. 13.
  • a method of subtracting a reference image from a target image and extracting a region image where a coronary artery is located in S123 includes:
  • denoising including: static noise and dynamic noise
  • part of the static noise is removed; further, mean filtering is used to remove part of the dynamic noise; and gray level histogram analysis is used to further denoise using a threshold value;
  • this application uses a multi-scale Hessian matrix to enhance the image
  • a region of the coronary artery is determined and extracted, that is, an image of the region where the coronary artery is located as shown in FIG. 15.
  • the area image shown in FIG. 15 in S124 uses the characteristic points of the catheter as shown in FIG. 13 as seed points for dynamic growth to obtain a three-dimensional structure of coronary angiography.
  • S1242 Perform a morphological operation on the binarized coronary artery image, use the characteristic points of the catheter as seed points, and perform dynamic region growth on the binarized coronary artery image according to the position of the seed point to obtain the resulting image shown in FIG. 16.
  • a method for obtaining a three-dimensional structure of a coronary artery includes:
  • S142 Project the centerline of each coronary artery in combination with the shooting angle of the body position, the L value of the blood vessel length, and the D value of the blood vessel diameter onto a three-dimensional space to generate a three-dimensional coronary artery structure.
  • the three-dimensional structure of the coronary artery has a vascular length L value of 120 mm; the generated three-dimensional structure of the coronary artery is shown in FIG. 21;
  • the existing technology cannot measure iFMR.
  • Example 1 By comparing Example 1 and Comparative Example 1, it can be known that the measurement results of IMR are basically the same. Therefore, the measurement results of Example 1 are accurate, and Example 1 of the present application does not require a dilation drug or a pressure guide wire, and only needs to measure the coronary portal The pressure does not need to pass through the distal end of the coronary artery stenosis, which reduces the difficulty and risk of the operation. Moreover, the IMR measurement is realized through the angiographic image, which makes up for the blank in the industry and the operation is simpler.
  • iFMR is a newly proposed index for judging myocardial ischemia. Based on the diastolic flow velocity measured by conventional angiographic flow velocity, the application does not need to calculate iFMR by simulating dilated flow velocity.
  • the iFMR is used to reflect the transient Waveform microcirculation resistance index; combining iFMR and IMR to judge coronary artery stenosis, which improves the accuracy of judgment.

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PCT/CN2019/102251 2018-09-19 2019-08-23 Procédé de mesure de l'indice de résistance microcirculatoire WO2020057323A2 (fr)

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