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WO2018148859A1 - 17节段心肌评分系统 - Google Patents

17节段心肌评分系统 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

Definitions

  • 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

一种17节段心肌评分系统，包括：帧捕捉端，用于捕捉动态造影视频帧；图像处理模块，根据帧捕捉端捕捉的视频帧提取动态造影图像中的血管边界和心脏边界，血管边界构成血管用于节段评分，在心脏的最小体积时，将此时的动态造影图像的视频帧上的血管按等间隔进行宽度取样，并记录宽度所在的血管边界的轨迹，将前述宽度与心脏的最小体积到最大体积之间视频帧内同一位置的血管宽度进行比对，找出血管宽度膨胀比例低于设定阈值的血管位置记录；节段设定端，对视频帧上的血管进行节段划分并评分。本系统能够快速计算出心肌的总体评分，避免复杂且粗放的计算过程，使评分更加准确。

Description

17节段心肌评分系统 所属技术领域
本发明涉及心脏造影图像的识别评价，特别地，是一种17节段心肌评分系统。
背景技术
冠心病是死亡的主要原因。冠状动脉造影已作为一项常规检查而应用于临床，因此，收集整理大量患者的冠状动脉树(正常或病变)有用信息既成为可能，也成为一项巨大挑战。需要一个方法用来系统描述冠脉树解剖学特征，并对冠心病患者血管病变复杂程度进行定量分级，由此获得患者健康与预后的重要信息。基于AHA推荐的冠脉树分段命名而开发的Syntax评分，可用来确定冠脉病变数目、位置、复杂性以及对心脏功能的影响。Syntax评分越高，病变越复杂。但必须承认的是Syntax系统有其局限性。一个显而易见的不足在于在Syntax系统中，冠状动脉循环分型过份简单化，仅有2型：即左优势型和右优势型。这种过份简单地分型不能反映冠脉血管系统的巨大变异。更为重要的是，Syntax评分系统本质上是基于血管，而非基于血管重要性的一个评分系统，因此其局限不言而喻。例如冠脉节段12系中间支血管，根据Syntax系统，不论其大小如何(＞1.5mm)，其权重均为1。事实上，个体间中间支血管变异极大，小至可以忽略，大至可以为整个钝缘区域供血。传统的Syntax评分试用的分类少，且计算时间较长。
发明内容
为了解决上述问题，本发明的目的在于提供一种17节段心肌评分系统，该17节段心肌评分系统能够对心脏造影图像进行快速定量分级。
本发明解决其技术问题所采用的技术方案是：
该17节段心肌评分系统包括：
帧捕捉端，用于捕捉动态造影视频的视频帧；
图像处理模块，根据帧捕捉端捕捉的视频帧提取动态造影图像中的血管边界和心脏边界，血管边界构成血管用于节段评分，心脏边界用于确定心脏跳动的规律波形，根据规律波形，在心脏的最小体积时，将此时的动态造影图像的视频帧上的血管按等间隔进行宽度取样，并记录宽度所在的血管边界的轨迹，将前述宽度与心脏的最小体积到最大体积之间视频帧内同一位置的血管宽度进行比对，找出血管宽度膨胀比例低于设定阈值的血管位置记录；
节段设定端，对视频帧上的血管进行节段划分；
节段权重数据库，存储血管节段的权重数据，通过节段设定端对血管的划分调取权重数据生成评分。
作为优选，还包括标记模块，根据血管宽度变化的高低标记模块将血管标记成由高到低的灰阶图。
作为优选，所述设定阈值为血管宽度变化百分比的均值。
本发明的优点在于：
心脏博动时，由于血管病变后造成短时堵塞，造成堵塞后方的压力急剧降低，血管扩张不足，采用图像处理的方式确定血管扩张宽度来定位病变血管的位置，结合节段分割，能够快速计算出心肌的总体评分，避免复杂且粗放的计算过程，使评分更加准确。
附图说明
图1是左室表面的3个解剖学标志勾勒出3个区域。
图2、图3、图4是右冠脉优势型的6种类型。
图5、图6、图7是不同长度的前降支(abc)及不同大小的对角支(def)。
图8、图9是冠脉树血管节段的画分。
图10、图11、图12是冠脉血管权重因子的分配。
图13是种情形下病变评分需修正。上排为闭塞性病变，下排为非闭塞性病变。
图14是常规评分生成示例。
图15是病变修正后的评分生成示例。
具体实施方式
下面结合附图和实施例对本发明进一步说明：
该17节段心肌评分系统包括：
帧捕捉端，用于捕捉动态造影视频的视频帧；将冠状动脉造影视频导入帧捕捉端，帧捕捉端将视频中的单帧图像逐个分离出来。
图像处理模块，根据帧捕捉端捕捉的视频帧提取动态造影图像中的血管边界和心脏边界，血管边界和心脏边界采用图像处理中常用的Matlab边缘检测算子如canny、sobel等提取边缘，根据提取 到的最大边缘即为心脏边界，当心脏每次拨动时心脏大小起伏变化，截取波峰波谷之间的视频帧，再次进行边缘提取，滤波后滤除最外层连续边缘(即心脏边界)，留下连续的血管边界，血管边界构成血管用于节段评分，心脏边界用于确定心脏跳动的规律波形，根据规律波形，在心脏的最小体积时，将此时的动态造影图像的视频帧上的血管按等间隔进行宽度取样，取样的宽度线条垂直于血管延伸的中轴，并记录宽度所在的血管边界的轨迹，将前述宽度与心脏的最小体积到最大体积之间视频帧内同一位置的血管宽度进行比对，找出血管宽度膨胀比例低于设定阈值的血管位置记录；
节段设定端，对视频帧上的血管进行节段划分；通过人工标记各节段采用如下的命名方式和节段分割：
54种冠状动脉循环类型
根据右冠状动脉供血范围，冠状动脉循环系统分为6种类型：
零后降支型(PDA zero)：左心仅接受左冠脉系统供血，右冠脉系统不向左心供血，谈即通常所说的左优势型(图2a)。
唯一后降支型(PDA only)：右冠脉系统仅发出后降支走行于后室间沟，为后室间隔供血。左室下膈面全部由左回旋支供血(图2b)。
小右冠脉型(small RCA)：右冠脉系统除发出后降支外，还发出后侧枝供应一部分下膈面。其余下膈面由起源于左回旋支的后侧枝供血(图3c)。
普通右冠脉型(average RCA)：右冠脉系统发出后降支及后侧枝灌注后间隔及整个下膈面(图3d)。
大右冠脉型(large RCA)：右冠脉系统除发出后降支及后侧枝灌注后间隔及整个下膈面外，还发出一小钝缘支灌注一小部分左心钝缘。而这部份左心钝缘本该由回旋支供血(图4e)。
超大右冠脉型(super RCA)：右冠脉系统除发出后降支及后侧枝灌注后间隔及整个下膈面外，还发出相当大的钝缘支灌注相当一部分左心钝缘。而这部份左心钝缘本该由回旋支供血(图4f)。
根据前降支(不包括对角支)供血范围，冠脉循环系统分为3型：短(图5a)、普通(图5b)及长(图6c)前降支3型；根据对角支供血范围，冠脉循环系统分为3型：小(图6d)、中(图7e)及大(图7f)对角支3型，共计54种冠脉循环类型，17节段心肌评分系统将用这54种冠脉循环类型来反映个体间冠脉树的巨大变异。
在我们的评分系统中，节段16系列，7系列，9系列，12系列，14系列，以及节段11,13,及15的定义均与传统定义相比有所改动。本评分系统中各冠脉节段定义于下文中详细列出。
参阅图8、图9，冠脉树节段命名
Seg 1.RCA proximal:右冠开口至心脏锐缘的一半。
Seg 2.RCA Mid:第一节段末至心脏锐缘。
Seg 3.RCA Distal:心脏锐缘至后降支之起始，通常走行于右侧后房室沟。
Seg 4.PDA from RCA:起源于右冠的后降支，走行于后室间沟。
Seg 16.起源于右冠后侧枝主支：开始于后降支起始，走行于左侧后房室沟，发出分支向左室膈面供血。
在右优势型中，左心膈面通常由起源于右冠的1－2支后侧支供血。1支后侧支通常较大，称为seg 16&。如果2支后侧支等大，则分别命名为seg 16a和16b。如果2支后侧支不等大，大的1支则命名为seg 16X，小的1支则命名为seg 16S。
Seg 16a.起源于seg 16的等大(与另一后侧支相比)的后侧支。
Seg 16b.起源于seg 16的等大(与另一后侧支相比)的后侧支。
Seg 16X.起源于seg 16的较大的后侧支，与发出位置无关。
Seg 16S.起源于seg 16的较小的后侧支，与发出位置无关。
Seg 16&.起源于seg 16的仅一支大的后侧支。
Seg 16c.起源于seg 16的钝缘支，灌注一部分钝缘。
Seg 5.起自左冠脉开口止于前降支及回旋支之分叉。
Seg 6.LAD proximal(前降支近段):第一主要穿隔支近段且包括主要穿隔支开口。
Seg 7.LAD mid(前降支中段):起自第一主要穿隔支以远，止于前降支在右前斜位置上成角处。如果成角不明显，则止于第一穿主要穿隔支至心尖的中点处。
前降支通常自近段或中段(seg 6或7)，发出1－2支对角支。仅发出一支对角支时通常较大，命名为seg 9&。如果两支对角支等大，则分别命名为seg 9a及seg 9b。如果两支对角支不等大，大的一支则命名为seg 9X，小的则命名为seg 9S。较大的对角支多发自seg 6。
Seg 9a.发自seg 6或7的等大的第一对角支。
Seg 9b.发自seg 6或7的等大的第二对角支。
Seg 9X.发自seg 6或7的较大对角支，无论其发出位置。
Seg 9S.发自seg 6或7的较小对角支，无论其发出位置。
Seg 9&.通常发自seg 6仅1支大的对角支。
Seg 7&.仅发出一支大对角支的前降支中段。
Seg 7X.发出较大对角支的前降支中段。
Seg 7S.发出较小对角支的前降支中段。
Seg 7E.发出等大对角支的前降支中段。
Seg 7.无对角支发出的前降支中段。唯一大对角支通常发自seg 6。
Seg 8.LAD distal(前降支远段)：起自前一节段末，止于心尖或绕过心尖，走行于前室间沟内，为前降支终末部分。
Seg 11.Proximal LCX(回旋支近段)：回旋支主干，起始于左主干，终止于心脏钝缘。
回旋支通常发出1－2支钝缘支。唯一1支钝缘通常较大，命名为seg 12&。如果2支钝缘支等大，则分别命名为seg 12a和12b。如果2支钝缘支不等大，较大的一支则命名为12X，较小的则命名为12S。
Seg 12a.发自回旋支的等大的第1钝缘支，走行于心脏钝缘。
Seg 12b.发自回旋支的等大的第2钝缘支，走行于心脏钝缘。
Seg 12X.发自回旋支的较大一支钝缘支，走行于心脏钝缘，无论其发出位置。
Seg 12S.发自回旋支的较小一支钝缘支，走行于心脏钝缘，无论其发出位置。
Seg 12&.仅一支大钝缘支发自回旋支，走行于心脏钝缘，无论其发出位置。
Seg interX.较大中间支，相当于seg 12X。
Seg interS.较小中间支，相当于seg 12S。
Seg interE.较小中间支，相当于seg 12a或12b。
Seg inter&.仅一支大钝缘支，相当于seg 12&，灌注心脏钝缘。自主干独立发出一回旋支，走行于左后房室沟。
Seg 13.LCX Distal(回旋支远段)：起始于心脏钝缘，沿左后房室沟走行。右优势型中，其尺寸 通常较小或缺如，而在左优势型中，其尺寸通常较大。
在左优势型中，左室膈面通常由发自LCX的1－2支后侧支供血。唯一1支大的后侧支命名为seg 14&。如果2支后侧支等大，则分别命名为14a和14b。如果2支侧支不等大，较大的一支命名为14X，较小则命名为14S。
Seg 14a:发自seg 13的等大的第一后侧支。
Seg 14b:发自seg 13的等大的第二后侧支。
Seg 14X:发自seg 13的较大一支后侧支，无论其发出位置。
Seg 14S:发自seg 13的较小一支后侧支，无论其发出位置。
Seg 14&:发自seg 13的唯一大的后侧支，无论其发出位置。
Seg 15:后降支。发自seg 13的回旋支最远段，走行于后室间沟，灌注后间隔。
根据标记后的节段内血管宽度百分比相对于设定阈值的高低，确定该节段病变的权重，再将各节段的因子相加生成评分。
节段权重数据库，存储血管节段的权重数据，通过节段设定端对血管的划分调取权重数据生成评分，权重数据以及权重计算采用以下规则：
冠脉树权重因子的计算和推导
冠脉树权重因子的推导基于下列法则：
1)3个区域的竞争性供血法则；
左心室表面清晰地存在3个解剖学标志：前室间沟，后室间沟以及钝缘界。这3个解剖学标志将左心恒定划分为3个区域：隔区，包括前间隔和后间隔(图1c)；对角支－钝缘区，包括前壁和侧壁，但不越过钝缘界(图1a)；下膈面(图1b)。相应地，存在3根血管相对恒定地沿这些解剖学标志走行：左前降支(12)，后降支以及钝缘支，尽管冠脉血管树在个体间极大变异。
竞争性供血法则
隔区由前降支(不包括对角支)和后降支(通常无主要分支)竞争性供血。长前降支将减少后降支的供血范围，反之亦然。对角－钝缘区由对角支及钝缘支竞争性供血。大对角支将减少钝缘支供血范围，反之亦然。下膈面由起源于左冠或右冠的后侧枝竞争性供血。巨大右冠将减少回旋支供血范围，反之亦然。
2)子血管流量相加等于主血管流量法则；
3)依据关键已知锚定值推算未知权重因子法则。
参阅图10-12，在所有54种冠脉循环类型中，冠脉总权重因子恒定不变为17.0，对角支－钝缘区域血管权重因子恒定不变为8.0，隔区血管权重因子恒定不变为6.0，下膈面血管权重因子恒定不变为3.0。在RCA普通右优势型中，远段LAD权重因子依LAD长度不同，依次为1.0，2.0及3.0；对角支权重因子依对角支大小不同，依次为2.0，3.0及4.0；LCX权重因子依对角支－钝缘区域竞争性供血法则，依次为6.0，5.0及2.0。对角支大小及LAD长度相同时，RCA权重因子按PDA only至super RCA类型顺序，逐级增加1.5。根据上述锚定值，54种类型冠脉树之权重因子均可由此推导出来。血管相同，但权重因子不同，反映了该血管在个体间灌注左心室节段数的不同。
普通优势型、对角支及前降支患者冠脉血管权重因子的分配(average RCA dominant circulation with intermediate diagonals and average LAD)
参阅图11浅色标记的一列，普通优势型、对角支及前降支患者中，右冠为下间隔区及下膈面供血，共计5个节段，其权重因子为5.0。前降支(除外对角支)为前间隔及心尖节段供血，共计4个节段；对角支为前壁供血，共计3个节段。因此，前降支(包括对角支)共计为7个节段供血，其权重因子为7.0。回旋支为剩余5个节段供血，其权重因子为5.0。总分共计17.0，对应于左室心肌的17个节段。
确切来说，在普通右优势型及普通对角支中，远段前降支(distal LAD)为1个心尖间隔节段及1个心尖节段供血，共计2个节段，其权重因子为2.0。中段前降支(mid LAD)，如果没有发出任何对角支，将为心中部前间隔、心尖部间隔及心尖节段供血，共计3个节段，其权重因子为3.0。如果中段前降支(mid LAD)发出对角支，其权重因子将依对角支权重的不同而分别为6.0，5.0及4.5。近段前降支(proximal LAD)权重因子恒定为7.0而不论对角支发出之位置。后降支(PDA)为下间隔2个节段供血，其权重因子为2.0。1－2支后侧支为下壁3个节段供血，其权重为3.0。如果2支后侧支血管不等大，较大1支权重为2.0，较小1支权重为1.0。如果2支后侧支等大，则每一支权重均为1.5。仅存1支大的后侧支，为下壁3个节段供血，其权重因子为3.0。后降支(PDA)及后侧支权重之和为5.0，则亦为远段右冠(distal RCA)权重。回旋支发出1－2支钝缘支，尺寸等大或不等大。唯一发出的大的钝缘支为5个节段供血，其权重因子为5.0。如果2支钝缘支不等大，则较大 1支权重为3.0，较小1支权重为2.0。如果2支钝缘支等大，则每支权重为2.5。Seg inter系列(seg interX,S,E及&)代表不同大小的中间支，其权重因子对应于seg 12系列(seg 12X,12S,12a,12b及12&)。
同一血管在不同个体间不断变化的权重因子反映了该血管所供血心肌节段数的不断变化。但在54种冠脉循环类型中，总权重因子恒定不变为17.0。
在我们设计的17节段心肌评分系统中，血管的重要性取决于该血管所供应的心肌节段数而非血管本身。在所有的54种冠脉循环类型中，一支血管的权重因子分配是基于该血管所灌注的心肌节段数。
在推导17节段心肌模型评分系统时，血管狭窄程度也在考虑之列。积分为血管权重因子与狭窄程度的乘积(公式1)。如果血管完全堵塞，则权重因子乘以5。如果血管直径狭窄50－99％，则权重因子乘以2，然后将血管节段所得积分相加，得到冠脉总积分(21)。积分为0表明冠脉树无狭窄。积分越高，狭窄越严重。
S＝W×D(1)
其中S为17节段模型评分；
W为血管的权重因子；
D为血管狭窄程度。
病变定义
目测超过50％直径狭窄为病变(血管直径大于1.5mm)。本评分系统中，仅考虑2类病变：闭塞性(100％狭窄)及非闭塞性(50－99％直径狭窄)。
病变评分
在本系统中，所有病变均应评分。每个病人之最大病变数设置为12，每个病变标以1-12相应的数字。非闭塞性病变累及相邻2个节段，又无主要边支者，仅对>1/2病变长度所在节段进行评分。非闭塞性病变累及相邻2个节段，存在主要边支者，若这些边支被判入同一个节段，应参照“病变评分修正”中列出的情形进行评分修正。
病变评分修正
下列情况需修正病变评分：
闭塞性病变
同一节段的主支闭塞性病变，主要分支正常(图13a)，病变评分以公式2修正，因为主支权重已包括了主要分支权重，但事实上，主要分支并未受累。
S＝subtotal score-W intact SBs×5；(2)
其中，intact SBs指所有正常边支。
同一节段的主支闭塞性病变，累及主要分支(图13b),病变评分按公式3修正，因为主支为闭塞性病变(相乘因子为5.0)，而主要分支为非闭塞性病变(相乘因子为2.0)，两者狭窄严重程度不同。
S＝subtotal score-W SBs*5-W involved SBs*5+W involved SBs*2；(3)
其中，SBs指所有正常或异常边支。Involved SBs仅指受累的边支。
同一节段的主支闭塞性病变，主要分支存在另一病变(>1个病变)(图13c)，该病变评分按公式4修正，因为主支权重已包括了主要分支权重，而且主要分支权重又被程序错误地当作了闭塞性病变(相乘因子为5.0)。事实上，主要分支病变为一独立病变，应单独评分(相乘因子为2.0)。
S＝subtotal score-W diseased SBs×5；(4)
非闭塞性病变
同一节段的主支非闭塞性病变，主要分支正常，且早于病变发出(图13d)，主支病变评分按公式5修正，因为主支权重已包括了主要边支权重，而主要边支并未受累。
S＝subtotal score-W intact SBs×2；(5)
同一节段的主支非闭塞性病变，累及了主要边支(1个病变)，且边支发出早于主支病变(图13e)，主支病变评分按公式6修正，而受累的主要边支不需要进行评分，因为受累的边支权重已包括在了主支中了。
S＝subtotal score-W involved SBs×2；(6)
同一节段的主支非闭塞性病变，主要边支亦有病变(>1病变)，且边支发出早于主支病变(图13f)，主支病变评分按公式7修正，因为主支权重已包括了主要分支权重，然而这一主要分支须按独立病变进行评分。
S＝subtotal score-W diseased SBs×2；(7)
其中S为病变节段修正得分，
Subtotal score为该病变常规评分，
W SBs为主要分支权重。
Intact SBs指主要边支正常，
Involved SBs指主要边支受累，但与主支病变一起应视为1个病变，
Diseased SBs指主要边支亦有病变，且与主支病变无关，为独立病变。
总之，在同一节段，所有主要边支(直径>1.5mm)，只要早于主支病变发出，无论其正常、受累或独立病变，软件评分均可能因边支的存在高估了病变的严重性，因此应扣除边支权重，从而修正评分。
作为优选，还包括标记模块，根据血管宽度变化的高低标记模块将血管标记成由高到低的灰阶图，便于人工观察病变部位的病变程度。
作为优选，所述设定阈值为血管宽度变化百分比的均值。
评分示例：
参阅图14，常规评分示例。在大RCA，短LAD且普通型对角支循环类型中，闭塞性病变常规评分(上排白色箭头)。在超大RCA，普通型LAD长度且普通型对角支循环类型中，非闭塞性病变常规评分(下排白色箭头)。
参阅图14，普通型LAD且大对角支循环类型中，同一节段的主支闭塞性病变，累及主要分支(上排白色箭头),病变评分按公式3修正：50-2*5(9a)-2*5(seg 9b)-2*5(seg 9b)+2*2(seg 9b)＝24.在左优势型，短LAD且大对角支循环类型中，同一节段的主支非闭塞性病变，主要分支正常，且早于病变发出(下图白色箭头)，主支病变评分按公式5修正：14-4*2(seg 9&)＝6.
以上所述仅为本发明的较佳实施例，并不用以限制本发明，凡在本发明的精神和原则之内，所作的任何修改、等同替换、改进等，均应包含在本发明的保护范围之内。

Claims (4)

  1. 一种17节段心肌评分系统，其特征在于：
    包括：帧捕捉端，用于捕捉动态造影视频的视频帧；
    图像处理模块，根据帧捕捉端捕捉的视频帧提取动态造影图像中的血管边界和心脏边界，血管边界构成血管用于节段评分，心脏边界用于确定心脏跳动的规律波形，根据规律波形，在心脏的最小体积时，将此时的动态造影图像的视频帧上的血管按等间隔进行宽度取样，并记录宽度所在的血管边界的轨迹，将前述宽度与心脏的最小体积到最大体积之间视频帧内同一位置的血管宽度进行比对，找出血管宽度膨胀比例低于设定阈值的血管位置记录；
    节段设定端，对视频帧上的血管进行节段划分；
    节段权重数据库，存储血管节段的权重数据，通过节段设定端对血管的划分调取权重数据生成评分。
  2. 根据权利要求1所述的17节段心肌评分系统，其特征在于：还包括标记模块，根据血管宽度变化的高低标记模块将血管标记成由高到低的灰阶图。
  3. 根据权利要求1所述的17节段心肌评分系统，其特征在于：所述设定阈值为血管宽度变化百分比的均值。
  4. 根据权利要求1所述的17节段心肌评分系统，其特征在于：所述节段权重数据库包含图10-图12的权重因子分布表。
PCT/CN2017/073350 2017-02-07 2017-02-13 17节段心肌评分系统 Ceased WO2018148859A1 (zh)

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