CN103477346A - 用于筛查、诊断和活检的双能和/或造影增强***成像的***和方法 - Google Patents
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Abstract
本发明提供用于与双能、单能、***摄影和断层融合模式组合X射线成像患者的***的***和方法，其便于***异常、特别是由异常血管分布表征的***异常的筛查和诊断。
Description
相关申请的引用
本专利申请要求于03/08/2011提交的临时申请第61/450,304号的权益并且通过引用合并其说明书和附图。
技术领域
本专利说明书涉及医学成像并且更具体地涉及能够在多个不同成像模式、多个不同成像过程、图像采集参数和图像处理技术之间进行选择的***。
背景技术
若干参考文献在本专利说明书的公开部分的结尾列出并且在下面由括号中的数字表示。这些参考文献以及在该专利说明书中提及的现有专利通过引用被合并于此。
在美国对于女性乳腺癌死亡率仅次于肺癌死亡率。由于其在早期肿瘤检测中的作用，x射线***摄影术在美国已成为进行乳腺癌筛查、诊断和评价的最常用的工具。***摄影照片是用于可视化***内的正常和异常结构的内部***组织的x射线图像。***摄影照片提供早期癌症检测，原因是它们常常可以显示***肿块和/或钙化（在它们可用手触知之前）。
尽管筛查x射线***摄影术被认为是用于乳腺癌的早期检测的最有效方法，但是它也具有挑战，原因在于在一些情况下可能难以确定检测到的异常是否与癌性或良性病变关联。这样的一个原因在于***摄影照片Mp是表示三维结构的二维投影图像，并且在压缩***中的重叠结构可能干扰图像判读和诊断。第二原因在于常常用于获得图像的x射线具有的能量在有助于获得理想的信噪比（SNR）的范围，但同时可能导致x射线由可能具有不同临床意义的***结构衰减到类似程度。
改善***x射线的敏感性和特异性所做的努力包括***断层融合***的发展。***断层融合是涉及在短扫描期间在多个角度采集静止压缩***的图像的三维成像技术。在成像x射线束相对于***的相应角度拍摄的单独的投影断层融合图像Tp然后被计算机处理成一系列重建断层融合切片图像Tr，每个重建断层融合切片图像表示***的相应切片。Tp和/或Tr图像可以单独地或同时地或在动态电影模式下被显示。***断层融合***摄影术[参考文献14-19]典型地使用现场数字***摄影（FFDM）平台。在一个例子中，x射线管在***之上以弧形移动并且获得一系列11至22个低剂量x射线2D断层融合投影图像Tp。来自所有2D断层融合投影图像Tp的剂量的和类似于来自单常规数字***摄影照片Mp的剂量。这些低剂量2D断层融合投影图像Tp被重建为一系列3D切片图像Tr，每个3D切片图像表示***的切片，其中切片例如为1-5mm厚。切片图像典型地与平行于在图像采集期间支撑***的平台的平面一致，但是可以不同地定向。与常规***摄影术相比***断层融合的优点在于通过将***显示为一系列切片而不是单***摄影照片，可以更清楚地看到病变，原因是存在于常规***摄影照片中的大量重叠组织已被去除。
重建断层融合切片图像Tr减小或消除由二维***摄影成像中的组织重叠和结构噪声导致的问题。数字***断层融合也提供减小***压缩、改善诊断和筛查精度、更少的召回（recall）和3D病变定位的可能性。多模式***断层融合/***摄影***的例子在共同转让的美国专利第7,869,563号中被描述。***断层融合和***摄影术的其它方面在美国专利第7,991,106，7,760,924，7,702,142和7,245,694号中被描述，上述专利通过引用被合并于此。
为了试图解决在***x射线成像中区分乳腺癌和良性异常的挑战，已考虑造影增强和双能成像。在造影增强成像中，可以是碘基的造影剂可以典型地通过在远离***的静脉中的注射引入***中，并且在造影剂到达***之后（以及可能之前）拍摄x射线图像。造影剂帮助突出显示***中的血管分布。如果在造影剂到达***中之前和之后拍摄的相同***的图像彼此减影（并且在拍摄两个图像的时间之间没有***运动），***血管分布可以更加清楚地出现在合成减影图像中。这可以有助于区分癌症和良性组织，原因是据信乳腺癌释放增加肿瘤附近的小血管的形成的血管生成因子（1，2）。（括号中的***数字表示在本专利说明书的结尾列出的相应出版物）。据信乳腺癌的生长取决于血管生成因子，并且这些血管与正常血管的区别在于它们具有增加的渗透性并且常常是曲折的。围绕肿瘤的血管的成像被认为允许改善乳腺癌的检测。
MRI（磁共振成像）可以与造影增强一起使用以通过成像靠近乳腺癌的血管网帮助表征乳腺癌（3）。尽管造影增强***MRI（CEMRI）在成像乳腺癌中可以是有效的，但是它具有限制，包括高成本、长程序时间、诸如纤维肿瘤的良性异常的增强和不能成像具有金属夹或患有幽闭恐惧症的女性。典型地，在CEMRI中使用的造影剂是钆基的并且不同于在x射线成像中使用的造影剂。
x射线成像也可以使用造影增强来改善癌症检测。建议诸如碘的造影剂与x射线方法一起使用以便成像靠近乳腺癌的血管网。这些x射线成像方法包括***CT（4，5）、***断层融合（6，7）和数字***摄影术（8-13）。造影增强x射线***摄影术（CEM）可以改善乳腺癌的显著性（8-13）。也建议CEM与CEMRI相比可以提供改善的特异性，原因是更少的良性病变增强（13）。这些研究少并且可能需要用更多的试验进行验证。
在x射线***摄影术中，使用两种方法评价造影增强***摄影术。第一方法涉及在造影之前和之后获得的图像的减影（9）。该方法被称为时间减影。第二方法被称为双能造影成像。在该方法中在注射造影剂之后以低能量和高能量获得图像。当使用碘基造影剂时以高于和低于碘的k边（33.2keV）的能量获得图像。在刚好高于k边的x射线能量处x射线的吸收增加，导致在高能图像中来自碘造影剂的造影的增加。这两个图像的减影增强碘造影，同时抑制正常***解剖结构的造影。双能造影成像***摄影术的优点在于可以在很短时间内获得两个图像并且因此可以以小的患者运动减影图像。这不适用于造影前和造影后图像的减影，原因是存在将两个图像的采集的一分钟以上分离。
任何x射线成像的一个目标是获得最高质量的图像以减少假阳性和假阴性诊断的出现。期望获得一种用于采集x射线图像以减轻与当前设计中的特异性和敏感性关联的问题的***和方法。
发明内容
本专利说明书描述便于患者、特别是患者的***并且特别地针对由可疑血管分布表征的异常的x射线筛查和诊断的x射线成像***和方法。在非限定性例子中，优选地在单***压缩中使用成像模式的组合以获得提供这样的异常的筛查和诊断的出乎意料的更加便利的x射线图像的收集。作为一个例子，在将x射线造影剂引入***中之后使用新***和方法来成像患者的***。在注射造影剂之后的选定时间，***获得表示患者的***的相应切片的3D切片图像。通过重建算法，经由计算机处理在成像x射线束相对于***的相应角度拍摄的***的多个x射线2D断层融合投影图像来形成这些3D切片图像。***也获得***的低能2D x射线***摄影照片和高能2D x射线***摄影照片的2D组合图像。这些2D投影图像以及低能和高能***摄影照片优选地在患者的***的单压缩中被拍摄。***优选地同时显示2D组合图像和3D切片图像中的一个或多个。被显示的组合2D图像便于在二维中识别可能血管异常的位置，并且3D切片图像便于在三维中识别异常的位置并且能够在相应的切片图像中可视化异常的外观。
在以下的详细描述中并且在附图中进一步解释***和方法的这些和其它方面。
附图说明
图1示出提供多个成像模式的选择的x射线***成像***，所述成像模式包括3D断层融合模式和2D***摄影模式，在每个模式中使用单能成像或双能成像，并且在每种情况下在***中具有或不具有造影剂。
图2更详细地示出图1的***的一部分。
图3示出图1的***的另外方面。
图4示出***成像***的操作的例子中的步骤。
图5示出在执行***成像中使用的参数的定制表。
图6a示出例如在图2中所示的***的不同成像模式下拍摄的图像的显示。
图6b示意性地示出在例如图1的***的六个不同成像模式下拍摄的图像的显示。
图7示出例如图1中所示的***的成像模式的可能组合。
图8是在仅仅拍摄2D图像的***中的成像模式的可能组合的类似图示。
图9是在仅仅拍摄3D图像的***中的成像模式的可能组合的类似图示。
图10示出例如图1中所示的***的操作的优选例子中的步骤。
具体实施方式
本专利说明书中所述的***和方法的例子利用并且组合包括二维（2D）、三维（3D）、双能（DE）和造影增强（CE）成像的一个或多个图像采集模式的优点以提供具有改善的敏感性和特异性并且具有更有效的筛查和诊断、放射科医师的更大便利和更好的患者工作流的益处的***成像***。
根据一个例子的***包括具有一个或多个x射线过滤器的x射线源、成像x射线检测器以及位于x射线源和检测器之间用于固定待成像的物体、例如患者的***的固定机构。在图像采集期间，通过改变包括但不限于x射线过滤器和x射线kV的至少一个x射线源采集参数，两个或更多个不同能量范围的x射线从x射线源生成。x射线传播通过被成像物体并且由检测器接收。被成像物体的组成通过诸如衰减、吸收和散射的机制调制x射线，导致被检测图像中的较亮和较暗区域。被检测图像使用计算机处理技术进行处理并且合成图像可以在放射科医师的工作站进行存储和/或显示。
***可以包括用于控制图像采集的控制模块，控制模块包括允许用户选择图像采集和/或图像处理的一个或多个模式的用户接口。用户接口可以包括小键盘、触摸板、控制杆或与在联接到显示器的计算机***上运行的计算机程序交互的其它输入机构。这样的用户接口可以使图像采集模式，例如2D***摄影模式、3D断层融合成像模式或组合2D/3D成像模式能够取决于***成像设备的能力来选择。
替代地（或组合地）接口可以经由每个被选择成像模式内的特定采集参数和采集过程的选择能够进一步定制图像采集。例如，***适合于针对在2D、3D或组合（combo）模式下采集的至少一个图像执行双能图像采集过程。另外，***可以配置成针对在双能2D、3D和/或组合模式下采集的图像执行背景减影图像采集过程。
除了能够进行每个成像模式内的各种成像过程的选择以外，***可以配置成使用户能够定制指定模式或过程的采集参数。因此***还可以允许用户识别采集参数，例如造影剂、kV、mA、图像定时和x射线过滤器类型。如本文中随后将更详细地描述，参数的选择可以在不同2D图像采集之间、例如在断层融合采集期间的序列投影图像Tp之间变化并且相对于引入造影剂的定时触发成像。
除了能够选择采集模式和操作参数以外，用户接口可以允许选择将在被捕捉图像上使用的图像处理的各种形式，包括3D重建过程（背向投影、正向投影、具有权重等）、噪声过滤算法、具有或不具有差别权重的不同能量图像的减影等。替代地，控制模块可以编程为根据被选择的采集模式或根据被选择的操作参数或它们的组合来选择图像处理的优选方法。
现在将参考附图更详细地描述这些和其它特征。
图像采集
一个例子是针对***摄影术和***断层融合优化并且针对双能成像和针对造影剂的使用进一步修改的x射线图像采集***。可以用作进一步修改的基础的一个***是由马萨诸塞州贝德福德（Bedford）的Hologic公司制造并且销售的
断层融合成像***。该***是能够在2D和3D模式下采集图像的组合模式***，但是应当清楚这不是合适***的唯一例子，断层融合***也可以用作修改的基础，并且***摄影***的一些方面也可以有用于进一步修改的基础。因此，本专利说明书中所述的***和方法不限于可以使用或修改以执行所需过程的特定起始***。起始***的例子的某些方面在上面引用的共同拥有的专利中被描述。
图1-3示出可以执行本专利说明书中所述的过程、针对下面所述的双能成像具有合适的增加或修改的多模式***摄影/断层融合***的非限定性例子的各种部件。***包括门架100和数据采集工作站102。门架100包括支撑管臂组件106的外壳104，管臂组件可旋转地安装在外壳上以围绕水平轴线402枢转并且携带x射线管组件108。x射线管组件108包括（1）在诸如20-50kV的选定范围内、以例如在3-400mAs的范围内的mAs、以诸如标称尺寸0.3mm大斑点和标称尺寸0.1mm小斑点的焦斑生成x射线能量的x射线管，（2）用于多个x射线过滤器、例如钼、铑、铝、铜、碘化铯、银和锡过滤器的支撑件，以及（3）可调节准直组件，其从例如在7乘8cm矩形到24乘29cm矩形的范围内的焦斑选择性地准直x射线束（当在包括在***中的x射线图像接受器502的图像平面处、以例如75cm的最大源-图像距离测量时）。压缩臂组件110也安装在外壳104上，用于围绕相同轴线402（或不同轴线）旋转，压缩臂部件包括压缩板或桨板122和接受器外壳114，接受器外壳具有用作***板或平台的上表面116并且封闭图像检测器子***117，图像检测器子***包括平板状x射线成像接受器502（图2）、可缩回防散射格栅以及用于在成像x射线束穿过格栅的位置和格栅在成像x射线束的外部的位置之间驱动和缩回防散射格栅的机构。外壳104也封闭用于上下移动管臂组件106和压缩臂组件110以适应特定患者或成像位置的竖直行程组件404，针对不同成像位置围绕水平轴线旋转管臂组件106的管臂组件旋转机构，用于围绕水平轴线旋转检测器子***117的部件以适应不同操作模式的检测器子***旋转机构，以及选择性地彼此耦合或去耦管臂组件106和压缩臂组件110并且选择性地彼此耦合或去耦管臂组件106和检测器子***117的耦合/去耦机构。外壳104也封闭合适的马达以及电和机械部件和连接以执行这里所述的功能。在图2中示意性示出的患者防护装置200可以固定到压缩臂组件110以提供机械互锁防止患者与旋转x射线管臂组件106接触。工作站102包括类似于
***摄影***和
组合***中的部件，包括显示屏（典型地是可以包括触摸屏功能的平板显示器）、用户接口装置（例如键盘，可能是触摸屏，以及鼠标或跟踪球）以及各种开关和指示灯和/或显示器。工作站102也包括类似于
和
***中的计算机设备（但是通过硬件、固件和软件差异进行适应性修改）以用于控制门架100并且用于处理、存储和显示从门架100接收的数据。用于x射线管组件108的发电设备可以包括在外壳104中或工作站102中。电源118为工作站102供电。门架100和工作站102在示意性示出的连接120上交换数据和控制。
如图3中所示，附加存储设备602可以连接到工作站102，例如用于存储信息、例如图像和/或用于将信息、例如先前获得的图像和软件提供给工作站102的一个或多个光盘驱动器，或本地打印机（未显示）。另外，公开的***可以连接到医院或局域网或其它网络604，并且通过网络连接到其它***，例如软拷贝工作站606、用于计算机处理***摄影和/或断层融合图像以识别可能异常的CAD（计算机辅助检测）工作站608、用于打印图像的图像打印机610、技术专家工作站612、诸如其它***摄影***或用于其它模态的***以便交换图像和/或其它信息的其它成像***614以及用于归档图像和其它信息和/或检索图像和其它信息的PACS（图片归档）***616。
在典型地用于筛查***摄影术的标准***摄影模式下，管臂组件106和压缩臂组件110被耦合和锁定在例如图1中所见的相对位置，使得当患者的***由压缩装置112压缩时来自x射线管组件108的x射线束照射x射线接受器502。在该模式下，***以类似于所述
***的方式操作以拍摄***摄影照片。竖直行程组件404和管臂旋转机构可以进行竖直调节以适应患者，并且可以针对不同图像取向、例如针对CC和针对MLO图像使管臂组件106和压缩臂组件110作为一个单元一起围绕水平轴线旋转。例如，管臂组件106和压缩臂组件110可以围绕轴线在（-195.度）和（+150.度）之间旋转。与
***中一样，压缩装置112包括可以在沿着患者的胸壁的方向上横向地移动以针对不同成像取向进行调节的压缩桨板122。压缩桨板可以包括多种类型的桨板中的任何一种，包括但不限于全桨板、局部桨板或弯曲桨板（其可以优选地用于下面所述的造影图像采集过程中），并且可以配置成克服弹簧偏压倾斜和/或横向地移动，如上面提到的共同拥有的专利中所述。
在例如用于所述
***中并且如所述美国专利7,869,563中所述的断层融合模式下，管臂组件106和压缩臂组件110去耦使得压缩臂组件110停留在一个位置，压缩患者的***，而管臂组件106围绕水平轴线、相对于压缩臂组件110例如旋转+/-15度。可以针对不同的图像取向执行断层融合，使得压缩臂组件110可以针对期望的图像取向围绕水平轴线（单独地或与组件106一起）旋转并且锁定就位，并且然后管臂组件106可以相对于压缩臂组件110的该位置在+/-15度或某个其它期望的角度范围上旋转，以用于断层融合成像。例如，低剂量断层融合可以在七度的角范围上执行以在七个投影图像的区域中收集。
在组合模式下，在患者的***的单压缩期间，***拍摄常规***摄影照片和断层融合图像。在该模式下，当***在压缩臂组件110中保持压缩时，（1）管臂组件106扫掠并且x射线接受器502摇动，每个通过合适的角，并且进行x射线曝光以获得断层融合图像，并且（2）拍摄标准***摄影照片。标准***摄影照片可以在管臂组件106和x射线接受器502的成像平面的法线之间的0（零）度角相对角被拍摄，并且可以在断层融合图像被拍摄之前或之后或在拍摄两个连续断层融合图像之间被拍摄。典型地，每个断层融合图像利用比标准***摄影照片显著更低的x射线剂量。
例如，如上所述，在断层融合期间拍摄的所有投影图像的总剂量可以在单***摄影照片的剂量的0.25到2.0倍的范围内。两个剂量之间的关系可以由用户选择以控制x射线管电压、电流、断层融合扫描角、所获得的投影图像的数量等中的任何一个。在替代实施例中，剂量可以经由门架上的简单开关或通过放射科医师工作站处的用户控制改变。在另外的替代实施例中当放射科医师在模式之间切换时剂量可以自动地改变。
图像采集过程选择
任何数字成像***的一个重要特性是能够改变用于生成任何图像的辐射的量和强度。辐射强度与x射线靶的原子序数（Z）、x射线电流（mA）、x射线电压和x射线束过滤相关。辐射强度改变以改善图像质量，这又可以改善诊断敏感性。当辐射强度增加时，量子斑纹（由光子吸收导致的图像噪声）倾向于减小，反之亦然。
许多***摄影和断层融合***允许操作者通过手动地设置诸如mA和mSec的技术因数来控制x射线曝光。一些***包括自动曝光控制（AEC）功能，该自动曝光控制功能控制施予辐射的持续时间，当已施予期望的剂量时关闭x射线源。自动曝光控制（AEC）方法可以改变包括曝光时间、kV、mA和图像的过滤模式的剂量参数以改变曝光和辐射强度。
尽管对采集参数的这样的控制可以提供图像质量的一定改善，根据本专利说明书中所述的***和方法的一个方面，可以通过将附加采集过程包含到2D、3D或组合***中提供改善的图像质量以根据本专利说明书中所述的新方法实现造影图像增强的益处。
根据本专利说明书中所述的例子的***成像***合并了组合式2D和/或3D***x射线成像的能力和来自造影图像采集过程的益处。通过利用选自以下组的任何图像的病变定位软件，活检能力（立体定向或断层融合引导）也可以被整合到***中，所述组包括简单的2D图像、3D投影图像、3D重建数据或在双能或背景减影图像采集过程期间获得的2D、3D投影和3D重建数据中的任何一项。
在这样的布置的情况下，支持以下图像协议：
■在2D或3D模式下使用单高或低能图像采集技术的造影成像（背景减影）；
■在2D或3D模式下的双能造影成像；
■在3D模式下的双能造影成像，其中高和低能曝光在断层融合扫描期间以不同角发生；[高和低能可以独立地重建并且组合以形成双能体积]；
■在采集双能2D和双能3D图像的组合***中的双能成像；
■在组合成像模式下，其中2D图像数据集使用单能采集，并且3D图像数据集使用双能成像采集；
■在组合成像模式下，其中2D图像数据集使用双能成像采集，并且3D图像数据集使用单能成像采集；
■断层融合成像模式，其中在整个扫描期间***保持压缩的造影断层扫描中的总共N个视图之中，不同投影图像被分配不同剂量、kVps、mAs和过滤器以获得不同应用的更大灵活性；
■断层融合模式，其中低能扫描和高能扫描在一系列被采集投影图像中交替；
■断层融合模式，其中针对投影图像、以不等比率以用户可选择模式执行低能和高能扫描；
■使用造影剂和双能或背景减影成像的立体定向活检；
■使用通过造影剂和双能或背景减影成像获得的断层融合扫描图像的立式活检；
造影成像和图像采集模式的组合的其它变型在本专利说明书的范围内。
图像采集参数选择
一旦图像采集模式和采集过程被确定，可以通过改变用于每个2D图像捕捉的过滤器和/或kV、mA中的至少一项，以投影图像粒度改变采集参数和图像处理技术。
可以对现有的***摄影和/或断层融合***成像***进行若干修改以支持造影成像。例如，在x射线源内，允许在kV、mA和x射线束过滤器之间快速切换的机构可以被提供以支持图像捕捉模式之间和之内的双能成像。例如，x射线过滤轮可以被提供以在低和高能脉冲之间切换过滤器。诸如铑、银、铝、铜、钛和碘化铯的各种不同的过滤器可以被提供以提供用于不同造影剂的期望能量。
图3a示意性地示出例子，其中在x射线源108的内部的焦斑108a朝着成像x射线接受器发射成像x射线束108b。射束穿过可变过滤器组件108c，该可变过滤器组件包含用于将选定过滤器置于射束路径中的机构，由此控制朝着成像接受器延续的x射线的能量范围。过滤器变化控制108d确定哪个过滤器将拦截x射线束，并且又由***设置或由用户工作单元102控制。可变过滤器布置在本领域中是已知的，原因是它们在各种***中使用，包括由共同受让人提供的类型的双能骨密度测量***。可变准直器108e控制在接受器的成像平面处的x射线成像束的面积，并且又由也可以接收来自单元102的命令的准直器控制器108f控制。
该专利说明书中所述的新***允许用户在投影图像粒度选择物理采集参数。例如，图4示出可以遵循的过程步骤的例子。在步骤400决定是否将***设置成在造影增强模式下操作并且在步骤402决定是否在双能模式下操作***。这些决定可以由用户作出，或者可以由***根据用户输入的一些信息自动地作出。在步骤404用户或***选择是否仅仅在2D模式下、仅仅在3D模式下或在2D和3D模式的组合下操作。在步骤406，***或用户可以定制采集参数，例如kV、mAs等，并且在步骤408***以在步骤400-406中选择的设置操作以采集图像Tp和/或Mp。
图5示出可以呈现给用户以便手动定制断层融合扫描的图像的断层融合投影图像定制表的例子。尽管在表中显示某些字段，但是本专利说明书预见任何采集变量可由用户获得以便以该方式定制图像。这样的表可以初始用缺省值（其可以是***缺省或在响应AEC接收的图像数据的分析之后填充的缺省值）填充，或者可以由用户填充并且输入***中。
图像处理选择
新***也允许对被接收图像执行不同的图像处理，其中可以响应采集的类型（即，断层融合采集、2D采集、双能采集、造影采集）确定图像处理技术。因此，例如使用高能采集的图像可以使用与使用低能采集的图像不同的算法。图像处理技术可以基于被选择采集模式预编程或者可以替代地响应用户输入被选择。为了本专利说明书的目的，图像处理指的是图像的任何操作和组合，包括噪声过滤和图像重建。一些处理可以是采集模式的函数。例如，当使用断层融合图像执行背景减影造影成像时，注射前和后投影图像可以被减影，并且合成信号移位以配准图像从而补偿患者运动。
在一个实施例中，新***能够利用增益控制图像或空中地图修正图像作为造影图像处理的基础（即，在减影或加法过程之前处理图像）。增益控制图像是例如已经使用在所述共同转让的美国专利第7,991,106号中所述的技术被处理以补偿***增益从而增加SNR的图像。
显示器
新***的显示器可以用于显示使用任何模态（2D、3D、组合）、使用任何图像采集过程捕捉的图像。显示器包括在各种配置中显示图像的能力，包括单独、并排、切换或电影模式。使用这样的布置，健康专家可以以低能采集、高能采集或在两者的减影之后在使用或不使用造影剂的情况下同时观察（或切换，或在电影中观察）***的2D图像、3D投影图像或3D切片图像，由此增强可视化和表征病变的能力。
图6a示出例子，其中不同类型的图像在计算机显示器102a的相应窗口中并排呈现。图6b示意性地示出同时显示患者的***的六个不同图像的计算机显示器102a的例子，所述六个不同图像为：单能断层融合投影图像TpSE，单能重建断层融合切片图像TrSE，单能***摄影照片MpSE，双能断层融合投影图像TpDE，双能重建断层融合切片图像TrDE，和双能***摄影照片MpDE。应当理解在该上下文中术语单能指的是x射线管以确定x射线的参数的特定参数设置，来发射该管所发射的能量的能量的范围，并且术语双能指的是可以部分重叠的两个这样的能量范围。也应当理解图6b示出根据本专利说明书的布置图像的许多例子中的一个，并且图像显示器可以仅仅显示所示图像的子集，可以以不同相对布置显示图像，可以显示相同类型的多个图像（例如，多个图像Tp等），可以显示叠加图像，和/或可以在电影模式下显示图像，并且可以在整个屏幕上显示单图像或者可以将屏幕分成不同数量的窗口。
图7示出在2D成像***摄影模式和3D成像断层融合模式之一或两者下操作的组合***的不同操作模式下的成像的范围。在这些2D和3D模式的每一个下，***可以在***中有或没有造影剂的情况下对***进行成像。在2D和3D模式之一或两者下，并且在***中有或没有造影剂的情况下，***可以执行双能成像或背景减影成像。在图7中可以看到，这些能力允许模式的许多不同组合，例如使用单能（SE）和造影增强（CE）的2D、使用SE的2D、使用CE的3D、使用DE的3D等。图8示出当使用仅2D***（即，不包括3D断层融合能力的***）时的成像的范围。在图8的例子中，***可以在单能或双能模式下使用，在每种情况下在***中有或没有造影剂。图9示出可以在3D成像模式下使用单能或双能成像操作的仅3D***的操作，在任一情况下在***中有或没有造影剂。
尽管上面关于断层融合和***摄影照片图像的采集描述了新***的使用，但是本专利说明书不限于整合多模式***，而是适应于能够执行断层融合的任何***。例如新***可以仅仅包括断层融合成像能力。这样的***可以例如使用遗留***摄影照片以便钙化检测，或者可以以更高剂量获得单断层融合图像以用作它们的2D图像，或者可以从断层融合投影图像合成***摄影照片图像。另外，新***可以包含具有不同模态的断层融合成像能力，例如分子***成像或超声成像。总之包括断层融合成像能力的任何***成像***属于本专利说明书的范围内。此外，本专利说明书中所述的一些改进也适应于仅仅拍摄2D图像的***。
以上具体例子和实施例是示例性的，并且可以对这些例子和实施例进行许多变化而不脱离本公开的精神或附带权利要求的范围。例如，在本公开和附带权利要求的范围内不同示例性实施例的要素和/或特征可以彼此组合和/或彼此替代。
优选例子
在优选例子中，本专利说明书中所述的***获得（i）患者的***的3D断层融合切片图像TrSE，其表示***的相应切片并且通过患者的***的多个单能x射线2D断层融合投影图像TpSE的计算机处理重建，（ii）低能x射线2D***摄影照片MpL，以及（ii）***的高能x射线2D***摄影照片MpH。Tp、MpL和MpH图像优选地在单***压缩中被拍摄，同时***保持固定。***计算机处理2D低能***摄影照片MpL和2D高能***摄影照片MpH以形成倾向于突出显示***中的血管分布的加权组合双能2D***摄影照片图像MpCDE。***优选地同时显示（i）组合2D图像MpCDE，其可以帮助在二维中展示可能血管异常的位置，以及（ii）3D切片图像TrSE，其中出现异常并且其可以帮助展示异常的3D位置和切片图像中的异常的外观。
优选地，***配置成响应MpCDE图像中的异常的识别而自动地识别其中出现异常的TrSE图像的子集。也优选地，***配置成同时显示MpCDE图像以及TrSE图像的所述子集的图像中的一个或多个但不是全部，或整个子集。
图10示出用于执行根据优选例子的成像的方法的步骤。在步骤1000，针对成像序列设置例如图4中所示的成像参数。这可以通过将缺省存储在***中、例如图1所示的采集工作站102中或更典型地通过例如使用例如图5中所示的表选择适合于特定患者和/或特定研究的参数完成。在步骤1001，注射造影剂，例如标准的FDA批准的低渗量碘造影剂。在一个例子中，以3至3.5ml/sec的速率或在IV号的安全参数内注射350-370mg/ml的造影剂，以1.5ml/kg患者重量的总体积直到最大150ml。一般而言，试剂可以与临床上常用于胸和腹的造影增强CT扫描的相同。注射可以在肘前或前臂静脉中。步骤1002是典型地在注射开始之后大约一或两分钟的等待时间。基于造影剂在***中达到期望浓度所需的时间的健康专家的评估，设置步骤1002的持续时间。在步骤1004，以用于断层融合图像的已知方式压缩患者的***并且例如图1中所示或可从受让人获得的
的***在单能断层融合模式下操作以拍摄***的多个单能投影图像TpSE，例如22个图像TpSE，每个在例如±15°的角范围上从成像x射线束相对于***的相应不同角度获得。在步骤1006并且当患者的***保持压缩和固定时，***例如通过将x射线源返回到0°位置并且以在成像x射线束中一个x射线过滤器拍摄图像MpL、然后变化到不同x射线过滤器并且拍摄图像MpH而拍摄低能***摄影照片MpL和高能***摄影照片MpH。优选地，在30-40kVp范围内的x射线能量用于TrSE图像，小于35kVp（例如，在28-32kVp范围内）用于MpL图像，并且大于45kVp（例如，在45-49kVp范围内）用于MpH图像。然而，不同能量可以以与临床实践一致的方式被使用。作为一个例子，铑或银x射线过滤器可以用于MpL图像，但是铜过滤器用于MpH图像。其它成像参数遵循典型的临床实践并且可以取决于诸如压缩***的厚度和x射线密度的因素。
在步骤1008，TpSE图像使用通过引用被合并的资料中所述类型的重建算法被计算机处理以形成TrSE图像，并且MpL和MpH图像被计算机处理以形成组合图像MpCDE。例如，根据关系MpCDE=MpH-kMpL获得组合图像，其中在双能x射线成像技术中公知，k是加权因数并且典型地k<1。在步骤1010，显示协议根据预设缺省协议自动地被选择或者由用户针对特定患者研究或特定显示器选择，并且可以设置到诸如图1的单元102的工作站中或独立成像工作站中。在步骤1012，图像TrSE和MpCDE中的一个或多个显示在屏幕、例如图6b中所示的屏幕102a上。另外，其它图像可以显示在相同屏幕或其它屏幕上，例如图像TpSE和其它图像的任何一个，例如在其它时间用相同或不同模态（例如但不限于MRI、CT、核医学成像设备和超声）获得的***的图像。
在图10所示的步骤的顺序中许多变化是可能的。例如，步骤1004和1006的顺序可以颠倒。步骤108可以在步骤1006之前或者在步骤1006之后很久开始。步骤1008、1010和1012可以在远离图1中所示的单元100的设备中执行。
应当领会上面例示的优选例子仅仅是与本专利说明书一致的许多例子中的一个，并且模式和步骤的其它组合也在说明书的范围内。
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Claims (15)
1.一种造影增强患者的***的多模式x射线检查的方法，其包括：
将血管造影剂引入患者的***中；
获得（i）患者的***的多个单能x射线2D断层融合投影图像，（ii）低能x射线2D***摄影照片，以及（ii）***的高能x射线2D***摄影照片；
其中所述2D断层融合投影图像和所述2D***摄影照片在单***压缩中被拍摄；
将2D断层融合投影图像计算机处理成表示***的相应切片的3D切片图像；
计算机处理2D低能***摄影照片和2D高能***摄影照片以形成突出显示***中的血管分布的加权组合2D图像；以及
显示组合2D图像和3D切片图像中的一个或多个；
其中被显示的组合2D图像便于在二维中识别可能血管异常的位置，并且3D图像便于在三维中识别异常的位置以及在相应的切片图像中可视化异常的外观。
2.根据权利要求1所述的方法，其中所述显示包括同时显示组合2D图像和3D切片图像中的至少一个。
3.根据权利要求1所述的方法，其中所述显示包括相互配准地显示组合2D图像和3D切片图像中的至少一个。
4.根据权利要求1所述的方法，其中所述显示包括同时显示组合2D图像和多个3D切片图像。
5.根据权利要求1所述的方法，其中所述显示包括同时显示组合2D图像和3D切片图像的子集，其中所述子集包括其中出现异常的3D切片图像并且响应组合2D图像中的异常的识别自动地选择所述子集。
6.一种造影增强患者的***的多模式x射线检查的方法，其包括：
将血管造影剂引入患者的***中；
获得（i）患者的***的3D切片图像，其表示***的相应切片并且通过计算机处理患者的***的多个单能x射线2D断层融合投影图像被重建，（ii）低能x射线2D***摄影照片，以及（ii）***的高能x射线2D***摄影照片；
其中所述2D断层融合投影图像和所述2D***摄影照片在单***压缩中被拍摄；
计算机处理2D低能***摄影照片和2D高能***摄影照片以形成突出显示***中的血管分布的加权组合2D图像；以及
显示组合2D图像和3D切片图像中的一个或多个；
其中被显示的组合2D图像便于在二维中识别可能血管异常的位置，并且3D切片图像便于在三维中识别异常的位置以及在相应的切片图像中可视化异常的外观。
7.根据权利要求6所述的方法，其中所述显示包括同时显示组合2D图像和3D切片图像中的至少一个。
8.根据权利要求6所述的方法，其中所述显示包括相互配准地显示组合2D图像和3D切片图像中的至少一个。
9.根据权利要求6所述的方法，其中所述显示包括同时显示组合2D图像和多个3D切片图像。
10.一种患者的***的多模式x射线检查的方法，其包括：
获得表示患者的***的相应切片的3D切片图像，通过用重建算法计算机处理在成像x射线束相对于***的相应角度拍摄的***的多个x射线2D断层融合投影图像形成所述3D切片图像；
在***中存在造影剂的情况下获得***的低能2D x射线***摄影照片和高能2D x射线***摄影照片的2D组合图像；以及
在计算机显示器上同时显示2D组合图像和3D切片图像中的一个或多个；
其中被显示的组合2D图像便于在二维中识别可能血管异常的位置，并且3D切片图像便于在三维中识别异常的位置以及在相应的切片图像中可视化异常的外观
11.根据权利要求10所述的方法，其中所述2D断层融合投影图像是单能图像。
12.根据权利要求10所述的方法，其中所述组合2D图像是高能和低能图像的加权组合。
13.根据权利要求10所述的方法，其中所述2D投影图像是双能图像。
14.一种用于成像患者的***的***，其包括：
数据采集和计算机处理***，其配置成用x射线成像患者的***并且生成（i）患者的***的3D切片图像，其表示***的相应切片并且通过计算机处理患者的***的多个单能x射线2D断层融合投影图像被重建，（ii）低能x射线2D***摄影照片，以及（ii）***的高能x射线2D***摄影照片；
所述数据采集和计算机处理***还配置成组合所述2D低能***摄影照片和2D高能***摄影照片以形成突出显示***中的血管分布的组合2D图像；以及
计算机显示***，其配置成选择性地显示组合2D图像和3D切片图像中的一个或多个；
其中被显示的组合2D图像便于在二维中识别可能血管异常的位置，并且3D切片图像便于在三维中识别异常的位置以及在相应的切片图像中可视化异常的外观。
15.根据权利要求14所述的***，其中所述数据采集和计算机处理***还配置成通过选择所述3D切片图像的子集响应所述组合2D图像中的异常的识别，所述子集包括其中出现被识别异常的3D切片图像，并且所述显示***还配置成同时显示组合2D图像和3D切片图像的所述子集。
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| CN109171783A (zh) * | 2018-07-31 | 2019-01-11 | 山东大骋医疗科技有限公司 | 双能计算机x射线断层扫描装置 |
| CN113367709A (zh) * | 2020-02-25 | 2021-09-10 | 通用电气精准医疗有限责任公司 | 用于数字***造影成像的方法和*** |
| CN111904445A (zh) * | 2020-08-18 | 2020-11-10 | 深圳蓝韵医学影像有限公司 | 一种乳腺对比增强图像的获取及处理方法、装置 |
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| US11406332B2 (en) | 2022-08-09 |
| AU2012225398A1 (en) | 2013-09-26 |
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| AU2017202882A1 (en) | 2017-05-18 |
| CA2829349C (en) | 2021-02-09 |
| EP2684157B1 (en) | 2017-12-13 |
| JP6057922B2 (ja) | 2017-01-11 |
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