JP5562775B2 - Medical image display system - Google Patents

Description

  Embodiments described herein relate generally to a medical image display system.

  In recent years, since early detection and early treatment of coronary artery disease is very important, the use of CT (Computed Tomography) as a screening test for acute myocardial infarction is increasing. A screening test is a test or diagnostic technique for detecting a disease at an asymptomatic stage.

  When a disease is found as a result of this screening test, an operation / treatment called percutaneous coronary intervention (PCI) is performed. This refers to an operation in which a catheter is inserted into a patient while an angiographic image obtained by a cineangio device is viewed in a cardiac catheter examination room, a blood vessel in an infarcted portion is expanded with a balloon, and then a stent is inserted.

  Furthermore, using an intravascular ultrasound (IVUS) inspection apparatus, it is performed to check the pressure-bonding state between the inserted stent and the blood vessel.

  In the post-surgery explanation given to the patient who has undergone surgery and the family of this patient, individual examinations such as CT images and IVUS images collected by the examination equipment used during examination, treatment, and surgery, etc. It is common practice to collect data and explain it by simply arranging it on a Schaukasten or multi-screen. However, for the patient or the patient's family, the medical images acquired by the individual inspection devices are difficult for the amateur to understand and the correspondence between the treatment sites is not fully understood, so it is impossible to fully understand the explanation of the doctor. The current situation is difficult.

  In addition, even in the case of doctors, the three-dimensional coronary artery stenosis vascular lumen CT image collected in the screening test for coronary artery disease and the IVUS image before and after treatment are collected in the same spatial image. Since the inspection conditions such as the inspection date and time and the image collection angle at the time of inspection, the image reconstruction method, and the display method are different, the inspection images collected by each inspection system are individually observed, It is necessary to consider the structure in the middle, and it takes time to explain to the patient.

  As described above, conventionally, inspection data acquired by a plurality of inspection apparatuses is generally processed individually (see Patent Document 1). There is a technique in which inspection data obtained by a plurality of inspection systems are displayed in time synchronization (see Patent Document 2).

International Publication 2003-001421 Pamphlet Japanese Patent Laid-Open No. 2008-301984

  However, even though the inspection data obtained by a plurality of inspection apparatuses can be displayed in time synchronization, the same inspection site in space cannot be displayed in synchronization.

  The present invention provides a medical image display system for synchronizing and displaying spatially identical examination sites of examination data obtained by a plurality of examination apparatuses.

  According to one embodiment, a first reference point setting unit that sets first and second spatial reference points located before and after the diseased part from a CPR image generated from volume data of blood vessels including the diseased part, A second reference point setting unit for setting third and fourth spatial reference points corresponding to the first and second spatial reference points from IVUS cross-sectional image data of a blood vessel including the diseased part, A long-axis image generating unit that generates an IVUS long-axis image from the IVUS cross-sectional image data, and dividing the CPR image by the number of slices of the IVUS cross-sectional image included between the third and fourth spatial reference points; A mapping unit that obtains a spatial correspondence between slice positions of the IVUS long-axis image and the CPR image, a cross-sectional image generation unit that generates a CPR cross-sectional image at a slice position obtained by dividing the CPR image, and the CPR image VUS long axis image display simultaneously, to provide a medical image display system characterized by having a synchronous playback unit for synchronously display the IVUS sectional image and CPR sectional images of the same spatial position corresponding.

1 is a configuration diagram of a medical image display system according to an embodiment. It is explanatory drawing with respect to PCI surgery. (A) is the figure which inserted the balloon catheter which covered the stent, (b) is the figure which inflated the balloon, (c) is the figure which removed the balloon catheter. 5 is a flowchart showing an operation and a processing procedure of the medical image display system according to the embodiment. It is a figure explaining the IVUS image before the operation | movement of the medical image display system which concerns on the embodiment. (A) is a schematic diagram of an IVUS cross-sectional image, and (b) is a schematic diagram of an IVUS long-axis image. It is a schematic diagram which shows the IVUS long-axis image and slice line after the operation | movement of the medical image display system which concerns on the embodiment. It is a flowchart of the mapping process of the medical image display system according to the embodiment. It is the figure which showed the correspondence of the CPR image and IVUS long-axis image of the medical image display system which concerns on the embodiment. It is an example of the synchronous display of the medical image display system which concerns on the embodiment.

  An embodiment will be described in detail with reference to the drawings. In the embodiments described below, a case will be described in which screening for cardiovascular diseases such as acute myocardial infarction is performed with a CT apparatus, and an examination before PCI surgery and a stent crimping situation after PCI surgery are observed with an IVUS apparatus.

  A CT apparatus is an apparatus that captures a tomographic image of a human body using a computer tomography method. It is possible to reconstruct not only a tomographic image but also an image obtained by extracting only a blood vessel region from acquired volume data and a CPR (Curved Planar Reformation) image along the blood vessel. The CPR image is a method of reconstructing a cross section along a meandering surface or curved surface, and is a method used when observing along a curved surface such as an organ, a lesion, or a blood vessel. Therefore, in the present embodiment, a CPR image along the blood vessel direction is generated and used.

  In addition, an IVUS apparatus that is performed before and after PCI surgery, for example, as an inspection of a stenotic blood vessel is an inspection apparatus for performing an ultrasonic inspection in a blood vessel. An ultrasonic probe is attached to the tip of the catheter, inserted into the blood vessel, and mechanically or electrically scanned with ultrasonic waves, an ultrasonic image of the blood vessel circumference at a certain position can be acquired. Therefore, it is possible to take a cross-sectional image (hereinafter referred to as an IVUS cross-sectional image) as if the blood vessel was cut horizontally at the catheter insertion position. In addition, a long axis image obtained by longitudinally cutting a blood vessel can be generated from this IVUS cross-sectional image group (hereinafter referred to as an IVUS long axis image).

  In the actual examination, the IVUS catheter is inserted deeper than the stenotic blood vessel, and the catheter is advanced to the blood vessel branch point beyond that. IVUS image acquisition starts from the vessel branch point, and the cross-section is taken at a frame rate of, for example, about 30 frames / second while the catheter is retracted at a predetermined constant speed such as 0.5 mm / second by a function such as automatic pullback. Acquire images continuously. After the catheter acquires a cross-sectional image of the stenotic blood vessel, the cross-sectional image is acquired up to the vicinity of the next blood vessel branch point, and the examination ends. Therefore, the number of slices of the IVUS image measured by such a method is about 600 per 1 cm, and a continuous high-definition and continuous blood vessel cross-sectional image can be observed.

  First, the configuration of a medical image display system according to an embodiment of the present invention will be described with reference to FIG. The medical image display system according to the embodiment includes a CT apparatus 1 used for screening for cardiovascular diseases such as acute myocardial infarction, and an IVUS apparatus for confirming a disease state before PCI surgery or a crimping state of a stent after surgery. 2 and the image of the same stenotic blood vessel acquired by the CT apparatus 1 and the IVUS apparatus 2, a spatial positional relationship (hereinafter referred to as spatial synchronization or spatial mapping) is obtained, and a plurality of examination images are spatialized. And a medical image display device 3 for synchronously displaying.

The CT apparatus 1, the IVUS apparatus 2, and the medical image apparatus display apparatus 3 are normally connected to a network 4 in the hospital and can communicate with each other.

  The medical image display apparatus 3 includes a CT image processing unit 11 that acquires CT image data from the CT apparatus 1 and performs image processing, and an IVUS image processing unit 12 that acquires IVUS image data from the IVUS apparatus 2 and performs image processing. An operator for the synchronization processing unit 13 that performs spatial synchronization (spatial mapping) between the CT image and the IVUS image, the display unit 14 that displays a plurality of spatially synchronized examination images, and the medical image display device 3 Comprises an operation unit 15 for giving instructions / commands, a system control unit 16 for controlling the entire medical image display device 3, and a database unit 17 for reading and storing images. A broken line arrow represents a control line from the system control unit 16, and a solid line arrow represents a data flow.

  The CT image processing unit 11 includes a plurality of examination apparatuses such as a CT image acquisition unit 111 that acquires CT image data from the CT apparatus 1, a 3D image generation unit 112 that generates a CPR image, and a branch point of a blood vessel from the CPR image. A CT branch detection unit 113 that sets or automatically detects a spatial reference point capable of taking a spatial correspondence between acquired images. In particular, in the present embodiment, the CT branch detection unit 113 automatically detects the first and second blood vessel branch points located before and after the stenotic blood vessel part to be treated as a spatial reference point, or the operator It can be set via the operation unit 15. When both are included, it is called a setting. Further, the spatial reference point is not limited to the branch point of the blood vessel, but may be a position where the same portion can be accommodated spatially.

  In the present embodiment, image processing is performed by extracting a blood vessel region from the volume data of the CT apparatus. Further, when a CPR image obtained by directly extracting a blood vessel region in the CT apparatus 1 can be reconstructed and acquired, the 3D image generation unit 112 may be bypassed.

  The IVUS image processing unit 12 includes an IVUS image collection unit 121 that acquires IVUS image data from the IVUS device 2, a long-axis image generation unit 122 that generates an IVUS long-axis image, and a branch point of a blood vessel from the IVUS long-axis image. The IVUS branch detection unit 123 sets or automatically detects a spatial reference point for taking a correspondence relationship between them. In particular, in the present embodiment, the third and fourth blood vessel branch points located before and after the stenotic blood vessel to be treated are automatically detected as spatial reference points, or set by the operator via the operation unit 15. The spatial reference point is not limited to the branch point of the blood vessel. Further, when the IVUS long-axis image can be directly acquired in the IVUS apparatus 2, the long-axis image generation unit 122 may be bypassed.

  The synchronization processing unit 13 slices the branch points of the same blood vessel obtained by the CT branch detection unit 113 and the IVUS branch detection unit 123 at equal intervals with the same number of slices (arbitrary integer N). A mapping unit 131 that performs spatial mapping of both images based on N, a cross-sectional image generation unit 132 that generates a CPR cross-sectional image corresponding to the slice number N, and a plurality of inspection images corresponding to the slice number N are synchronized. The synchronous playback unit 133 is displayed.

  FIG. 2 is an explanatory diagram for PCI surgery. The PCI operation will be briefly described with reference to this figure. First, a doctor inserts a catheter with a balloon at the tip over a guard wire, inserts it into a stenotic blood vessel to be treated, and performs a treatment to widen the blood vessel by pushing and expanding the balloon. Thereafter, as shown in FIG. 2A, a catheter 22 having a balloon 23 covered with a stent 23 is inserted into a stenotic blood vessel 20 to be treated. Then, as shown in FIG. 2 (b), the balloon 21 is inflated, and the stent 23 is crimped to the blood vessel wall surface of the stenotic blood vessel portion 20. Thereafter, as shown in FIG. 2C, only the stent 23 is left in the blood vessel, and the operation is completed.

  FIG. 3 is a flowchart showing an example of the operation and processing procedure of the medical image display system in the present embodiment. Steps S301 to S305 show a flow of examination / operation by a doctor or the like, and the other steps show processing operation / operation steps of the medical image display system. The description will be made with reference to FIG.

  In the example of the present embodiment, a CT test is performed on a screening test or a patient suspected of having a heart disease in the screening test (step S301), and an IVUS test is performed on a stenotic blood vessel before PCI surgery (step S302). After the operation (step S303), an IVUS examination of the treated blood vessel is performed again (step S304). Using these CT images and pre- and post-operation IVUS images, surgery or Assume a flow of explaining the treatment progress (step S305).

  From the volume data of the CT apparatus 1 obtained in step S301, the 3D image generation unit 112 of the CT image collection unit 11 generates a CPR image in which only the blood vessel region is extracted from the volume data (step S306).

  With respect to this CPR image, the spatial coordinates are acquired using the two blood vessel branch points positioned before and after the stenotic blood vessel as the first spatial reference point and the second spatial reference point (S307). The determination of the blood vessel branch point may be determined visually by the operator or may be automatically acquired by image processing.

  Next, the IVUS image performed in the IVUS examination before operation (step S302) is acquired by the IVUS image collection unit 121 of the IVUS image processing unit 3 (step S308).

  From the IVUS cross-sectional image group 40 as shown in FIG. 4A, an IVUS long-axis image 41 in the blood vessel direction as shown in FIG. 4B is generated in the long-axis image generation unit 122 (step S309). When the IVUS long-axis image 41 is generated from the IVUS cross-sectional image group 40 including the stenotic blood vessels, the first branch blood vessel 42 (the third spatial reference point P3) can be confirmed and the next branch blood vessel 44. Each IVUS cross-sectional image 45 in which (the fourth spatial reference point P4) can be confirmed is extracted (step S310). The determination of the blood vessel branch point based on the branch blood vessels 42 and 44 may be set visually by the operator, or may be automatically acquired by image processing.

  The number of slices N of the IVUS cross-sectional image from the extracted blood vessel branch cross-sectional image 43 to the next blood vessel branch cross-sectional image 45 is acquired (S311). Further, as shown in FIG. 4B, a slice line 46 indicating the slice position is added to the long axis display image of the IVUS image including the stenotic blood vessel (S312).

  As for the number of slices, the operator selects an arbitrary integer N equal to or less than the maximum resolution slice number Nmax determined by the IVUS catheter pullback speed and the number of imaging frames, or automatically determines the slice number.

  A PCI operation is performed (step S303), and an IVUS test is performed after the operation (step S304). Similar to the IVUS image processing performed in the IVUS examination before surgery (step S302), the IVUS image after surgery is acquired by the IVUS image collection unit 121 (step S313). The IVUS cross-sectional image is generated as an IVUS long-axis image in the blood vessel direction by the long-axis image generation unit 122 (step S314). When generating an IVUS long-axis image including this stenotic blood vessel, a cross-sectional image from which the first branch blood vessel (fifth spatial reference point P5) can be confirmed and the next branch blood vessel (sixth spatial reference point P6) are obtained. Each cross section that can be confirmed is extracted (step S315).

  The determination of the blood vessel branch point may be determined visually by the operator or may be automatically acquired by image processing. The number of slice sections of the IVUS image from the extracted blood vessel branch section to the next blood vessel branch section is acquired (step S316). Further, a slice line indicating the slice cross-sectional position is added to the long axis display image of the IVUS image including the stenotic blood vessel (step S317). The number of slices is set to the same number N in IVUS images before and after surgery. FIG. 5 shows the long-axis image 51 and the slice line 52 set in this way.

  Next, mapping with the CPR image is performed based on the slice number N of the IVUS image (step S318). Step S318 of the mapping process performed by the mapping unit 131 will be described with reference to FIG.

  First, for the CPR image, the coordinates of the blood vessel branch point positions P1 and P2 are acquired (step S601). On the other hand, the number of slices N between the branches of the IVUS image is acquired (step S602), the branch points P1 and P2 of the CPR image are allocated at equal intervals at this slice interval, and the slice position corresponding to each slice is calculated (step). S603).

  Returning to the flow of FIG. 3, when the mapping process in step S318 is completed, a slice line is added to the CPR image (step S319). Then, for each slice position mapped to the CPR image, each CPR cross-sectional image is generated by the cross-sectional image generation unit 132 (step S320).

  As shown in FIG. 7, the CPR image and the IVUS image are associated with each other in steps S601 to S603 and step S319. In the CPR sectional view 70, a first blood vessel branch point P1 and a second blood vessel branch point P2 are set, and a slice line 71 is added therebetween. In the IVUS image 72, the third blood vessel branch point P3 (or the fifth blood vessel branch point P5) corresponds to the first blood vessel branch point P1, and the fourth blood vessel branch point P4 (or the sixth blood vessel branch point). P6) corresponds to the second blood vessel branch point P2. Accordingly, the IVUS long axis image 72 and the CPR image 70 are spatially associated with each slice line 71.

  That is, each slice slice image group 73 in the CPR image 70 is A (i) (i is an integer from 1 to N), and each slice slice image group 74 in the IVUS long-axis image 72 is B (i) (i is 1 to N). , Each i-th slice image can display the corresponding slice cross section of the same part.

In step S321, the synchronized playback unit 133 outputs the CPR image and the IVUS image before and after the operation in a spatially synchronized manner. The patient is explained using this (step S305). This is shown in FIG. A CPR image 81, a pre-operative IVUS long-axis image 82, and a post-operative IVUS long-axis image 83 are displayed side by side, and each cross-sectional image is displayed horizontally in synchronization with the selected slice number i as indicated by a solid line arrow. Is displayed. Therefore, in the CPR cross-sectional image 81 and the preoperative IVUS long-axis image 82, the state of the stenosis 84 can be confirmed spatially corresponding to each other even if the inspection apparatus is different. In addition, in the pre-operative IVUS long-axis image 82 and the post- operative IVUS long-axis image 83, it can be clearly seen how the stent 85 is fixed after the operation with respect to the image before the operation.

  At this time, by setting two slice numbers, it is possible to display the images between the two points continuously or repeatedly (synchronized loop reproduction) while spatially synchronizing.

  The slice number can be easily specified from the scanning unit 15 by a user interface such as a mouse.

  Although the said embodiment described before and after PCI surgery, it is not restricted to this case. For example, it can be applied to the course after treatment. That is, it is possible to confirm the state of the stent and the blood vessel in the healing process after the operation and to confirm the state in synchronism spatially when removing the stent.

  In the present embodiment, the CT apparatus has been described as an example. However, as long as the blood vessel portion can be extracted from the volume data and can display the CPR image, it can be similarly configured in another apparatus, for example, an MRI apparatus. In general, volume data may be obtained from different medical image diagnostic apparatuses.

  In the description of the above embodiment, the blood vessel branch point is automatically detected by the CT branch detection unit 113 and the IVUS branch detection unit 123. However, the operator can determine the branch point visually.

  When the blood vessel branch point is determined visually from the CT image, for example, an image obtained by the 3D image generation unit 112 is displayed on the screen of the display unit 14, and the operator operates the screen of the display unit 14 from the operation unit 15. Then, move the cursor with a mouse and click to specify the branch point of the blood vessel. The same can be done for IVUS images as well as CT images.

  In the above embodiment, an example has been described in which the present invention is applied to a blood vessel, the branch point thereof is used as a spatial reference point, and the spatial corresponding positions of the CPR cross-sectional image and the IVUS cross-sectional image are displayed in synchronization. However, the present invention is not limited to application to blood vessels. In general, according to the present invention, a spatial reference point is set for a tubular structure, the correspondence between the spatial positions of two generated images is obtained from the corresponding relationship, and the generated images are located at substantially the same position. A cross-sectional image can be displayed.

  As described above, in the present embodiment, it is possible to synchronize and display the spatially identical examination sites of examination data obtained by a plurality of examination apparatuses. As a result, in the post-surgery explanation given to the patient who has undergone surgery and the family of this patient, the positional relationship of the treatment site between the images is clear, so that the doctor can deal with the progress and effects of the surgery. The explanation is very easy to understand.

  In addition, doctors also have three-dimensional coronary artery stenosis vascular lumen CT images collected in acute myocardial infarction screening tests, and IVUS images before and after treatment, such as the examination date and time, the image collection angle at the time of examination, etc. Even if the examination conditions are different, the correspondence between the examination images collected by the individual examination systems becomes clear, so that the patient can be explained accurately in a short time.

  In addition, the present invention is not limited to the above-described embodiment itself, and can be embodied by modifying constituent elements without departing from the scope of the invention in the implementation stage. Moreover, the some component currently disclosed by the said embodiment can be combined suitably. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, constituent elements over different embodiments may be appropriately combined. As long as the technical idea of the present invention is used, these modified examples are also included in the technical scope of the present invention.

1 ... CT device,
2 ... IVUS device,
3 ... Medical image display device,
11 ... CT image processing unit,
12 ... IVUS image processing unit 13 ... Image synchronization processing unit,
14 ... Display unit 15 ... Operation unit,
16 ... System control unit,
17 ... Database section.

Claims (7)

A first reference point setting unit for setting first and second spatial reference points located before and after the diseased part from a CPR image generated from volume data of blood vessels including the diseased part;
A second reference point setting unit for setting third and fourth spatial reference points corresponding to the first and second spatial reference points from IVUS cross-sectional image data of a blood vessel including the diseased part;
A long-axis image generation unit that generates an IVUS long-axis image from the IVUS cross-sectional image data;
Mapping that divides the CPR image by the number of slices of the IVUS cross-sectional image included between the third and fourth spatial reference points and obtains a spatial correspondence between the slice positions of the IVUS long-axis image and the CPR image And
A cross-sectional image generation unit that generates a CPR cross-sectional image at a slice position obtained by dividing the CPR image;
A medical image display system, comprising: a synchronous reproduction unit that simultaneously displays the CPR image and the IVUS long-axis image, and displays the IVUS cross-sectional image and the CPR cross-sectional image at the same spatial corresponding position in synchronization.   The medical image display system according to claim 1, wherein the spatial reference point is a blood vessel branch point.   3. The medical image display system according to claim 2, wherein an image is displayed by associating the slice position with a slice number.   4. The medical image display system according to claim 3, wherein a corresponding cross-sectional image is displayed by selecting the slice position or slice number.   5. The medical image display system according to claim 4, wherein the cross-sectional image from the slice start position to the end position is continuously displayed and repeatedly displayed by selecting a start position and an end position of the slice position.   6. The medical image display system according to claim 5, wherein IVUS image data before and after treatment is acquired, and the CPR cross-sectional image and the IVUS cross-sectional image before and after the treatment are displayed in synchronization. A first generating image along the long axis of the annular structure which is made volume data or al raw consisting sectional images intersecting the long axis of the annular structure which is collected by IVUS examination device, a medical non IVUS examination device A receiving unit for receiving a second generated image along the long axis of the annular structure generated from the volume data of the annular structure collected by the diagnostic imaging apparatus ;
A first reference point setting unit for setting first and second spatial reference points from the first generated image;
A second reference point setting unit for setting third and fourth spatial reference points corresponding to the first and second spatial reference points of the second generated image;
A mapping unit for obtaining a correspondence between spatial positions of the first generated image and the second generated image from the correspondence between the spatial reference points;
Based on the correspondence relationship of the spatial position obtained by the mapping unit, a display unit that generates and extracts cross-sectional images at substantially the same position from the respective volume data, and displays them,
A medical image display system comprising:

Images