JP6322971B2 - Medical image diagnosis support apparatus, method and program - Google Patents

Description

  The present invention relates to a technique for supporting image diagnosis in the medical field and the like, and more particularly, to a medical image diagnosis support apparatus, method, and program suitable for image diagnosis support related to the annulus of an aorta.

  Conventionally, aortic valve replacement is usually accompanied by a midline thoracotomy (midline sternotomy), and even patients with aortic valve lesions may not be able to operate depending on the patient's condition and condition. There were also many. On the other hand, the first treatment example reported in 2002 is called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). Surgery is known. This operation is attracting attention because it may be applicable even to patients who are not indicated for normal aortic valve replacement, and in recent years, hospitals and surgeons are increasing in particular in Europe and the United States. In Japan, it is anticipated that clinical practice will begin in recent years.

  In TAVR (TAVI), a replacement prosthetic valve purchased from a prosthetic valve maker is prepared in advance for surgery. Therefore, it is necessary to grasp in advance information necessary for the operation, such as the size (diameter, area, circumference length, etc.) of the annulus of the aorta, which is the part where the artificial valve is placed. For observation of the heart whose shape changes greatly due to pulsation, images by echocardiography (cardiac ultrasonography) are often used (see, for example, Patent Document 1 below), and TAVR (TAVI) has become widespread. In Europe and the United States, in general, the size of the annulus is measured using an image of the annulus by echocardiographic aortic short axis display.

JP-A-9-131345

  Echocardiography has the advantage that it can be measured non-invasively many times. However, image information obtained by echocardiography is generally two-dimensional, and an accurate short-axis display image of the aortic valve annulus cannot often be obtained by probe operation. For this reason, the measurement based on the image information obtained by echocardiography has a problem that the reproducibility is low. In TAVR (TAVI), it is also required to know in advance the distance between the annulus and the leaflet of the aorta and the coronary artery origin. However, it is difficult to obtain such distance information from two-dimensional image information obtained by echocardiography.

  The present invention has been made in view of such circumstances, and a medical image capable of acquiring desired information (information such as the position and size of the aortic annulus) with high reproducibility regarding the aortic annulus. It is an object to provide a diagnosis support apparatus, method, and program.

  In order to achieve the above object, a medical image diagnosis support apparatus, method and program according to the present invention have the following features.

That is, the medical image diagnosis support apparatus according to the present invention includes a specifying unit that specifies a blood channel including the ascending aorta based on three-dimensional medical image data including the heart, and a blood channel specified by the specifying unit. A calculation means for calculating a measurement value of the contour perimeter in a cross section perpendicular to the longitudinal direction of the blood channel, and a position at which the measurement value of the contour perimeter calculated by the calculation means is minimized And determining means for determining the position of the aortic annulus based on the above. According to this aspect of the present invention, the position of the aortic annulus can be specified with high reproducibility on the image data. In addition, by specifying the aortic annulus position with high accuracy, it is possible to assist a doctor, engineer, or the like based on the information on the aortic annulus position so as to easily obtain desired information on the aortic annulus. It becomes possible.

The medical image diagnosis support method according to the present invention includes a specifying step of specifying a blood channel including the ascending aorta based on three-dimensional medical image data including the heart, and a cross section of the blood channel specified by the specifying step. A calculation step of calculating a measurement value of the contour perimeter in a cross section orthogonal to the longitudinal direction of the blood flow path, and a position where the measurement value of the contour perimeter calculated in the calculation step is minimized. And determining a position of the aortic annulus. According to the present invention of this aspect, the aortic annulus position can be specified with high reproducibility and high accuracy on the image data, and a doctor, a technician, or the like can determine the aortic annulus part based on the information on the aortic annulus position. It is possible to assist so as to easily obtain desired information regarding the information.

The computer program according to the present invention is a computer program that can be executed on a medical image diagnosis support apparatus, and specifies a blood flow path including an ascending aorta based on three-dimensional medical image data including a heart. When the a cross-section of the blood channel specified by the specifying step, a calculating step of calculating a measured value of the contour perimeter in a cross section perpendicular to the longitudinal direction of the blood flow path, calculated by the calculating step And determining the position of the aortic valve annulus based on the position where the measured value of the contour perimeter is minimum , in the medical image diagnosis support apparatus. According to this aspect of the present invention, the aortic annulus position can be specified on the image data with high reproducibility and with high accuracy, and a doctor, a technician, or the like can specify the aortic valve based on the information on the aortic annulus position. It becomes possible to assist so as to easily obtain desired information related to the ring portion.

The above “three-dimensional medical image data” refers to X-ray CT (Computed Tomography) and MRI (Magnetic Resonance).
This means three-dimensional image data (volume data) carrying morphological information obtained by an image diagnostic apparatus such as Imaging.

  According to the medical image diagnosis support apparatus, method, and program of the present invention, the aortic annulus position is specified based on three-dimensional medical image data obtained by an image diagnostic apparatus such as X-ray CT or MRI. It is possible to acquire desired information with high reproducibility regarding the part.

1A and 1B are diagrams illustrating an outline of a medical image generation apparatus according to an embodiment of the present invention (FIG. 1A is a schematic configuration diagram, and FIG. 1B is a block diagram illustrating an internal configuration of an arithmetic processing apparatus). It is a block diagram which shows the functional structure of the arithmetic processing unit shown in FIG. It is a flowchart which shows the flow of the procedure of the medical image diagnosis assistance process regarding an aortic valve annulus. It is a figure which shows the body-axis cross-sectional image (The order of (A), (B), (C) from a body-axis direction head side) of a chest. It is a figure which shows the VR image of the channel space of the ascending aorta where the area | region range was tentatively determined by the area | region expansion method. The VR image of the channel space of the ascending aorta is shown ((A) shows the channel space of the ascending aorta expanded outward by the expansion process, and (B) shows the channel space of the ascending aorta before and after the expansion process. FIG. It is an image ((A) is a body axis cross-sectional image, (B) is a VR image) showing the tip region of the left ventricular apex. It is a figure which shows the VR image which displays the flow-path core line extended from the upper end part of the ascending aorta to the front-end | tip of the left ventricular apex. It is a figure which shows the CPR image (straight line display) which displays the flow-path core line extended from the upper end part of the ascending aorta to the front-end | tip of the left ventricular apex. It is a figure (B) which shows a CPR image (straight line display) of a flow path space of a contour ascending aorta and a left ventricle corresponding to a contour peripheral length change graph (A) showing a change state of a contour peripheral length of the flow path space. It is a figure which shows the cross-sectional image perpendicular | vertical with respect to a flow-path core line of the flow-path space in an aortic annulus position. It is a schematic diagram for demonstrating the method of calculating the shortest distance from a coronary artery origin part to an aortic annulus part. It is a figure which shows the CPR image (curve display) which displays the shortest distance from a left coronary artery origin part to an aortic annulus.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the above-mentioned drawings. First, the configuration of a medical image diagnosis support apparatus according to an embodiment of the present invention will be described with reference to FIGS.

  The medical image diagnosis support apparatus 1 of the present embodiment acquires information such as the position of the aortic annulus and the diameter of the annulus based on the three-dimensional medical image data of the spatial region including the heart. ), An arithmetic processing unit 10 including a computer, an input unit 20 including a keyboard 21 and a mouse 22, and an image display unit 30 having an image display unit 31 including a liquid crystal display panel are provided. .

  As shown in FIG. 1B, the arithmetic processing unit 10 includes a CPU (Central Processing Unit) 101 that executes various arithmetic operations such as image processing, a DRAM (Processing Program, image data to be processed, etc.). A main memory 102 including a dynamic random access memory) and a chip set 103 for controlling input / output of data to / from the CPU 101 and the main memory 102. The image processing apparatus also includes a GPU (Graphic Processing Unit) 105 that configures a display image based on image data and processing instructions sent from the CPU 101, and a VRAM (Video Random Access Memory) 106 that stores a display image configured by the GPU 105. A graphics board 104, a storage device 107 including a hard disk, and a data bus 108 that mediates exchange of data and the like between these components are provided. Furthermore, an interface 109 that mediates exchange of data and the like between the arithmetic processing device 10 and the input device 20 and the image display device 30 is provided.

  Further, from a functional viewpoint, the arithmetic processing device 10 includes an image data acquisition unit 11, an image data analysis unit 12, and an image generation unit 13, as shown in FIG. Each block illustrated in FIG. 2 includes hardware such as the CPU 101, the main memory 102, the graphics board 104, and the storage device 107 illustrated in FIG. 1B, and various programs executed by the CPU 101 and the GPU 105 (according to the present invention). Each function realized by a medical image diagnosis support program) is embodied as a component.

  The image data acquisition unit 11 acquires various medical image data obtained by various medical image diagnostic apparatuses such as an X-ray CT apparatus and an MRI apparatus. In the following, when the image data acquisition unit 11 acquires CT image data obtained by a multi-slice X-ray CT apparatus (for example, contrast CT image data of a heart region imaged by applying an electrocardiogram synchronization method). Will be described as an example.

  The image data analysis unit 12 performs various types of analysis and measurement based on the CT image data acquired by the image data acquisition unit 11, and includes a channel space specifying unit 121, a channel core setting unit 122, and contour measurement. A value calculating unit 123, an aortic valve position specifying unit 124, an aortic valve ring diameter calculating unit 125, and a distance calculating unit 126 are provided.

  The channel space specifying unit 121 (corresponding to the channel space specifying means) is formed by an aorta and a left ventricle in an image space (hereinafter, referred to as “voxel space” as appropriate) constructed by acquired CT image data. In this embodiment, a flow path space constituting a part of the blood flow path (in this embodiment, from the upper end of the ascending aorta to the left ventricular apex) is specified.

  The flow path core wire setting unit 122 (corresponding to the flow path core wire setting means) is a flow path core line C (FIG. 8) extending in the length direction of the flow path space in the flow path space specified by the flow path space specifying unit 121. , 9 etc.) are set.

  The contour measurement value calculation unit 123 (corresponding to the contour measurement value calculation means) follows the flow path in each cross section perpendicular to the flow path core line C along the flow path core line C set by the flow path core line setting unit 122. A measurement value related to the size of the outline of the space (in this embodiment, the outline perimeter) is calculated.

  The aortic valve position specifying unit 124 (corresponding to the aortic annulus position specifying means) measures the contour perimeter of the flow path space in each cross section perpendicular to the flow path core C calculated by the contour measurement value calculation unit 123. Based on the value, the position where the contour perimeter of the flow path space is minimum is specified as the aortic annulus position in a predetermined section (details will be described later) in the length direction of the flow path space.

  The aortic valve ring diameter calculating unit 125 (corresponding to the aortic valve ring diameter estimated value calculating unit) is based on the measured value of the perimeter of the flow path space at the aortic valve position specified by the aortic valve position specifying unit 124. Each estimated value (details will be described later) relating to the valve diameter of the aorta is calculated.

  The distance calculation unit 126 (corresponding to the distance calculation unit) calculates the shortest distance from the coronary artery origin to the aortic valve annulus based on the image data of the channel space specified by the channel space specifying unit 121. It is configured.

  On the other hand, the image generation unit 13 generates various images for use in image diagnosis support based on the CT image data acquired by the image data acquisition unit 11 and the various analysis or measurement results obtained by the image data analysis unit 12. The cross-sectional image generation unit 131, the VR image generation unit 132, and the contour graph generation unit 133 are provided.

The cross-sectional image generation unit 131 (which also functions as an annulus cross-sectional image generation unit) carries cross-sectional images carrying image information (CT values, etc.) in an arbitrary cross-section (plane or curved surface) set (designated) in the voxel space MPR (Multiplanar Reconstruction) method and CPR (Curbed Planar
It is configured to generate using a reconstruction method or the like.

  The VR image generation unit 132 is configured to create a volume rendering image (VR image) corresponding to an arbitrary spatial region set (designated) in the voxel space using a volume rendering method. In the volume rendering method, for each voxel constituting the voxel space, a color and an opacity are given corresponding to the data value (CT value, etc.) carried by each voxel, and the information is predetermined in the line-of-sight direction. This is a technique for integrating and imaging with this method.

  The contour graph creation unit 133 (corresponding to the contour graph creation means) indicates a change state of the contour perimeter of the flow path space in the predetermined section based on the measurement value calculated by the contour measurement value calculation unit 123. Configured to create graphs.

  Next, a procedure of medical image diagnosis support processing related to the aortic annulus by the medical image diagnosis support device 1 of the present embodiment will be described with reference mainly to FIGS. This medical image diagnosis support process is executed based on the medical image diagnosis support program according to the embodiment of the present invention, and is roughly divided into the following steps <1> to <8>.

  <1> In the voxel space, the flow path space constituting the upper end of the ascending aorta to the left ventricular apex is specified (flow path space specifying step; see step S1 in FIG. 3). The flow path space is specified in detail by the following procedure, for example.

  First, in the voxel space, a flow path space region corresponding to the ascending aorta is specified. Specifically, data on each body axis cross section in the voxel space is searched from the head side to the foot side in the body axis direction. Then, on each body axis cross section, the region closer to the body axis in the region having a high circularity (for example, 0.8 or more) and a high CT value (region having a CT value of contrast-enhanced blood vessels) is the ascending aorta. Specify as the area of. This is because the region of the descending aorta is located on the back side farther from the body axis than the ascending aorta on each body axis cross section. In addition, circularity is represented by the following formula (1).

4πS / L ² (1)
Here, π is the circumference ratio, S is the area of the region, and L is the perimeter of the region.

  Regions (hereinafter referred to as “regions of interest”) indicated by arrows on the respective body axis cross-sectional images in FIGS. 4A to 4C are regions close to the body axis and having a high CT value. Since the region of interest in FIGS. 7A and 7B has a high degree of circularity, it is determined as the region of the ascending aorta. However, the region of interest in FIG. It is not judged. Each of the body axis cross-sectional images in FIGS. 4A to 4C is for explaining the ascending aorta region specifying method in an easy-to-understand manner. When specifying the ascending aorta region, It is not essential to generate and display an axial cross-sectional image (may be displayed for confirmation by a doctor or the like).

  Next, the region range of the ascending aorta (particularly, the region range at the lower end thereof) is provisionally determined (schematically determined in order to set the flow path core C). Specifically, a region expansion method (particularly the lower end portion) is applied to an image data group (particularly the lower end portion) obtained by three-dimensionally connecting image data determined to belong to the region of the ascending aorta in each body axis section. region growing) is applied to temporarily determine the region range of the ascending aorta. FIG. 5 shows a VR image of the ascending aorta in which the region range is provisionally determined by the region expansion method. Note that the VR image in FIG. 5 is for ease of explanation, and it is not essential to generate and display such a VR image, but it may be displayed for confirmation by a doctor or the like (others). The same applies to the VR image of FIG.

  Next, the region of the coronary artery origin is specified. Specifically, the temporarily established region of the ascending aorta is expanded outside the region by a dilation process (for example, one voxel) (see FIG. 6A) and the ascending aorta before the expansion process is performed. Find the difference from the region. At this time, two regions (refer to FIG. 6B) having a CT value of the contrasted blood vessel among regions remaining due to the difference (specifically, image data belonging to the region) are represented by coronary artery origin (left coronary artery origin). The region of the beginning and the right coronary artery origin) is specified. In the VR image of FIG. 6B, the region pointed to by the right arrow is the region of the left coronary artery origin, and the region pointed to by the left arrow is the region of the right coronary artery origin.

  Next, in the voxel space, a flow path space region corresponding to the left ventricle is specified. Specifically, data on each body axis section is searched from the lower end of the ascending aorta toward the foot side in the body axis direction. Then, on each body axis section, a region having a high CT value (a region having a CT value of a contrasted blood vessel) is specified as a region of the left ventricle. At this time, among the parts specified as the left ventricular region, the part that is three-dimensionally located farthest on the foot side in the body axis direction from the lower end of the ascending aorta may be specified as the tip region of the left ventricular apex. it can. In the body axis cross-sectional image of FIG. 7A and the VR image of FIG. 7B, the region indicated by the arrow is the tip region of the left ventricular apex. By the above procedure, the flow path space from the upper end of the ascending aorta to the left ventricular apex can be roughly specified in the voxel space.

  <2> In the flow path space specified by the above procedure <1>, a flow path core C (see FIG. 8) extending from the upper end of the ascending aorta to the tip of the left ventricular apex is set (flow path core setting) Step; see step S2 in FIG. Specifically, for the region of the ascending aorta, a line obtained by smoothly connecting the coordinate points of the center or the center of gravity of each region determined to correspond to the ascending aorta on each body axis cross section by a spline curve or the like. And set as the flow path core C in the region of the ascending aorta. On the other hand, for the region of the left ventricle, a line obtained by smoothly connecting the lower end position of the flow path core line C set in the region of the ascending aorta and the distal end position of the left ventricular apex by a spline curve or the like is Set as channel core C in the ventricle.

  In addition, by setting the flow path core line C, the cross section along the flow path core line C (specifically, a straight line group in the same direction (direction can be arbitrarily set) intersecting the flow path core line C) is formed. It is possible to generate a CPR image carrying image information in a cross section, which is generally a curved surface. Such a CPR image is suitable for a doctor or the like to visually identify a change state in the radial direction of the flow path space along the flow path core line C (particularly, the flow path core line C is a three-dimensional straight line. A linear display of a CPR image in which the cross-sectional image is reconstructed and displayed so that For this reason, in the present embodiment, such an CPR image (straight line display) can be generated and displayed as an image presenting the change state in the radial direction of the flow path space along the flow path core line C. (See FIG. 9).

  <3> The outline of the flow path space in each cross section perpendicular to the flow path core line C (hereinafter referred to as “core vertical cross section” as appropriate) along the flow path core line C set by the procedure of <2> above. The perimeter is calculated (contour measurement value calculation step; see step S3 in FIG. 3). The contour perimeter is calculated in detail, for example, by the following procedure.

  First, with regard to the flow path space region of the ascending aorta, the outline of the flow path space in each core vertical section is specified (evaluated) in detail. Specifically, in each core wire vertical cross section, for example, a circular area centered on the flow path core line C (taken slightly larger so as to include the flow path space area) is set, and within the set circular area The distribution of CT values at is obtained. Since the distribution of the CT value is generally a Gaussian distribution, a curve obtained by smoothly connecting the coordinate points corresponding to the CT value corresponding to the half value of the maximum value is represented in the flow path space in each core vertical section. Specify as contour. Then, the perimeter of the specified contour is calculated for each core line vertical section.

  Next, also for the channel space region of the left ventricle, the contour of the channel space in each core line vertical section is specified (evaluated). Specifically, in the same manner as specifying the contour of the channel space area of the ascending aorta, in each core vertical cross section, an area having a size including the channel space area (the shape can be arbitrary) is set, and within the set area The distribution of CT values at is obtained. Then, a curve obtained by smoothly connecting each coordinate point corresponding to the CT value corresponding to the half value of the maximum value in the distribution of the CT value is specified as the contour of the channel space in each core vertical section, and the perimeter of the specified contour Is calculated for each vertical cross section of the core wire.

  <4> Based on the contour perimeter of the channel space from the upper end of the ascending aorta to the left ventricular apex calculated by the procedure of <3> above, the contour perimeter of the channel space A graph indicating the change state (hereinafter referred to as “contour circumference change graph”) is created and displayed (contour change graph creation step; see step S4 in FIG. 3).

  The graph shown in FIG. 10A is the contour perimeter change graph. In this embodiment, in order to make it easy to understand the correspondence between the contour perimeter change graph and the flow path space (positional relationship in the direction of the flow path core C), as shown in FIG. An image (different from the image of FIG. 9) is generated and displayed side by side with the image of the contour perimeter change graph.

  A curve P shown in FIG. 10 (A) represents the perimeter of the outline of the flow path space from the upper end of the ascending aorta to the left ventricular apex for each core vertical cross section. More specifically, a straight line X shown in FIG. 10 (A) represents a coordinate axis of a position along the flow path core C, and a direction perpendicular to the straight line L from each position of the straight line L to each position of the curve P is shown. The distance (horizontal distance in the figure) represents the contour perimeter at each coordinate position along the flow path core C. Although an oblique straight line is displayed in FIG. 10A, this is a control straight line generated in the course of the graph creation process and is not directly related to the contour perimeter.

  <5> The position of the aortic annulus is specified based on the contour perimeter of each core vertical section of the flow path space from the upper end of the ascending aorta to the left ventricular apex calculated by the procedure in <3> above (Aortic annulus position specifying step; see step S5 in FIG. 3). For example, the position of the aortic valve annulus is specified by the following procedure in detail.

  First, a search section for searching for the position of the aortic annulus in the flow path space is set. This search section is set so as to include at least the boundary between the aorta and the left ventricle in the length direction of the flow path space (the direction of the flow path core line C). In the present embodiment, from the position of the left coronary artery origin (the position indicated by the top arrow in the graph of FIG. 10A, and the position indicated by the arrow in the CPR image of FIG. 10B), the flow path Up to the position where the contour perimeter of the space becomes the maximum (the position indicated by the bottom arrow in the graph of FIG. 10A) is set as this search section.

  Next, in the set search section, the position where the contour perimeter of the flow path space is minimum (the position indicated by the second arrow from the top in the graph of FIG. 10A). Also, the CPR of FIG. The position of a short straight line orthogonal to the flow path core line C in the image is specified as the position of the aortic annulus (aortic annulus position). In addition, in FIG. 10, the arrow line extended in the direction of the same figure (B) from the position of the left coronary artery origin part in the graph of the same figure (A) is also shown. This arrow line is used to easily associate the graph and the position of each left coronary artery origin in the CPR image, and is not directly related to the specification of the aortic annulus position.

  <6> A cross-sectional image perpendicular to the flow path core C in the flow path space at the aortic annulus position specified by the procedure of <5> is generated (aortic annulus position cross-sectional image generation step; step of FIG. 3) (See S6).

  The image shown in FIG. 11 is a cross-sectional image at the aortic annulus position. More specifically, a circular region (the contour line is also displayed) shown in the central portion of the image shown in FIG. 11 is a cross-sectional image of the channel space at the aortic annulus position.

  <7> Based on the contour perimeter of the channel space calculated by the procedure of <3> above at the aortic annulus position specified by the procedure of <5>, each estimated value related to the annulus diameter of the aorta is calculated. (Aortic valve ring diameter estimated value calculating step; see step S7 in FIG. 3).

  In the present embodiment, the maximum diameter, minimum diameter, average diameter, perimeter length, and area of the aortic annulus are calculated as the estimated values. Various modes can be considered as the calculation method. For example, the contour of the flow path space at the specified aortic annulus position is regarded as an aortic annulus as it is, and the maximum diameter (indicated by a downward-sloping line segment in FIG. 11) and the minimum diameter (upward-sloping in FIG. 11). (Indicated by line segment), average diameter, circumference length and area are calculated, and the calculated values are respectively estimated values of maximum diameter, minimum diameter, average diameter, circumference length and area of the aortic annulus Can be mentioned.

  On the other hand, each estimated value of the aortic annulus may be corrected by correcting each calculated value of the contour of the channel space at the specified aortic annulus position based on the anatomical characteristics of the aortic annulus. Specifically, according to anatomical knowledge, the aortic annulus is known not to have a planar shape (a shape that is entirely located in one plane) but to have a three-dimensional shape. Therefore, it is possible to correct each calculated value of the flow path space contour in consideration of this point. Further, a VR image or MPR image carrying the estimated three-dimensional shape information of the aortic annulus is created and displayed, and a doctor or the like corrects the shape of the aortic annulus based on these images (for example, Further, the control point or the like defining the annulus shape on the image may be moved using the mouse 22 or the like.

  <8> From the coronary artery origin to the aortic annulus based on the image data of the channel space specified by the procedure of <1> and the aortic annulus position specified by the procedure of <5> The shortest distance is calculated (distance calculation step; see step S8 in FIG. 3). In detail, the calculation of the shortest distance is performed in the following procedure, for example.

  That is, the contour of the flow path space at the specified aortic annulus position is regarded as the aortic annulus V (see FIG. 12), and each point on the aortic annulus V and the left coronary artery origin LK (see FIG. 12). ) Is calculated as the shortest distance from the left coronary artery origin LK to the aortic annulus V. Similarly, of the straight distances (three-dimensional straight distances) between each point on the aortic annulus V and the right coronary artery origin RK (see FIG. 12), the shortest straight distance is determined as the right coronary artery. It is calculated as the shortest distance from the origin RK to the aortic annulus V. The shortest distance from the coronary artery origin to the aortic annulus may be calculated in consideration of the anatomical characteristics of the aortic annulus.

  FIG. 13 shows the shortest distance from the left coronary artery origin LK to the aortic valve annulus V on a curved CPR image. 1 on the left coronary artery origin LK and the aortic annulus V The numerical value of the shortest distance is displayed near the straight line connecting the points.

  According to the medical image diagnosis support apparatus 1 of the present embodiment described above, the estimated values of the maximum diameter, minimum diameter, average diameter, circumference length, and area of the aortic annulus, the coronary artery origin (left coronary artery origin) Alternatively, the shortest distance from the right coronary artery origin) to the aortic annulus can be automatically calculated with high reproducibility. Therefore, it is possible to provide useful information (for example, information for determining the size of the artificial valve) in the TAVR (TAVI) procedure.

  As mentioned above, although one Embodiment of this invention was described, this invention is not limited to the said embodiment, It is possible to change an aspect variously.

  For example, in the above-described embodiment, the position of the aortic annulus and the information on the diameter of the annulus, the distance information from the coronary artery origin to the aortic annulus, and the like are automatically obtained. When a doctor or the like instructs to correct the information, the information may be automatically corrected based on the correction instruction. For example, when a doctor or the like instructs the position of the aortic valve annulus obtained once to a different position, a measured value such as the diameter of the annulus based on the image data of the instructed other position It may be configured to recalculate.

  In the above embodiment, CT image data acquired by an X-ray CT image diagnostic apparatus by applying an electrocardiogram synchronization method as 3D medical image data suitable for acquiring information such as the position of the aortic annulus. However, other medical image data such as MRI image data obtained by the MRI image diagnostic apparatus may be used.

1 Medical Image Diagnosis Support Device 10 Arithmetic Processing Device 20 Input Device 21 Keyboard 22 Mouse 30 Image Display Device 31 Image Display Unit C Channel Core V Aortic Annulus LK Left Coronary Artery Origin RK Right Coronary Artery Origin

Claims (11)

A specifying means for specifying a blood flow path including the ascending aorta based on three-dimensional medical image data including the heart;
A calculating means for calculating a measurement value of a contour perimeter in a cross section of the blood flow path specified by the specifying means and perpendicular to the longitudinal direction of the blood flow path;
Determining means for determining the position of the aortic annulus based on the position where the measured value of the contour perimeter calculated by the calculating means is minimized ;
A medical image diagnosis support apparatus comprising:   The medical image diagnosis support apparatus according to claim 1, wherein the blood flow path includes at least a region from the ascending aorta of the heart to the left ventricular apex, which is included in the three-dimensional medical image data. The said determination means determines the position of the said aortic annulus based on the comparison result of the measured value of the said perimeter circumference in the several cross section along the said longitudinal direction. Medical image diagnosis support device. A setting means for setting a flow path core wire extending in the longitudinal direction of the blood flow path specified by the specifying means;
The said calculation means calculates the measured value of the outline perimeter of the blood flow path in the cross section perpendicular | vertical to the flow path core line set by the said setting means, The one of Claim 1 to 3 characterized by the above-mentioned. Medical image diagnosis support device. 2. The apparatus according to claim 1, further comprising: an estimation unit configured to estimate a value related to a valve diameter of the aortic annulus based on a measured value of the position of the aortic annulus determined by the determining unit and the circumference of the contour. 5. The medical image diagnosis support apparatus according to any one of 1 to 4 . The estimating means, as the value related to the valve Wa径, maximum diameter of the aortic annulus, the minimum diameter, the average diameter, in claim 5, wherein the estimating at least one of the values of perimeter and area The medical image diagnosis support apparatus described. Further comprising coronary artery origin identifying means for identifying the position of the coronary artery origin based on the region of the ascending aorta contained in the blood flow path identified by the identifying means;
Based on the position of the aortic annulus determined by the determining means and the position of the coronary artery starting part specified by the coronary artery starting part specifying means , the aortic annulus from the coronary artery starting part in the three-dimensional data is determined. the medical image diagnosis assisting apparatus according to any one of claims 1 6, characterized by further comprising a distance calculating means for calculating the shortest distance to the part. The medical image diagnosis according to any one of claims 1 to 7 , further comprising display control means for causing the display means to display a change state in a longitudinal direction of a measured value of the contour perimeter of the blood channel. Support device. The display control means causes the display means to display a cross-sectional image of a cross-section at the position of the aortic annulus determined by the determining means and perpendicular to the longitudinal direction of the blood flow channel. The medical image diagnosis support apparatus according to claim 8 . A specific step of identifying a blood flow path including the ascending aorta based on three-dimensional medical image data including the heart;
A calculation step of calculating a measurement value of a contour perimeter in a cross section of the blood flow path specified by the specifying step, the cross section being orthogonal to the longitudinal direction of the blood flow path;
A determination step of determining the position of the aortic annulus based on the position where the measurement value of the contour perimeter calculated in the calculation step is minimized ;
A control method for a medical image diagnosis support apparatus, comprising: A computer program executable on a medical image diagnosis support apparatus,
A specific step of identifying a blood flow path including the ascending aorta based on three-dimensional medical image data including the heart;
A calculation step of calculating a measurement value of a contour perimeter in a cross section of the blood flow path specified by the specifying step, the cross section being orthogonal to the longitudinal direction of the blood flow path;
A determination step of determining the position of the aortic annulus based on the position where the measurement value of the contour perimeter calculated in the calculation step is minimized ;
Is executed by a medical image diagnosis support apparatus .