WO2022228464A1 - 基于血管内成像的血流速度、血流储备分数的分析方法 - Google Patents

基于血管内成像的血流速度、血流储备分数的分析方法 Download PDF

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WO2022228464A1
WO2022228464A1 PCT/CN2022/089546 CN2022089546W WO2022228464A1 WO 2022228464 A1 WO2022228464 A1 WO 2022228464A1 CN 2022089546 W CN2022089546 W CN 2022089546W WO 2022228464 A1 WO2022228464 A1 WO 2022228464A1
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blood flow
blood
flow velocity
blood vessel
detected
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WO2022228464A9 (zh
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涂圣贤
杨钒
朴忠烈
吴继刚
刘洵
凌莉
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上海博动医疗科技股份有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/0261—Measuring blood flow using optical means, e.g. infrared light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0033—Features or image-related aspects of imaging apparatus classified in A61B5/00, e.g. for MRI, optical tomography or impedance tomography apparatus; arrangements of imaging apparatus in a room
    • A61B5/0035—Features or image-related aspects of imaging apparatus classified in A61B5/00, e.g. for MRI, optical tomography or impedance tomography apparatus; arrangements of imaging apparatus in a room adapted for acquisition of images from more than one imaging mode, e.g. combining MRI and optical tomography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0062—Arrangements for scanning
    • A61B5/0066—Optical coherence imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/06—Measuring blood flow

Definitions

  • the invention relates to the field of intravascular interventional imaging medical devices to be detected, in particular to an analysis method of blood flow velocity, blood flow reserve fraction and microcirculation resistance based on intravascular imaging.
  • PCI percutaneous coronary intervention
  • Intraluminal imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are of great clinical significance for the identification of atherosclerotic plaques, stent placement and evaluation, and have been used to guide PCI treatment.
  • OCT optical coherence tomography
  • IVUS intravascular ultrasound
  • OCT has a high resolution (longitudinal: 10 ⁇ m, lateral: 20-40 ⁇ m), and has absolute advantages in identifying the structural and morphological characteristics of coronary arteries and detecting vulnerable plaques, but it is only limited to morphological and structural comparisons. Evaluation of atherosclerosis and coronary stenosis cannot accurately reflect the functional changes in coronary blood flow and blood supply caused by changes in the shape of the blood vessels to be detected.
  • fractional flow reserve (FFR) by measuring the pressure difference between the distal and proximal ends of coronary stenosis, can effectively reflect the influence of stenotic lesions on the blood supply function of the blood vessels to be detected, and evaluate whether coronary artery ischemia of perfused myocardium.
  • FFR has become the gold standard for clinical diagnosis, guidance and evaluation of PCI treatment.
  • traditional FFR needs to measure blood pressure through a pressure guide wire, but this inspection operation is complicated, time-consuming, and the required surgical consumables (FFR guide wire) are expensive.
  • the side effects caused by the injection of the vasodilator drug to be tested will cause discomfort to the patient, and the guide wire may easily cause damage to the blood vessel to be tested in the patient during the intervention process. The above reasons limit the promotion of FFR.
  • the purpose of the present invention is to provide a simple, fast and accurate analysis method for calculating the blood flow velocity based on intravascular imaging.
  • the invention also provides a rapid and accurate analysis method of blood flow reserve fraction.
  • the present invention also provides a rapid and accurate analysis method for microcirculation resistance.
  • Step S1 acquiring a first intraluminal image of the blood vessel to be detected, where the first intraluminal image is an optical coherence tomography image or an intravascular ultrasound image;
  • Step S2 acquiring a blood flow signal based on the first intraluminal image, and calculating the blood flow velocity in the blood vessel to be detected based on the blood flow signal.
  • the dynamic blood flow value in the blood vessel that is, the blood flow velocity
  • the blood flow velocity can be accurately measured, and more blood flow information in the blood vessel can be obtained.
  • the first intracavity image may be an optical coherence tomography image (OCT image) or an intravascular ultrasound image (IVUS image).
  • OCT image optical coherence tomography image
  • IVUS image intravascular ultrasound image
  • OCT is preferable because of its high resolution (longitudinal direction: 10 ⁇ m, lateral direction: 20-40 ⁇ m).
  • the blood flow velocity is obtained by Doppler frequency shift. That is, the blood flow velocity is calculated by measuring the phase difference of the blood flow signal at the same position in the two images. The dynamic blood flow velocity can be accurately calculated by the Doppler frequency shift.
  • step S1 includes:
  • Step S11 extending the imaging catheter into the predetermined position of the blood vessel to be detected
  • Step S12 making the imaging catheter rotate at the predetermined position while scanning at a predetermined time interval within a predetermined time to obtain the first intraluminal image, wherein the predetermined time is one or more cardiac cycles,
  • step S2 a Doppler frequency shift is obtained based on the blood flow signals obtained by two adjacent scans, and the blood flow velocity is determined based on the Doppler frequency shift.
  • the imaging catheter is firstly inserted into the predetermined position of the blood vessel to be detected, and then scanning is performed at predetermined time intervals within a predetermined time, and the Doppler can be obtained by determining the blood flow signals obtained by two adjacent scans. frequency shift to determine blood flow velocity.
  • the blood flow velocity is different in different periods in one cardiac cycle, such as diastolic blood pressure or systolic blood pressure, more blood flow information can be obtained by monitoring one or more cardiac cycles.
  • the cardiac cycle is calibrated, for example, by means of x-ray imaging or electrocardiography. That is to say, combining X-ray imaging technology or electrocardiography technology to monitor the cardiac cycle, and based on the information of the cardiac cycle obtained by monitoring, determine the state of the cardiac cycle corresponding to the measured blood flow velocity, and can obtain more blood vessels and blood flow information.
  • the Doppler frequency shift is obtained by the blood flow signal in the images scanned twice at the same position and adjacent moments, or the Doppler frequency shift is obtained by the same position in different frame images. Blood flow signals are obtained.
  • the measured Doppler frequency shift can be obtained by two scans of blood flow signals at the same position and at the same time. There is sufficient overlap between adjacent A-scans, so that the phase change of the signal at the same position and at the same time can be approximately obtained.
  • the Doppler frequency shift is obtained from the blood flow signal at the same position in different frame images, because there is also overlap of imaging areas between different frame images, so the signal at the same position corresponding to different frame images can also be obtained .
  • the first intraluminal image is an optical coherence tomography image, wherein, in the step S12, before scanning, a first predetermined amount of flushing agent is injected into the blood vessel to be detected, so that the flushing agent and blood mix.
  • the operation imaging catheter When measuring the blood flow velocity at the distal end, the operation imaging catheter is first extended to the distal end of the blood vessel to be detected. Because of the strong scattering and absorption of OCT light by blood, it is necessary to inject a small amount of flushing agent and blood into the blood vessel to be detected. Mixed to wash away part of the blood to increase the penetration depth of the light signal, as the flushing agent can be, for example, X-ray contrast agent or physiological saline. After the irrigant is mixed with the blood in the blood vessel to be detected, the imaging catheter rotates and acquires multiple blood flow signals at the same position, obtains the Doppler frequency shift based on the multiple blood flow signals, and obtains the Doppler frequency shift based on the Doppler frequency Move to determine the maximum blood flow velocity.
  • the flushing agent can be, for example, X-ray contrast agent or physiological saline.
  • thermodilution method in which cold saline of known temperature is injected into the coronary artery through a catheter at a certain rate, and the temperature drop range and time of blood flow are measured by a temperature sensing element inserted in the coronary artery. , to estimate the blood flow velocity. If this method is used for blood flow velocity detection, blood flow velocity detection and intraluminal image acquisition need to be performed in steps.
  • the OCT image is used to obtain the Doppler frequency shift. Before scanning, a small amount of flushing agent such as X-ray contrast agent and normal saline is injected into the blood vessel to be detected to dilute the blood in the blood vessel to be detected. Therefore, the Doppler frequency shift of the blood flow signal therein can be obtained, and then the dynamic blood flow value can be obtained based on the Doppler frequency shift.
  • the target substance ie, X-ray contrast agent, normal saline
  • the target substance is driven into the coronary artery by the heartbeat to reach the measurement position, that is, the position of the OCT lens.
  • the OCT signal returned by this part of the mixed liquid can be detected by the system.
  • the Doppler frequency shift occurs between the signals obtained at different times due to the flow of blood.
  • the flow rate of the mixed liquid can be calculated by the following formula (aka blood flow velocity):
  • Vz is the blood flow velocity along the direction of the blood vessel to be detected
  • ⁇ c is the central wavelength of the OCT light source
  • ⁇ T is the time interval between the two detections
  • n is the refractive index of the liquid to be measured
  • ⁇ is the angle between the outgoing beam from the catheter and the direction of blood flow.
  • the maximum value and accuracy of the blood flow velocity that can be measured will be determined by the time interval ⁇ T. That is, by adjusting the time interval, higher accuracy can be obtained.
  • ⁇ T actually corresponds to the time interval for scanning between adjacent lines. If ⁇ T is set too small, it cannot be accurately identified due to the limitation of resolution. In this case, the sampling density can be reduced by appropriately increasing the time interval.
  • Step S10 obtain the average flow velocity of the blood flow velocity in one or more cardiac cycles in the blood vessel to be detected, and the blood flow velocity is analyzed and obtained according to the analysis method of the blood flow velocity described in any one of the above;
  • Step S20 acquiring a second intraluminal image of the blood vessel to be detected, and performing hydrodynamic analysis and calculation based on the second intraluminal image and the average flow velocity to obtain the blood flow reserve fraction,
  • the second intracavity image is an optical coherence tomography image or an intravascular ultrasound image.
  • the blood flow velocity is usually set as a constant.
  • the actual blood flow velocity changes due to the individual differences of the subjects, the disease status, and the cardiac cycle.
  • the real-time blood flow measurement results can more accurately measure and analyze the blood flow in the blood vessels to be tested, and further optimize the fluid dynamics simulation. and calculation of fractional flow reserve. That is to say, according to the method for analyzing fractional blood flow reserve of the present invention, the average flow velocity of the blood flow velocity in the whole cardiac cycle is determined through the first intraluminal image, and the fluid dynamics is performed in combination with the second intraluminal image of the blood vessel to be detected. Analysis was performed to obtain fractional flow reserve (FFR).
  • FFR fractional flow reserve
  • the real-time blood flow is calculated based on the intraluminal image of the blood vessel to be detected, and the target blood flow obtained by combining the intraluminal image is obtained.
  • the fractional flow reserve can be calculated more accurately.
  • the blood flow velocity includes the average velocity of the distal end and/or the proximal end of the blood vessel to be detected
  • the step S20 after the second intraluminal image is obtained, based on the Perform blood vessel segmentation on the second intraluminal image, reconstruct the structure and shape of the blood vessel in three dimensions, and perform hydrodynamic analysis and calculation based on the average flow velocity to obtain the blood flow reserve fraction.
  • the average velocity of the distal end, the average velocity of the proximal end, and the average velocity of the distal end and the proximal end can also be used to combine with the structural mentality of the blood vessel obtained from the second intraluminal image.
  • the FFR value was obtained by hydrodynamic analysis calculation.
  • the blood vessels at the distal position are thinner, and the imaging catheter may have a greater impact on the average flow rate.
  • the distal velocity measurement and retraction to obtain the second intraluminal image can be completed in one step, and the procedure is more simplified . Therefore, the average flow velocity at the distal end, the average flow velocity at the proximal end, and the comprehensive average flow velocity at the distal end and the proximal end can be selected according to specific conditions.
  • step S20 includes:
  • the imaging catheter is retracted to the proximal end of the blood vessel to be inspected while the imaging catheter is rotated, and the second intraluminal image of the blood vessel to be inspected is obtained.
  • the imaging catheter is first placed at the distal end of the blood vessel to be detected, and then the imaging catheter is rotated and retracted to the proximal end of the blood vessel to be detected, and then returned to the Scanning is performed during withdrawal to obtain a second intraluminal image reflecting the structural information of the entire blood vessel to be detected.
  • the imaging catheter In terms of measuring the blood flow rate, it can be as follows: firstly, the imaging catheter reaches the distal end of the blood vessel, and then the imaging catheter is rotated to obtain the first intraluminal image at this position, and then the imaging catheter is rotated and retracted to perform scanning. , obtain the second intraluminal image, analyze the average flow velocity of the blood flow velocity at the distal end based on the first intraluminal image, obtain the structural shape of the blood vessel based on the second intraluminal image, based on the average flow velocity and structural shape, through hydrodynamic analysis, For example, CFD simulation can obtain the FFR value.
  • blood flow velocity and intraluminal images can be acquired simultaneously through one retraction, which reduces measurement steps and time, and greatly improves the accuracy and efficiency of functional analysis of vascular lesions.
  • the second intraluminal image is an optical coherence tomography image, wherein before withdrawing the imaging catheter, a second predetermined amount of flushing agent is injected into the blood vessel to be detected to flush away the blood.
  • flushing agent such as X-ray contrast agent, normal saline, etc.
  • the average flow velocity of the blood flow velocity corresponding to one or more cardiac cycles at the distal end of the blood vessel to be detected is obtained, and the determination of the blood flow velocity to be detected is determined. Said microcirculatory resistance of blood vessels.
  • the distal pressure is determined in combination with the pressure at the proximal end of the blood vessel, and the microcirculation resistance can be determined by the distal pressure and the average flow velocity.
  • FIG. 1 is a schematic flowchart of a method for analyzing blood flow velocity based on intravascular imaging according to Embodiment 1 of the present invention
  • Figure 2 is a schematic diagram of fractional blood flow reserve analysis using a high-speed OCT system
  • FIG. 3 is a schematic flowchart of a method for analyzing fractional blood flow reserve according to Embodiment 2;
  • FIG. 4 is a schematic flowchart of a method for analyzing fractional blood flow reserve according to Embodiment 3;
  • FIG. 5 is a schematic flowchart of a method for analyzing microcirculation resistance according to Example 4.
  • the analysis of the blood flow velocity in this embodiment includes the following steps:
  • Vz is the blood flow velocity along the direction of the blood vessel to be detected
  • ⁇ c is the central wavelength of the OCT light source
  • ⁇ T is the time interval between the two detections
  • n is the refractive index of the liquid to be measured
  • ⁇ is the angle between the outgoing beam from the catheter and the direction of blood flow.
  • the fractional flow reserve was analyzed by a high-speed OCT system.
  • a high-speed OCT system is used to obtain the average flow velocity of the blood flow velocity and the intraluminal image (ie, the OCT retraction image) for analyzing the structural shape through one detection.
  • the high-speed OCT system includes an OCT imaging system 101 , a scanning device 102 , an electric control mechanism 103 , and a catheter 104 .
  • the OCT imaging system 101 includes an OCT light source and an image acquisition system.
  • the electric control mechanism 103 drives the catheter 104 (that is, drives the imaging lens) to move to the distal end of the blood vessel 105 to be detected, and then the electric control mechanism 103 controls the scanning device 102 to perform a 360-degree rotation scan, and Helical 3-D scans are achieved by retraction to obtain OCT images.
  • the catheter 104 reaches the designated position, that is, the distal end, a large amount of flushing agent such as x-ray contrast agent or normal saline is injected into the blood vessel to flush the blood.
  • the flushing agent reaches the distal end ( That is, when the OCT imaging system 101 can clearly acquire the OCT signal)
  • the scanning device 102 is controlled by the electric control mechanism 103 to perform 360-degree rotational scanning and retract.
  • the specific operation is as follows: the electric control mechanism 103 drives the catheter 104 (that is, drives the imaging lens) to move to a predetermined position such as the distal end of the blood vessel 105 to be detected, and then injects into the blood vessel.
  • a small amount of irrigant such as x-ray contrast agent or normal saline is used to mix the irrigant with the blood.
  • the motorized control mechanism 103 controls the scanning device 102 for a predetermined time (eg, equivalent to one or more heartbeats). cycle time) to perform 360-degree rotational scanning at predetermined time intervals, obtain blood flow signals at different times, obtain Doppler frequency shifts from blood flow signals at different times, and determine blood flow velocity based on the Doppler frequency shifts.
  • FIG. 3 shows a schematic flowchart of the method for analyzing the fractional blood flow reserve of the present embodiment.
  • the method for analyzing fractional blood flow reserve in this embodiment includes the following steps:
  • IVUS Imaging Intravascular Ultrasound Imaging
  • FIG. 4 shows a schematic flowchart of the method for analyzing the fractional blood flow reserve of the present embodiment.
  • the method for analyzing fractional blood flow reserve includes the following steps:
  • the imaging catheter can be rotated to acquire an intravascular ultrasound image immediately, and then the Doppler frequency shift can be acquired based on the intravascular ultrasound image, and the Doppler frequency shift can be acquired based on the Doppler ultrasound image.
  • the frequency shift determines blood flow velocity.
  • FIG. 5 shows a schematic flowchart of the microcirculation resistance analysis in this embodiment.
  • the microcirculation resistance analysis method according to the present embodiment includes the following steps:
  • the average velocity V can be obtained with reference to the method of Embodiment 1
  • the FFR value can be obtained with reference to the method of Embodiment 2
  • the proximal pressure Pa can be measured by a pressure guide wire, and can also be set according to experience.

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Abstract

一种基于血管内成像的血流速度的分析方法、血流储备分数的分析方法、以及微循环阻力分析方法。其中基于血管内成像的血流速度的分析方法包括以下步骤：步骤S1，获取待检测血管的第一腔内影像，所述第一腔内影像为光学相干断层影像或血管内超声影像；步骤S2，基于所述第一腔内影像，获取血流信号，并基于所述血流信号计算所述待检测血管内的血流速度。该血流速度的分析方法，能够准确地测得血管内的动态血流值也即血流速度，能够获得更多的血管内血流信息，且可以用于优化计算FFR、微循环阻力的计算等。

Description

基于血管内成像的血流速度、血流储备分数的分析方法 技术领域
本发明涉及待检测血管内介入影像医疗器械领域，具体涉及一种基于血管内成像的血流速度、血流储备分数、微循环阻力的分析方法。
背景技术
冠状动脉疾病已经成为全球第一大致死疾病。目前，经皮冠状动脉介入治疗(percutaneous coronary intervention，简称PCI)是冠状动脉疾病有效的治疗方法之一。
光学相干断层成像(OCT)、血管内超声(IVUS)等腔内影像技术，对于动脉粥样硬化病变斑块的识别，支架的放置与评估有着重大的临床意义，已经用于指导PCI治疗。其中因OCT具有高分辨率(纵向：10μm,横向：20-40μm)，在识别冠脉的结构形态特征及易损斑块的检测上具有绝对的优势，但仅局限于在形态与结构上对动脉粥样硬化及冠脉狭窄进行评估，并不能准确反映待检测血管形态变化引起的冠脉血流与供血等功能性的变化。
另一方面，血流储备分数(fractional flow reserve,简称FFR)通过测量冠状动脉狭窄段远端与近端的压力差值，可有效反映狭窄病变对待检测血管供血功能的影响，评估是否导致冠脉灌注心肌的缺血。
目前，FFR已成为临床上诊断，指导并评估PCI治疗的金标准。然而，传统的FFR需要通过压力导丝来测定血液压力，但是这种检查操作复杂、耗时较长，所需手术耗材(FFR导丝)价格昂贵。另外，注射待检测血管扩张药物产生的副作用会使患者出现不适反应，导丝在介入过程中容易造成病人待检测血管损伤。上述原因限制了FFR的推广。
此外，现有的通过影像学计算获得FFR的方法通常是基于使用固定的平均血流压力作为计算流体力学血流模型的边界条件。但是，实际的血流压力并非恒定不变的，被检测者个体化的差异以及下游血管的病变程度都影响着实际 的血流情况。
因此，迫切需要一种能够准确地测得血管内的动态血流值的方法，以便进一步优化FFR计算，同时还可以用于了解心动周期中不同状态之间的压差、准确计算微循环阻力等。
发明内容
有鉴于此，本发明的目的在于提供一种简单、快速且能够准确计算基于血管内成像的血流速度的分析方法。
本发明还提供一种快速、准确的血流储备分数的分析方法。
此外，本发明还提供一种快速、准确的微循环阻力的分析方法。
为了实现上述目的，本发明采用以下技术方案：
根据本发明第一方面实施例的基于血管内成像的血流速度的分析方法，包括以下步骤：
步骤S1，获取待检测血管的第一腔内影像，所述第一腔内影像为光学相干断层影像或血管内超声影像；
步骤S2，基于所述第一腔内影像，获取血流信号，并基于所述血流信号计算所述待检测血管内的血流速度。
根据本发明实施例的血流速度的分析方法，能够准确地测得血管内的动态血流值也即血流速度能够获得更多的血管内血流信息。
其中，作为第一腔内影像，可以为光学相干断层影像(OCT影像)或血管内超声影像(IVUS影像)。其中OCT具有高分辨率(纵向：10μm,横向：20-40μm)，故而优选。
进一步地，所述步骤S2中，所述血流速度通过多普勒频移获得。也就是说，通过测量测量两次图像中相同位置处的所述血流信号的相位差来计算血流速度。通过多普勒频移能够准确地计算得到动态的血流速度。
进一步地，所述步骤S1包括：
步骤S11，将成像导管伸入所述待检测血管的预定位置；
步骤S12，使得所述成像导管在所述预定位置转动的同时在预定时间内以预定时间间隔扫描，获得所述第一腔内影像，其中，所述预定时间为一个或多 个心动周期，
步骤S2中，基于相邻两次扫描得到的所述血流信号获取多普勒频移，基于所述多普勒频移确定所述血流速度。
也就是说，首先将成像导管伸入待检测血管的预定位置处，此后在预定时间内以预定时间间隔进行扫描，通过确定相邻两次扫描得到的所述血流信号即可获取多普勒频移，由此来确定血流速度。其中，由于在一个心动周期内的不同时期例如舒张压或收缩压状态下，其血流速度是不同的，因此通过监测一个或多个心动周期，能够获得更多的血流信息。
其中，所述心动周期例如通过x射线造影或心电图进行标定。也就是说，结合x射线造影技术或心电图技术来监测心动周期，并基于监测得到的心动周期的信息，确定所测得的血流速度所对应的心动周期的状态，能够获取更多的血管及血流信息。
进一步地，所述多普勒频移通过相同位置相邻时刻两次扫描的图像中的所述血流信号获得，或者，所述多普勒频移通过不同帧图像中相同位置处的所述血流信号获得。
也就是说，测量多普勒频移可以通过相同位置处相近时刻两次扫描的血流信号获得，例如成像导管位于所检测的待检测血管远端时趋于慢速旋转的状态，以保证相邻的A扫描之间有着足够的重叠，从而能够近似获得相同位置处，相近时刻信号的相位的变化。或者，多普勒频移通过不同帧图像中相同位置处的血流信号获得，因为不同帧图像之间也会存在着成像区域的重叠，所以也可获得不同帧图像相对应的同一位置的信号。
进一步地，所述第一腔内影像为光学相干断层影像，其中，所述步骤S12中，在扫描之前，向所述待检测血管注入第一预定量的冲洗剂，使得所述冲洗剂与血液混合。
当测量远端的血流速度时，首先将操作成像导管伸入至待检测血管的远端，因为血液对OCT光的强散射与吸收，因此需要向待检测血管中注入少量的冲洗剂与血液混合以便冲走部分血液从而提高光信号的穿透深度，作为冲洗剂例如可以为X射线造影剂或生理盐水。当冲洗剂与待检测血管中的血液中混合后，成像导管进行旋转的同时获取相同位置处的多个血流信号，基于多个血流 信号获取多普勒频移，并基于多普勒频移确定最大血流速度。
现有血流速度测量方法已知有温度稀释法，将已知温度的冷盐水按一定速率通过导管注射至冠状动脉，通过插入在冠脉内的温度传感元件测量血流温度下降幅度和时间，来估算血流速度。如果使用该方法来进行血流速度检测，则血流速度检测、腔内影像获取需要分步进行。根据本实施例的分析方法，采用OCT影像来获取多普勒频移，在扫描之前，向待检测血管中注入少量的冲洗剂例如X射线造影剂、生理盐水来稀释待检测血管中的血液，从而能够获取其中的血流信号的多普勒频移，继而基于该多普勒频移获取动态的血流值。
具体地，通过在血液中加入适量的标的物(即X射线造影剂、生理盐水)，通过心跳带动该标的物进入冠脉到达测量位置即OCT镜头位置，由于先期到达的标的物与血液混合，这部分混合液体返回的OCT信号可由系统检测到，不同时刻获取的信号之间由于血液的流动产生多普勒频移，通过测定多普勒频移则可通过下述公式计算出混合液体的流速(也即血流速度)：
Figure PCTCN2022089546-appb-000001
其中Vz为沿待检测血管方向流动的血流速度，λc为OCT光源的中心波长，
Figure PCTCN2022089546-appb-000002
为两次检测之间的相位变化，ΔT为两次检测之间的时间间隔，n为被测液体的折射率，θ为导管出射光束与血流方向的夹角。
由计算的公式可以看出，由于已知中心波长、折射率、角度，只要确定两次检测的时间间隔，以及该两次检测所对应的多普勒频移(也即相位变化)，即可得到对应的血流速度。
当系统对于相位分辨的能力一定时，所能测得的血流速度的最大值以及精度将由时间间隔ΔT所决定。也就是说，通过调整时间间隔，可以获得更高的精度。另外，ΔT实际对应相邻线间扫描通过的时间间隔，如果ΔT设置过小，则受分辨率限制不能准确识别，此时可以通过适当增加时间间隔来减小采样密度。
根据本发明第二方面实施例的血流储备分数的分析方法，包括以下步骤：
步骤S10，获取待检测血管中的一个或多个心动周期内的血流速度的平均 流速，所述血流速度根据上述任一项所述的血流速度的分析方法分析得到；
步骤S20，获取所述待检测血管的第二腔内影像，基于所述第二腔内影像以及所述平均流速进行流体力学分析计算，获得所述血流储备分数，
其中，所述第二腔内影像为光学相干断层影像或血管内超声影像。
基于腔内影像直接进行计算流体动力学仿真模拟时，通常将血流速度设定为一个常数。而实际血流速度因被检测者个体差异，病变状况，及心动周期等情况发生变化，实时的血流测量结果可以更准确地测定和分析待检测血管内的血流分析，进一步优化流体力学模拟和血流储备分数的计算。也就是说，根据本发明的血流储备分数的分析方法，通过第一腔内影像确定整个心动周期的血流速度的平均流速，并且结合该待检测血管的第二腔内影像进行流体动力学分析计算，获得血流储备分数(FFR)。相比于现有的FFR使用固定的平均血流压力作为计算流体力学血流模型的边界条件而言，基于待检测血管的腔内影像来计算其实时血流情况，结合腔内影像获得的待检测血管的具体的结构，可以更准确地计算血流储备分数。
进一步地，所述步骤S10中，所述血流速度包括所述待检测血管远端和/或近端的平均速度，所述步骤S20中，在获得所述第二腔内影像后，基于所述第二腔内影像进行血管分割，三维重建出血管的结构形态，并基于所述平均流速进行流体动力学分析计算，获得所述血流储备分数。
也就是说，既可以采用远端的平均速度，也可以采用近端的平均速度，还可以同时采用远端以及近端的平均速度来与由第二腔内影像得到的血管的结构心态进行结合，通过流体动力学分析计算获得FFR值。其中，远端位置处的血管较细，成像导管可能对其平均流速的影响较大，但是从程序上而言，远端测速、回撤获得第二腔内影像，可以一步完成，程序更加简化。因此可以结合具体条件选用远端平均流速、近端平均流速、远端与近端的综合平均流速。
进一步地，所述步骤S20包括：
使成像导管到达所述待检测血管的远端；
使所述成像导管旋转的同时回撤至所述待检测血管的近端，并获得所述待检测血管的所述第二腔内影像。
也就是说，作为获取第二腔内影像的具体流程，先将成像导管置于所述待 检测血管的远端，此后使成像导管旋转的同时回撤至所述待检测血管的近端，回撤途中进行扫描获得反应了整个待检测血管的结构信息的第二腔内影像。
结合测量血流流速而言，既可以如下：先将成像导管到达血管远端，此后使得成像导管旋转获取该位置处的第一腔内影像，此后使得成像导管旋转的同时回撤，并进行扫描，获得第二腔内影像，基于第一腔内影像解析远端的血流速度的平均流速，基于第二腔内影像获得血管的结构形态，基于平均流速及结构形态，通过流体动力学解析，例如CFD仿真模拟，即可得到FFR值。
由此，通过一次回撤即可同时获取血流速度以及腔内影像，减少了测量步骤和时间，并大大提高了对血管病变功能学分析的准确率和效率。
进一步地，所述第二腔内影像为光学相干断层影像，其中，在使所述成像导管回撤之前，向所述待检测血管内注入第二预定量的冲洗剂以冲走所述血液。
也就是说，在采用OCT影像作为第二腔内影像时，在回撤之前，需要向血管内注入大量的冲洗剂(例如X光造影剂、生理盐水等)来冲走血液，也更准确地反应血管内的结构形态。
根据本发明第三方面实施例的微循环阻力的分析方法，包括如下步骤：
获取待检测血管近端的压力；
基于上述任一项所述的血流储备分数的分析方法分析血流储备分数；
基于近端的压力与所述血流储备分数，获得远端压力；
基于所述远端压力，以及基于上述任一项所述的血流速度的分析方法获得待检测血管的远端的一个或多个心动周期相应的血流速度的平均流速，确定所述待检测血管的所述微循环阻力。
也就是说，通过血流速度的平均流速来解析得到FFR值之后，结合血管近端的压力来确定远端压力，通过远端压力与平均流速即可确定微循环阻力。
附图说明
图1为本发明实施例1的基于血管内成像的血流速度的分析方法的流程示意图；
图2为使用高速OCT系统进行血流储备分数分析的示意图；
图3为根据实施例2的血流储备分数分析方法的流程示意图；
图4为根据实施例3的血流储备分数分析方法的流程示意图；
图5为根据实施例4的微循环阻力的分析方法的流程示意图。
具体实施方式
为使本发明实施例的目的、技术方案和优点更加清楚，下面将结合本发明实施例的附图，对本发明实施例的技术方案进行清楚、完整地描述。显然，所描述的实施例是本发明的一部分实施例，而不是全部的实施例。基于所描述的本发明的实施例，本领域普通技术人员所获得的所有其他实施例，都属于本发明保护的范围。
除非另作定义，本发明中使用的技术术语或者科学术语应当为本发明所属领域内具有一般技能的人士所理解的通常意义。本发明中使用的“第一”、“第二”以及类似的词语并不表示任何顺序、数量或者重要性，而只是用来区分不同的组成部分。同样，“一个”或者“一”等类似词语也不表示数量限制，而是表示存在至少一个。“连接”或者“相连”等类似的词语并非限定于物理的或者机械的连接，而是可以包括电性的连接，不管是直接的还是间接的。“上”、“下”、“左”、“右”等仅用于表示相对位置关系，当被描述对象的绝对位置改变后，则该相对位置关系也相应地改变。
下面，通过具体实施例进一步详细说明本发明的血流速度的分析方法、血流储备分数的分析方法、以及微循环阻力的分析方法。
实施例1通过OCT影像的多普勒频移分析血流速度
如图1所示，本实施例的血流速度的分析包括如下步骤：
1a)将成像导管伸入带检测血管的预定位置处；
1b)向血管内注入少量的X光造影剂；
1c)在X光造影剂与血液的混合液到达该预定位置处时，使得成像导管原地转动，并以预定时间间隔例如1s进行扫描，
同时，通过心电图监测心动周期，确定所述成像导管获取1个或多个心动周期的第一腔内影像；
1d)对于相邻两次扫描得到的第一腔内影像，通过下述公式计算血流速度：
Figure PCTCN2022089546-appb-000003
其中Vz为沿待检测血管方向流动的血流速度，λc为OCT光源的中心波长，
Figure PCTCN2022089546-appb-000004
为两次检测之间的相位变化，ΔT为两次检测之间的时间间隔，n为被测液体的折射率，θ为导管出射光束与血流方向的夹角。
得到一整个心动周期中分别对应不同状态的血流速度。
实施例2通过OCT影像分析血流储备分数
如图2所示，通过高速OCT系统来分析血流储备分数。本实施例中采用高速OCT系统通过一次检测，获取血流速度的平均流速以及用于解析结构形态的腔内影像(即OCT回撤影像)。
其中，如图2所示，高速OCT系统包括OCT成像系统101、扫描装置102、电动控制机构103、以及导管104构成。其中，OCT成像系统101包括OCT光源、图像采集系统。
在获取OCT回撤影像的操作中，电动控制机构103带动导管104(也即带动成像镜头)运动到待检测血管105的远端，此后电动控制机构103控制扫描装置102进行360度旋转扫描，并通过回撤实现螺旋形3-D扫描，获得OCT图像。考虑到血液对OCT光的强散射和吸收，在导管104到达指定位置即远端后，向血管内注入大量冲洗剂例如x射线造影剂或生理盐水对血液进行冲洗，当冲洗剂到达远端(也就是，当OCT成像系统101能够清楚地获取OCT信号时)，通过电动控制机构103控制扫描装置102进行360度旋转扫描并回撤。
另外，为了获取血流信号的多普勒频移，具体操作如下：电动控制机构103带动导管104(也即带动成像镜头)运动到待检测血管105的预定位置例如远端，此后向血管内注入少量冲洗剂例如x射线造影剂或生理盐水以使得该冲洗剂与血液混合，当混合的血液到达远端，电动控制机构103控制扫描装置102在预定时间内(例如相当于1个或多个心动周期的时间)以预定的时间间隔进行360度旋转扫描，获取不同时刻的血流信号，从不同时刻的血流信号获取多普勒频移，基于多普勒频移来确定血流速度。
具体地，图3示出了本实施例的血流储备分数分析方法的流程示意图。
如图3所示，本实施例的血流储备分数分析方法包括如下步骤：
2A)获取待检测血管的远端的血流速度的整个心动周期内的平均流速；
具体地，采用跟实施例1同样的方法进行分析计算获得，
2B)向血管内注入大量X光造影剂以冲走血液；
2C)当X光造影剂到达远端，使得成像导管旋转的同时回撤，直至近端，以获得OCT回撤影像；
2D)对于OCT回撤影像进行血管分割，三维重建出血管的结构形态；
2E)基于上述得到的远端的平均流速、以及血管的结构形态，进行流体动力学仿真模拟，获得FFR值。
实施例3通过血管内超声影像(IVUS影像)分析血流储备分数
图4示出了本实施例的血流储备分数的分析方法的流程示意图。
如图4所示，根据本实施例的血流储备分数的分析方法，包括如下步骤：
3A)获取待检测血管的远端的血流速度的整个心动周期内的平均流速。
该步骤中，与实施例1不同的是，不需要在血管内注入冲洗剂。也就是说，无需执行1b)步骤，在成像导管到达远端后，可以立刻使得该成像导管旋转获取血管内超声影像，此后基于该血管内超声影像获取多普勒频移，并基于多普勒频移确定血流速度。具体的其他细节可以参考实施例1进行，在此不再赘述。
3B)使得成像导管旋转的同时回撤，直至近端，获得IVUS回撤影像；
3C)对于IVUS回撤影像进行血管分割，三维重建出血管的结构形态；
3D)基于上述得到的远端的平均流速、以及血管的结构形态，进行流体动力学仿真模拟，获得FFR值。
实施例4微循环阻力分析
图5示出了本实施例的微循环阻力分析的流程示意图。
如图5所示，根据本实施例的微循环阻力分析方法，包括如下步骤：
4A)确定平均流速V以及FFR值；
具体地，可以参考实施例1的方法获得平均速度V，并参考实施例2的方法获得FFR值，
4B)获取近端压力Pa，并计算远端压力Pd，其中Pd＝Pa*FFR；
其中，近端压力Pa可以通过压力导丝测量得到，也可以根据经验设定等。
4C)基于平均流速以及远端压力，计算微循环阻力IMR，其中，
IMR＝Pd/V。
以上所述是本发明的优选实施方式，应当指出，对于本技术领域的普通技术人员来说，在不脱离本发明所述原理的前提下，还可以作出若干改进和润饰，这些改进和润饰也应视为本发明的保护范围。

Claims (10)

  1. 一种基于血管内成像的血流速度的分析方法，其特征在于，包括以下步骤：
    步骤S1，获取待检测血管的第一腔内影像，所述第一腔内影像为光学相干断层影像或血管内超声影像；
    步骤S2，基于所述第一腔内影像，获取血流信号，并基于所述血流信号计算所述待检测血管内的血流速度。
  2. 根据权利要求1所述的分析方法，其特征在于，所述步骤S2中，所述血流速度通过多普勒频移获得。
  3. 根据权利要求2所述的分析方法，其特征在于，所述步骤S1包括：
    步骤S11，将成像导管伸入所述待检测血管的预定位置；
    步骤S12，使得所述成像导管在所述预定位置转动的同时在预定时间内以预定时间间隔扫描，获得所述第一腔内影像，其中，所述预定时间为一个或多个心动周期；
    步骤S2中，基于相邻两次扫描得到的所述血流信号获取多普勒频移，基于所述多普勒频移确定所述血流速度。
  4. 根据权利要求3所述的分析方法，其特征在于，所述心动周期通过x射线造影或心电图进行标定，
    或者，所述多普勒频移通过相同位置相邻时刻两次扫描的图像中的所述血流信号获得，
    或者，所述多普勒频移通过不同帧图像中相同位置处的所述血流信号获得。
  5. 根据权利要求3所述的分析方法，其特征在于，所述第一腔内影像为光学相干断层影像，其中，所述步骤S12中，在扫描之前，向所述待检测血管注入第一预定量的冲洗剂，使得所述冲洗剂与血液混合。
  6. 一种血流储备分数的分析方法，其特征在于，包括如下步骤：
    步骤S10，获取待检测血管中的一个或多个心动周期内的血流速度的平均流速，所述血流速度根据权利要求1至5任一项所述的基于血管内成像的血流 速度的分析方法分析得到；
    步骤S20，获取所述待检测血管的第二腔内影像，基于所述第二腔内影像以及所述平均流速进行流体力学分析计算，获得所述血流储备分数，
    其中，所述第二腔内影像为光学相干断层影像或血管内超声影像。
  7. 根据权利要求6所述的血流储备分数的分析方法，其特征在于，
    所述步骤S10中，所述血流速度包括所述待检测血管远端和/或近端的平均速度，
    所述步骤S20中，在获得所述第二腔内影像后，基于所述第二腔内影像进行血管分割，三维重建出血管的结构形态，并基于所述平均流速进行流体动力学分析计算，获得所述血流储备分数。
  8. 根据权利要求7所述的血流储备分数的分析方法，其特征在于，所述步骤S20包括：
    使成像导管到达所述待检测血管的远端；
    使所述成像导管旋转的同时回撤至所述待检测血管的近端，获得所述待检测血管的所述第二腔内影像。
  9. 根据权利要求8所述的血流储备分数的分析方法，其特征在于，所述第二腔内影像为光学相干断层影像，其中，在使所述成像导管回撤之前，向所述待检测血管内注入第二预定量的冲洗剂以冲走所述血液。
  10. 一种微循环阻力的分析方法，其特征在于，包括如下步骤：
    获取待检测血管近端的压力；
    基于权利要求6至9任一项所述的血流储备分数的分析方法分析血流储备分数；
    基于近端的压力与所述血流储备分数，获得远端压力；
    基于所述远端压力，以及权利要求1至4任一项所述的血流速度的分析方法获得待检测血管的远端的一个或多个心动周期相应的血流速度的平均流速，确定所述待检测血管的所述微循环阻力。
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