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WO2018148859A1 - Système de notation du myocarde à 17 segments - Google Patents

Système de notation du myocarde à 17 segments Download PDF

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WO2018148859A1
WO2018148859A1 PCT/CN2017/073350 CN2017073350W WO2018148859A1 WO 2018148859 A1 WO2018148859 A1 WO 2018148859A1 CN 2017073350 W CN2017073350 W CN 2017073350W WO 2018148859 A1 WO2018148859 A1 WO 2018148859A1
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blood vessel
branch
heart
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贺永明
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    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/0002—Inspection of images, e.g. flaw detection
    • G06T7/0012—Biomedical image inspection
    • G06T7/0014—Biomedical image inspection using an image reference approach
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10016—Video; Image sequence
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30048—Heart; Cardiac

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  • the present invention relates to the recognition and evaluation of cardiac contrast images, and in particular to a 17-segment myocardial scoring system.
  • Coronary heart disease is the leading cause of death. Coronary angiography has been used clinically as a routine examination, so it is both possible and a huge challenge to collect useful information from a large number of patients with coronary arteries (normal or diseased).
  • a method is needed to systematically describe the anatomical features of the coronary tree and to quantify the complexity of vascular lesions in patients with coronary heart disease, thereby obtaining important information on the health and prognosis of patients.
  • the Syntax score based on the AHA-recommended coronary tree segmentation nomenclature, can be used to determine the number, location, complexity, and impact on cardiac function of coronary lesions. The higher the Syntax score, the more complex the lesion. But it must be acknowledged that the Syntax system has its limitations.
  • the 17-segment myocardial scoring system includes:
  • a frame capture end for capturing a video frame of a dynamic contrast video
  • the image processing module extracts a blood vessel boundary and a heart boundary in the dynamic contrast image according to the video frame captured by the frame capturing end, the blood vessel boundary constitutes a blood vessel for the segment score, and the heart boundary is used to determine a regular waveform of the heart beat, according to the regular waveform,
  • the blood vessels on the video frame of the dynamic contrast image at this time are sampled at equal intervals, and the trajectory of the blood vessel boundary where the width is located is recorded, and the width between the aforementioned width and the minimum volume of the heart to the maximum volume is recorded. Aligning the widths of the blood vessels at the same position in the frame, and finding a blood vessel position record in which the blood vessel width expansion ratio is lower than a set threshold;
  • the segment setting end divides the blood vessels on the video frame into segments
  • the segment weight database stores the weight data of the blood vessel segment, and generates a score by dividing the weight data by dividing the blood vessel at the segment setting end.
  • a marking module is further included, and the blood vessel is marked as a high to low gray scale map according to a height mark module of a change in blood vessel width.
  • said set threshold is an average of a percentage change in vessel width.
  • the pressure behind the occlusion is drastically reduced, and the vasodilation is insufficient.
  • the position of the vascular expansion is determined by image processing to locate the position of the diseased vessel, and the segmentation can be quickly calculated.
  • the overall score of the myocardium avoids complicated and extensive calculations, making the scores more accurate.
  • Figure 1 shows three anatomical landmarks on the left ventricular surface that outline three regions.
  • FIGS 2, 3, and 4 show six types of right coronary superiority.
  • 5, 6, and 7 are front descending branches (abc) of different lengths and diagonal branches (def) of different sizes.
  • Figures 8 and 9 show the scores of the coronary vessel segments.
  • Figures 10, 11, and 12 show the distribution of coronary vessel weight factors.
  • Figure 13 is a case where the lesion score needs to be corrected.
  • the upper row is an occlusive lesion and the lower row is a non-occlusive lesion.
  • Figure 14 is an example of a conventional score generation.
  • Fig. 15 is an example of score generation after lesion correction.
  • the 17-segment myocardial scoring system includes:
  • the frame capture end is used to capture the video frame of the dynamic contrast video; the coronary angiography video is introduced into the frame capture end, and the frame capture end separates the single frame images in the video one by one.
  • the image processing module extracts the blood vessel boundary and the heart boundary in the dynamic contrast image according to the video frame captured by the frame capturing end, and the blood vessel boundary and the heart boundary adopt the Matlab edge detection operator commonly used in image processing such as canny, sobel, etc. to extract the edge, according to the extraction
  • the largest edge is the boundary of the heart.
  • the heart size fluctuates each time, the video frame between the peaks and valleys is intercepted, the edge is extracted again, and the outermost continuous edge (ie the heart boundary) is filtered out. Leaving a continuous blood vessel boundary, the blood vessel boundary constitutes a blood vessel for segment scoring, and the heart boundary is used to determine a regular waveform of the heart beat.
  • the video frame of the dynamic contrast image at this time is The blood vessels are sampled at equal intervals, the width of the sample is perpendicular to the central axis of the vessel extension, and the trajectory of the vessel boundary where the width is located is recorded, and the width is the same as the position between the smallest volume of the heart and the maximum volume in the video frame. Aligning the vessel widths to find a vessel position record with the vessel width expansion ratio below a set threshold;
  • Segment setting end segmentation of blood vessels on video frames; by manual marking each segment using the following naming method and segmentation:
  • the coronary circulatory system is divided into six types:
  • PDA zero The left heart only receives blood from the left coronary system, and the right coronary system does not supply blood to the left heart. This is called the left dominant type (Fig. 2a).
  • the only posterior descending branch (PDA only): the right coronary artery system only sends the posterior descending branch to the posterior interventricular sulcus to supply blood for the posterior chamber.
  • the left ventricular hypospadiaa was supplied by the left circumflex artery (Fig. 2b).
  • Small right coronary artery type (small RCA): In addition to the posterior descending branch, the right coronary artery system also sends a posterior lateral branch to supply a part of the lower chin. The remaining lower jaw surface was supplied by the posterior branch originating from the left circumflex artery (Fig. 3c).
  • Ordinary right coronary artery (average RCA): the posterior descending branch of the right coronary artery and the posterior collateral perfusion interval and the entire chin surface (Fig. 3d).
  • Large right coronary artery type (large RCA): In addition to the posterior descending branch and the posterior branch perfusion interval and the entire chin surface, the right coronary artery system also emits a small blunt edge to infuse a small part of the left blunt edge. This part of the left heart blunt edge should have been supplied by the circumflex artery (Fig. 4e).
  • the coronary circulatory system is divided into three types: short (Fig. 5a), normal (Fig. 5b) and long (Fig. 6c) anterior descending branch type 3;
  • the scope of blood supply, coronary circulatory system is divided into 3 types: small (Fig. 6d), medium (Fig. 7e) and large (Fig. 7f) diagonal branch type 3, a total of 54 coronary circulation types, 17-segment myocardial scoring system will These 54 types of coronary circulation are used to reflect the large variation of the coronary tree between individuals.
  • segment 16 series, 7 series, 9 series, 12 series, 14 series, and segments 11, 13, and 15 are modified compared to the conventional definition.
  • the definitions of each coronary segment in this scoring system are detailed below.
  • Seg 4.PDA from RCA originated from the posterior descending branch of the right crown, walking in the posterior interventricular sulcus.
  • Seg 16 Originated from the posterior branch of the right crown: starting at the beginning of the posterior descending branch, walking in the left posterior atrioventricular sulcus, issuing branches to the left ventricle for blood supply.
  • the left ventricle In the right dominant type, the left ventricle usually supplies blood from 1-2 posterior branches originating from the right coronary artery.
  • One posterior lateral branch is usually larger and is called seg 16&. If the two rear side branches are equal, they are named seg 16a and 16b, respectively. If the two posterior branches are not equal, the larger one is named seg 16X, and the smaller one is named seg 16S.
  • Seg 16a originates from the posterior collateral of the equal size (compared to the other posterior branch) of seg 16.
  • Seg 16b originates from the posterior branch of the seg 16 equal (compared to the other posterior branch).
  • Seg 16X originates from the larger posterior branch of seg 16, independent of the firing position.
  • Seg 16S. originates from the smaller posterior branch of seg 16, independent of the firing position.
  • Seg 16&. originated from only one large posterior branch of seg 16.
  • Seg 16c originates from the blunt edge of seg 16 and infuse a part of the blunt edge.
  • Seg 5 From the left coronary artery, the end of the anterior descending branch and the circumflex branch.
  • the first main perforating branch is near the segment and includes the main perforating branch opening.
  • Seg 7.LAD mid (middle section of the lower descending branch): starting from the first main piercing branch, ending at the corner of the front descending branch at the right front oblique position. If the angle is not obvious, it stops at the midpoint of the first piercing of the apex.
  • the anterior descending branch usually emits 1-2 diagonal branches from the proximal or middle segment (seg 6 or 7). When only one diagonal branch is issued, it is usually larger and is named seg 9&. If the two diagonal branches are equal, they are named seg 9a and seg 9b, respectively. If the two diagonal branches are not equal, the larger one is named seg 9X, and the smaller one is named seg 9S. Larger diagonal branches are mostly from seg 6.
  • Seg 9a The first diagonal branch of the same size from seg 6 or 7.
  • Seg 9b A second diagonal branch of the same size from seg 6 or 7.
  • Seg 9X A larger diagonal branch from seg 6 or 7, regardless of its position.
  • Seg 9S Smaller diagonal branch from seg 6 or 7, regardless of its position.
  • Seg 9&. usually comes from seg 6 with only one large diagonal branch.
  • Seg 7 The middle section of the front descending branch without a diagonal branch.
  • the only large diagonal branch is usually from seg 6.
  • Seg 8.LAD distal From the end of the previous section, stop at the apex or bypass the apex, and walk in the anterior chamber groove, which is the end part of the anterior descending branch.
  • LCX proximal circumflex
  • the gyroscopic branch usually emits 1-2 blunt edge branches.
  • the only one blunt edge is usually larger and is named seg 12&. If the two blunt edge branches are equal, they are named seg 12a and 12b, respectively. If the two blunt edges are not equal, the larger one is named 12X and the smaller one is named 12S.
  • Seg 12a The first blunt edge of the same size from the circumflex, running on the blunt edge of the heart.
  • Seg interE Smaller intermediate branch, equivalent to seg 12a or 12b.
  • Seg inter&. is only a large blunt edge, equivalent to seg 12&, perfused with a blunt edge of the heart. Independently, the volunteers independently issued a pivotal branch and walked in the left posterior chamber.
  • LCX Distal Starting at the blunt edge of the heart, along the left posterior chamber.
  • Right advantage type its size Usually smaller or absent, and in the left dominant type, the size is usually larger.
  • the left ventricle In the left dominant type, the left ventricle is usually supplied with blood from 1-2 posterior branches from the LCX.
  • the only large back side branch is named seg 14&. If the two rear side branches are equal, they are named 14a and 14b, respectively. If the two side branches are not equal, the larger one is named 14X and the smaller one is named 14S.
  • Seg 14a The first posterior branch of the same size from seg 13.
  • Seg 14b The second posterior branch of the same size from seg 13.
  • Seg 14X The larger rear side branch from seg 13 regardless of its position.
  • Seg 14S The smaller rear side branch from seg 13 regardless of its position.
  • Seg 14& The only large posterior branch from seg 13 regardless of its position.
  • Seg 15 After the fall.
  • the farthest segment of the gyroscopic branch from seg 13 travels in the posterior interventricular sulcus and is spaced after perfusion.
  • the weight of the segment lesion is determined, and the factors of each segment are added to generate a score.
  • the segment weight database stores the weight data of the vascular segment, and the weighting data is generated by the segment setting end to collect the weight data, and the weight data and the weight calculation adopt the following rules:
  • the derivation of the coronary tree weighting factor is based on the following rules:
  • anatomical landmarks on the left ventricular surface there are clearly three anatomical landmarks on the left ventricular surface: the anterior interventricular sulcus, the posterior interventricular sulcus, and the blunt margin. These three anatomical landmarks divide the left heart into three regions: the compartment, including the anterior and posterior septum (Fig. 1c); the diagonal branch-blunt edge, including the anterior and lateral walls, but not over the blunt edge Boundary (Fig. 1a); Lower ridge (Fig. 1b). Accordingly, there are three vessels that travel relatively constantly along these anatomical landmarks: the left anterior descending branch (12), the posterior descending branch, and the blunt edge branch, although the coronary vessel tree varies greatly between individuals.
  • the compartment is competitively supplied by the anterior descending branch (excluding the diagonal branch) and the posterior descending branch (usually without major branches).
  • a long anterior descending artery will reduce the blood supply range of the posterior descending branch, and vice versa.
  • the diagonal-blunt edge zone is competitively supplied by the diagonal branch and the blunt edge. Large diagonal branches will reduce the blood supply range of the blunt edge, and vice versa.
  • the lower jaw is competitively supplied by the posterior branch of the left or right crown. A huge right crown will reduce the circumflex blood supply range and vice versa.
  • the total coronary weighting factor is constant at 17.0
  • the diagonal branch-blunt edge region vascular weighting factor is constant at 8.0
  • the compartmental vascular weighting factor is constant.
  • the lower vascular weight factor is constant at 3.0.
  • the LAD weighting factors of the far segment are different according to the length of the LAD, which are 1.0, 2.0 and 3.0, respectively
  • the diagonal weighting factors are different according to the diagonal branch size, which are 2.0, 3.0 and 4.0, respectively
  • the LCX weighting factor is The competitive blood supply rule for the diagonal branch-blunt edge region is 6.0, 5.0 and 2.0, respectively.
  • the RCA weighting factor is increased by 1.5 in steps from PDA only to super RCA type.
  • the weighting factors of the 54 types of coronary trees can be derived therefrom.
  • the blood vessels are the same, but the weighting factors are different, reflecting the difference in the number of left ventricular segments perfused between the vessels.
  • the right coronary artery is the lower septum and the lower tibia, with a total of 5 segments, with a weighting factor of 5.0.
  • the anterior descending branch (except for the diagonal branch) provides blood for the anterior septum and apical segment, with a total of 4 segments; the diagonal branch provides blood for the anterior wall, for a total of 3 segments. Therefore, the anterior descending branch (including the diagonal branch) supplies blood for a total of 7 segments with a weighting factor of 7.0.
  • the gyroscopic branch supplies blood to the remaining 5 segments with a weighting factor of 5.0.
  • the total score was 17.0, corresponding to 17 segments of the left ventricular myocardium.
  • distal anterior descending artery in the normal right dominant type and the common diagonal branch, the distal anterior descending artery (distal LAD) is a apical interval segment and a apical segment of the apex segment, with a total of 2 segments, the weighting factor of which is 2.0.
  • the mid-left anterior descending (mid LAD) if no diagonal branches are issued, will provide blood for the anterior septum, apical interval, and apical segment of the heart, for a total of three segments with a weighting factor of 3.0. If the mid-left descending branch (mid LAD) issues a diagonal branch, its weighting factor will be 6.0, 5.0 and 4.5 depending on the diagonal branch weight.
  • the proximal LAD weighting factor is constant at 7.0 regardless of the position of the diagonal branch.
  • the posterior descending branch (PDA) supplies blood to the lower interval of 2 segments, and its weighting factor is 2.0.
  • the 1-2 posterior lateral branches supply blood to three segments of the inferior wall with a weight of 3.0. If the two posterior collateral vessels are not equal, the larger one has a weight of 2.0 and the smaller one has a weight of 1.0. If the two rear side branches are equal, each weight is 1.5. Only one large posterior branch was provided, and blood was supplied to three segments of the inferior wall with a weighting factor of 3.0.
  • the sum of the posterior descending branch (PDA) and the posterior branch weight is 5.0, which is also the far right crown (distal RCA) weight.
  • the circumflex branch emits 1-2 blunt edge branches, and the size is equal or large.
  • the only large blunt edge that was issued was a blood supply for 5 segments with a weighting factor of 5.0. If the two blunt edge branches are not equal, then the larger One weight is 3.0, and the smaller one is 2.0. If the two blunt edge branches are equal, each weight is 2.5.
  • the Seg inter series (seg interX, S, E, and &) represent intermediate branches of different sizes, with weighting factors corresponding to the seg 12 series (seg 12X, 12S, 12a, 12b, and 12&).
  • the weighting factor of the same blood vessel changing between different individuals reflects the constant change in the number of myocardial segments supplied by the blood vessel. However, of the 54 coronary cycle types, the total weighting factor was constant at 17.0.
  • the importance of blood vessels depends on the number of myocardial segments supplied by the blood vessels rather than the blood vessels themselves.
  • the weighting factor assignment of a vessel is based on the number of myocardial segments perfused by the vessel.
  • the degree of vascular stenosis is also considered when deriving the 17-segment myocardial model scoring system.
  • the integral is the product of the vascular weighting factor and the degree of stenosis (Equation 1). If the blood vessel is completely blocked, the weighting factor is multiplied by 5. If the diameter of the blood vessel is narrowed by 50-99%, the weighting factor is multiplied by 2, and then the integrals obtained from the vascular segment are added to obtain the total coronary artery integral (21). A score of 0 indicates that the coronary tree has no stenosis. The higher the score, the more severe the stenosis.
  • S is a 17-segment model score
  • W is the weighting factor of the blood vessel
  • D is the degree of vascular stenosis.
  • occlusion 100% stenosis
  • non-occlusion 50-99% diameter stenosis
  • the lesion score should be corrected in the following cases:
  • the main branch is normal (Fig. 13a), and the lesion score is corrected by Equation 2, because the main branch weight already includes the main branch weight, but in fact, the main branch is not involved.
  • integer SBs refers to all normal side branches.
  • the lesion score is modified according to formula 3, because the main branch is an occlusive disease (multiplying factor is 5.0), and the main branch is a non-occlusive disease (phase The multiplication factor is 2.0), and the severity of the two is different.
  • SBs refers to all normal or abnormal side branches. Involved SBs refer only to the affected side branches.
  • the lesion score is modified according to Equation 4, because the main branch weight already includes the main branch weight, and the main branch weight It was also mistakenly treated as an occlusive lesion (multiplier factor of 5.0). In fact, the primary branch lesion is an independent lesion and should be scored separately (multiplier factor of 2.0).
  • the main branch of the same segment was non-occlusive disease, the main branch was normal, and it was earlier than the lesion (Fig. 13d).
  • the score of the main branch lesion was modified according to Equation 5, because the main branch weight already included the main side branch weight, while the main side branch Not involved.
  • the main branch of the same segment was a non-occlusive lesion involving the main side branch (1 lesion), and the lateral branch was earlier than the main branch lesion (Fig. 13e).
  • the main branch lesion score was corrected according to Equation 6, and the affected primary side The score does not need to be scored because the affected side branch weights are already included in the main branch.
  • the main branch of the same segment is non-occlusive disease, the main side branch also has lesions (>1 lesion), and the side branch is issued earlier than the main branch lesion (Fig. 13f), the main branch lesion score is corrected according to formula 7, because the main branch weight Primary branch weights have been included, however this major branch has to be scored as independent lesions.
  • the Subtotal score is a regular score for the lesion.
  • W SBs is the main branch weight.
  • Intact SBs means that the main side branches are normal.
  • Involved SBs refers to the main side branch, but together with the main branch lesion should be considered as one lesion.
  • Diseased SBs refers to the main side branch and also has lesions, and is independent of the main branch lesions, and is an independent lesion.
  • the marking module further comprises: marking the blood vessel as a high-to-low gray scale map according to the height and low mark module of the blood vessel width change, thereby facilitating manual observation of the degree of lesion of the lesion.
  • said set threshold is an average of a percentage change in vessel width.

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Abstract

L'invention concerne un système de notation du myocarde à 17 segments, comprenant : une extrémité de capture de trame, utilisée pour capturer des trames vidéo à contraste dynamique ; un module de traitement d'image, pour extraire des limites de vaisseau sanguin et des limites cardiaques dans une image à contraste dynamique sur la base des trames vidéo capturées par l'extrémité de capture de trame, les limites de vaisseau sanguin constituant des vaisseaux sanguins pour une notation de segment, et lorsque le cœur est à un volume minimal, effectuer un échantillonnage de largeur d'un vaisseau sanguin sur la trame vidéo de l'image à contraste dynamique à ce moment à des intervalles égaux, enregistrer la trajectoire des limites de vaisseau sanguin de ladite largeur, comparer ladite largeur avec la largeur du vaisseau sanguin à la même position dans les trames vidéo entre le volume minimal et le volume maximal du cœur, et trouver un enregistrement de position de vaisseau sanguin avec un rapport de dilatation de largeur de vaisseau sanguin au-dessous d'un seuil défini ; et une extrémité de réglage de segment, pour diviser et noter les segments des vaisseaux sanguins sur la trame vidéo. Le présent système peut calculer rapidement une note globale du myocarde, éviter un processus de calcul complexe et étendu, et rendre la notation plus précise.
PCT/CN2017/073350 2017-02-07 2017-02-13 Système de notation du myocarde à 17 segments Ceased WO2018148859A1 (fr)

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