WO2015041312A1 - 血管内血流動態の画像処理方法及びシステム - Google Patents
血管内血流動態の画像処理方法及びシステム Download PDFInfo
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- WO2015041312A1 WO2015041312A1 PCT/JP2014/074801 JP2014074801W WO2015041312A1 WO 2015041312 A1 WO2015041312 A1 WO 2015041312A1 JP 2014074801 W JP2014074801 W JP 2014074801W WO 2015041312 A1 WO2015041312 A1 WO 2015041312A1
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Definitions
- the present invention relates to a method and system for imaging blood flow dynamics in blood vessels.
- CT Computer Tomography: computed tomography
- MRI Magnetic Resonance Imaging: nuclear magnetic resonance imaging
- a catheter The blood vessels are delineated by injecting a contrast agent from the patient, and the condition of the brain parenchyma, the movement of the blood vessels, and the blood flow are observed based on the images obtained by continuous imaging.
- Perfusion Imaging the blood flow (perfusion) of tissue capillaries or a functional vasculature equivalent thereto, some mark (tracer) on the blood flow on the artery side, and the tracer goes into the blood flow.
- An imaging method that observes passage through tissue which makes it possible to image tissue blood flow at the capillary level quantitatively or semi-quantitatively, and an image taken by such a method It is called a perfusion image.
- Perfusion imaging is an analysis of tissues (capillaries).
- the arrival time (AT: Arrival Time), time to maximum amplitude (TTP: Time To Peak), blood flow (BF: Blood Flow), blood volume (BV: Blood volume), mean transit time (MTT: Mean Transit Time), etc.
- AT Arrival Time
- TTP Time To Peak
- BF Blood Flow
- BV Blood volume
- MTT Mean Transit Time
- TDC Time Density Curve
- CT Perfusion The method of imaging using a CT apparatus is called CT Perfusion
- MRI Perfusion the method of imaging using an MRI apparatus.
- Perfusion images using CT and MRI are rapidly injected with a contrast agent as a tracer to highlight and capture blood vessels, and the same cross-sectional image is continuously taken, and individual pixels of the obtained tomographic image are obtained. It can be obtained by calculating and analyzing TDC representing concentration change over time.
- CT Perfusion and MRI Perfusion are both methods of analysis of tissue (capillaries).
- CT Perfusion has X-ray exposure and is a pathological condition in which blood brain barrier (Blood Brain Barrier) is abnormal
- blood brain barrier Blood Brain Barrier
- MRI Perfusion has the disadvantage that quantitative data can not be obtained because patients who have been operated on for implanting magnetic bodies in the body are out of indication and linearity between contrast agent concentration and signal intensity can not be guaranteed.
- CT Perfusion and MRI Perfusion can not be applied to patients who are allergic to contrast agents because they can not inject tracers intravenously.
- Xe CT ⁇ How to use Xe CT>
- Xe is diffused into brain tissue when Xe gas is inhaled and tomographic images are obtained sequentially with a CT apparatus, and tissue concentration (CT value) of CT image Take advantage of a slight rise.
- CT value tissue concentration
- TDC is calculated from the rise in CT value over time to image the blood flow state. Since Xe gas has excitatory action and anesthetic action and is difficult to use, it needs a closed circuit device to supply the gas, and consideration must also be given to X-ray exposure.
- RI drug is injected or inhaled into the peripheral vein by a method using radioisotope-containing drug (hereinafter referred to as RI drug) as a tracer, and SPECT device (Single Photon Emission Computed) of the distribution of RI drug in the body over time
- RI drug radioisotope-containing drug
- SPECT device Single Photon Emission Computed
- a catheter is guided to a target blood vessel from an artery such as the groin, elbow, wrist, etc., and a contrast agent is injected into the blood vessel and X-ray fluoroscopic imaging is performed to observe the travel of the blood vessel or the stenosis area.
- the procedure can be used to treat simultaneously.
- Images taken by digital subtraction angiography (DSA) can be observed with high contrast only for blood vessels injected with contrast agent.
- a blood flow state can be imaged by setting an ROI to a blood vessel to be evaluated of a captured DSA image and analyzing TDC of a blood vessel (contrast agent) present in the set ROI.
- Angiographic examination can easily determine the effect before and after endovascular surgery, but there is exposure to X-rays, and furthermore, patients who are allergic to contrast agents are not eligible for examination. Further, in order to directly insert a catheter into a blood vessel, the examination room and examination equipment are required to have a cleanliness level similar to that of the operating room. In addition, post-operative hemostasis requires absolute rest for several hours, and basically it is an examination that requires hospitalization.
- Diagnosis in vascular diseases is performed not only by imaging blood flow conditions, but also by quantifying blood flow conditions and blood flow quantitatively and qualitatively.
- the above information is calculated by analyzing the density change graph of the above-mentioned image with time, and using an ultrasonic Doppler wave using ultrasonic waves, and a blood flow measurement device by an electromagnetic blood flow meter (Electromagnetic Blood Flow Meter) There is a way.
- ⁇ Method using ultrasonic Doppler> Using color Doppler imaging of an ultrasonic examination apparatus, it is possible to color blood actors in a living body in real time and obtain a blood circulation state by superimposing on a two-dimensional tomographic image B mode image it can.
- the color Doppler method uses the fact that the frequency of the reflected sound wave changes due to the Doppler effect of ultrasonic waves, and determines whether the target object (blood) is approaching or away from the probe (probe). It is a technology to image Because the ultrasonic probe tip is large, it is impossible to evaluate small blood vessels, and blood flow measurement is impossible if the blood vessel diameter and the probe size are different, but it can be easily inspected anywhere and observation from multiple directions is possible. You can observe the results in real time.
- the type of information that can be acquired by the device to be used also determines the availability of the inspection and the measurement method. For example, in an electromagnetic blood flow meter, instantaneous blood flow, average blood flow, stroke volume, etc. can be measured, but the output data is numerical data (graph), and in intraoperative fluorescence angiography, it is visually Although AT and TTP images can be estimated, it is impossible to create blood flow evaluation images to which BV, BF, MTT data and their information are added. Therefore, it is necessary for the operator to appropriately select an instrument capable of obtaining information necessary for the evaluation after the operation even from the measurable data contents to evaluate the operation.
- Patent Document 1 discloses a method for evaluating the patency of a blood vessel that has undergone bypass graft surgery or the like using a fluorescence imaging agent that emits radiation of a specific wavelength.
- BV Boood Volume: blood volume
- BF Boood Flow: blood flow
- MTT Mean Transit Time: average transit time
- the image processing method for blood flow dynamics in blood vessels is an image output obtained by imaging a moving image with infrared light, with a part of a blood vessel into which a fixed amount of fluorescent contrast agent has been injected as an imaging target. It is characterized in that the shape of the luminance value time change curve is subjected to image analysis, and non-quantitative data of blood volume or blood flow is calculated based on the result of the image analysis.
- the blood flow volume is measured by the electromagnetic blood flow meter with a part of the blood vessel as a measurement target, and the determination of the blood volume or the blood flow volume based on the measurement result and the non-quantitative data. Calculate the data.
- an analysis image is generated from quantitative data of the blood volume or blood flow. Also, instead of the analysis image, an analysis moving image is generated.
- the fluorescent contrast agent is indocyanine green or fluorescein.
- a part of the blood vessel is imaged as a moving image by natural light, and an output image captured as a moving image by the natural light and an output image captured as a moving image as infrared light are fused.
- the image processing system for blood flow dynamics in a blood vessel comprises an infrared imaging device for imaging a part of a blood vessel into which a predetermined amount of fluorescent contrast agent has been injected as a moving image by infrared light, and imaging using the imaging device And analyzing the shape of the luminance value time change curve of the image output, and calculating non-quantitative data of blood volume or blood flow based on the result of the image analysis.
- the image analysis device includes an image analysis device that calculates quantitative data instead of non-quantitative data.
- the apparatus further comprises an analysis image generation device that generates an analysis image from the quantitative data of the blood volume or blood flow volume.
- a natural light imaging device for imaging a part of the blood vessel as a moving image by natural light, and an image for fusing an output image of the natural light imaging device and an analysis image generated from the analysis image generation device And a fusion device.
- the image processing method and system for blood flow dynamics in blood vessels make it possible to estimate information such as BV, BF, MTT, blood vessel wall thickness and the like.
- FIG. 5 is a flow diagram of a method that includes image fusion processing. It is a figure which shows the process sequence of an image fusion process.
- the system according to the present embodiment converts an infrared light imaging device 100 that picks up a blood vessel as a moving image with infrared light, and a video signal output from the infrared light imaging device 100 to obtain a moving image.
- a moving image conversion device 102 for creating a file an image analysis device 104 for analyzing a moving image file converted by the moving image conversion device 102, and calculating non-quantitative data of blood volume or blood flow based on the image analysis result,
- an analysis image generation device for generating an analysis image from quantitative data of blood volume or blood flow obtained by the analysis device.
- These devices may be provided, for example, inside one personal computer. Alternatively, they may be separate devices. Alternatively, some or all of the functions may be incorporated in the form of software in a personal computer, a measuring instrument, a display device, an analyzer, etc.
- FIG. 2 shows an example of the configuration of a system according to this embodiment.
- FIG. 2 an example of the configuration of the invention according to the present embodiment in micro-surgery (operation performed using a microscope) is described.
- the implementation procedure of the method according to the present embodiment is as follows.
- Indocyanine green is administered as a fluorescent contrast agent. Administration is by intravenous or transarterial routes. Example) Dilute 25 mg of indocyanine green to 10 ml and administer 2 ml once.
- fluorescent contrast agent indocyanine green (ICG: Indocyanin green), fluorescein (FITC: Fluorescein isothiocyanate), etc.
- ICG Indocyanin green
- FITC Fluorescein isothiocyanate
- the ICG polymerizes with .alpha.-lipopretein in blood to develop monochromatic fluorescence to infrared light. In the field of ophthalmology, this phenomenon is applied to fundus fluorescent angiography.
- FITC is a fluorescent dye and emits green light when it is exposed to ultraviolet light.
- any drug that emits light of a specific wavelength by irradiating light of a specific wavelength can be used appropriately.
- Imaging is performed by the infrared imaging device 100.
- the infrared imaging device 100 a general intraoperative microscope capable of infrared imaging can be used.
- the analog (composite) video signal picked up by the infrared light imaging device 100 is analog-digital converted of the video signal using the video capture device of the video conversion device 102.
- a digital video signal is captured as a moving image file on a local disk using a personal computer.
- the moving image file may be a general purpose moving image file such as MPEG or MOV.
- the image analysis device 104 analyzes the image output of the moving image pickup according to the following procedure.
- fluorescent angiography agents are used during surgery in parallel to measuring quantitative BF values using an electromagnetic blood flow meter for one specific blood vessel that appears in the intraoperative field of view before vascular surgery.
- the quantitative MTT data and the non-quantitative rBV and rBF data are calculated.
- one point (one pixel) of a blood vessel in an image is monitored. This makes it possible to obtain information on the change in luminance value of one point (one pixel) of the blood vessel.
- a target for obtaining information on change in luminance value may be one pixel, or information on an average value of luminance values of a plurality of pixels may be used.
- the quantitative analysis shown in FIG. 3 is performed on all pixels of the moving image. The analysis results are calculated in time (X axis) units. AT, TTP, and MTT can be obtained as quantitative image data.
- the analysis result is rBV and rBF, which are calculated from the integral value of the luminance value (Y axis), are obtained as non-quantitative image data.
- ROI While viewing moving image data of a fluorescent contrast agent as a guide image, an ROI is created at the same blood vessel position as the specific blood vessel position measured by the electromagnetic blood flow meter (FIG. 4).
- ROI statistical processing is performed on the rBF image.
- An average non-quantitative blood flow value calculated by ROI statistical processing is defined as rBF (ROI).
- a conversion factor value: Kbf that holds between eBF (ROI) and rBF (ROI) is calculated.
- eBF (ROI) Kbf * rBF (ROI)
- ROI creation is a region-of-interest creation process in which a region of interest on an image to be observed is surrounded by a two-dimensional closed curve.
- ROI statistics is image processing which calculates the average image value per unit pixel inside ROI shape.
- the output parameter image of the image analysis can be extracted from the shape of the luminance value time change curve obtained from the information of the change of the luminance value of one point of the blood vessel as shown in FIG.
- the relationship is as shown in.
- FIG. 1 An example of an analysis image before and after bypass surgery is shown in FIG.
- the AT is shortened (blood flow has become faster) and the dark part has increased in the central part of the image.
- the method according to the present embodiment it is possible to diagnose the condition of the blood vessel before or after the blood vessel surgery by measuring the quantitative BF value of the specific blood vessel using the electromagnetic blood flow meter, and in particular It can be provided in a form that is easy to visually recognize.
- the area under the curve is defined as non-quantitative rBV, and non-quantitative rBV image for each pixel is easily You can ask for it.
- the area centroid time when the AT time is defined as the origin zero [sec] is defined as the quantitative MTT.
- a quantitative MTT image for each pixel can also be easily obtained.
- Second Embodiment In the method of the second embodiment, the calculation method in the “quantitative analysis of moving image file” of the first embodiment is different, but other configuration of the system, other steps related to the method, and the like are the same as those of the first embodiment.
- perfusion image method First Moment method for CT Perfusion and MRI Perfusion, which are analysis methods for tissues (capillary blood vessels), is used to analyze blood vessels using intraoperative fluorescence angiography (using a microscope camera) data.
- the calculation method in the case of using in.
- Non-quantitative rBF can be converted to a quantitative value into a BF [ml / min] image by measuring the quantitative BF [ml / min] of a specific blood vessel position using an electromagnetic blood flow meter.
- BF [ml / min] Kbf * rBF: electromagnetic blood flow meter correction equation
- BF [ml / min] is the “flow per unit tissue” quantitative blood flow (Blood Flow).
- BF [ml / min] and BV [ml] can be directly calculated.
- tissue capillary blood
- BF [ml / min] and BV [ml] can be directly calculated.
- blood vessel analysis it can be expected that the concept of "flowing around unit tissue" is not appropriate.
- blood vessel analysis it is required to calculate BF [ml / min] and BV [ml] flowing through a single blood vessel.
- Quantitative MTT is a calculated amount that can be defined by the same concept in both tissue analysis and blood vessel analysis. The area under the curve is defined as r ⁇ .
- the rBF in FIG. 3 described above corresponds to r ⁇ .
- Non-quantitative rMFV can be converted to a quantitative value into an MFV [cm / sec] image by measuring the quantitative MFV [cm / sec] of a specific blood vessel position using an electromagnetic blood flow meter.
- MFV [cm / sec] Kbf * rMFV: electromagnetic blood flow meter correction formula
- MFV [cm / sec] is an average blood flow velocity “per unit space”.
- the space of the unit space is considered to indicate both blood vessels and tissues (capillaries).
- BF [ml / min] a method of calculating quantitative BF is considered.
- the following blood vessel diameter conversion formula holds between quantitative MFV and quantitative BF.
- BF [ml / min] S [mm * mm] * MFV [cm / sec]: Vessel diameter conversion formula
- S is defined as the inner blood vessel cross-sectional area at a certain blood vessel position.
- This blood vessel diameter conversion formula means that if the inner blood vessel cross-sectional area S can be measured at the position of each blood vessel, the quantitative BF can be calculated. It is an important fact that the inner vessel cross-sectional area S is not a single value.
- the thickness of the blood vessel differs for each blood vessel.
- the thickness of the blood vessel differs depending on the position of even one blood vessel when strictly considered. These differences mean that the inner vessel cross-sectional area S is strictly given by the image.
- the physical quantity obtained directly is non-quantitative rMFV.
- the method of the third embodiment differs from that of the second embodiment in the calculation formula of BF, but the system configuration, other steps relating to the method, and the like are the same as those of the first embodiment.
- the blood flow velocity (blood flow volume) at a certain blood vessel position is measured.
- the blood vessel diameter at this one blood vessel position; R [mm] can be measured.
- the inner blood vessel cross-sectional area: S is determined. In the first approximation, the inner vessel cross-sectional area: S approximates the same in the same single blood vessel measured by the electromagnetic blood flow meter.
- the perfusion image (First Moment method) blood vessel analysis method can be approximately calculated.
- Fourth Embodiment As a fourth embodiment, a method is described in which the same analysis as in the first to third embodiments can be performed by determining the operating conditions without performing the electromagnetic blood flow measurement.
- the fourth embodiment is the same as the first to third embodiments except that the operation condition is determined without performing the electromagnetic blood flow measurement.
- Quantitative BV and BF images can be approximately calculated by aligning the operating conditions without using an electromagnetic blood flow meter every operation.
- the operating conditions include the sensitivity of the microscope camera, the magnification of the microscope camera, the working distance of the microscope camera, the angle of the microscope camera, the dose of the fluorescent contrast agent (ICG, FITC), etc. is there.
- Working Distance is the distance from the tip of the objective lens of the microscope camera to the object in focus.
- Angle is the angle at which the microscope camera is looking at the subject.
- the dose of the fluorescent contrast agent refers to the amount of drug to be injected when injecting the fluorescent contrast agent (ICG, FITC) from the vein of the arm.
- the fluorescent contrast agent is diluted to facilitate injection. It means equalizing the condition of dilution and injecting the same amount of injection after dilution.
- the specific conditions for aligning the operating conditions may be determined for each institution such as a hospital, for example.
- the quantitative BV and BF images can be obtained by using the electromagnetic blood flow meter to calculate the quantitative BV and BF images and aligning the operation conditions without using the electromagnetic blood flow meter. It can be made approximate calculation possible. For this reason, there are specific effects such as the blood flow volume which the bypass graft can supply to the tissue, and the prediction of the patency of the bypass over a long period.
- the thickness information can provide information on the risk of surgical operations such as ease of rupture of the aneurysm and release of thrombus from the stenosis lesions.
- the ICG can see 10 mm deep from its fluorescence frequency.
- the blood vessel wall is about 0.1 to 10 mm, and the condition of the blood vessel wall is important at the time of surgery. Since the ICG brightness changes with the blood vessel wall thickness, the wall thickness can be estimated by keeping the dose, the microscope camera sensitivity, the distance to the object to be observed, and the magnification constant.
- FITC can see 5 mm deep from its fluorescence frequency. Observation of vascular lesions having relatively thin blood vessel walls, patency of bypass, etc. is possible.
- the purpose of this method is to know the blood vessel wall thickness from blood flow (BV) of blood vessel itself, blood volume (BF), mean transit time (MTT), and signal brightness, not brain tissue.
- BV blood flow
- BF blood volume
- MTT mean transit time
- signal brightness not brain tissue.
- Image fusion processing With the output parameter image data of the above-mentioned fluorescence contrast agent analysis results alone, the relationship between anatomic positions such as arteries, veins, and cerebral sulcus is unclear.
- the relationship of anatomic position can be grasped by performing image superposition processing (image fusion processing) of output parameter image data of a fluorescence contrast agent analysis result on anatomical image (moving image) data.
- Image fusion processing is an analysis method of tissue (capillary blood vessels), but requires an analysis method of blood vessels.
- the results of the above-described imaging of intravascular blood flow dynamics can be used.
- a system relating to an image processing method of blood flow dynamics in blood vessels including image fusion processing is configured as shown in FIG.
- the natural light imaging device 108 performs imaging as well as the imaging with the infrared light imaging device 100. Here, imaging with natural light is performed, and image or video data is recorded.
- a natural light imaging device 108 for imaging a part of a blood vessel as a moving image by natural light, an output image of the natural light imaging device 108 and an analysis (moving image) image generated from an analysis image (moving image) generation device 106.
- image (moving image) data of the following (A), (B) and (C) are used.
- (gray scale image) means a value type image (used mainly in MRI and CT for medical images) in which the display color is applied by referring to the gray scale color table.
- (Color scale image) is a meaning of a value type image (used mainly in nuclear medicine in medical images) to which a display color is applied by referring to a color table such as rainbow color.
- (Color image) means an image whose color is fixed as shown in a photograph.
- N pieces of moving image data mean an image consisting of N pieces of animation in the time axis direction.
- Still image data is the meaning of an image such as a single picture.
- the fluorescence contrast agent analysis according to the technique of the above embodiment 1 or 2 is a process of deriving (B) to (C).
- the important point is that (A) is not used in the processing of fluorescence contrast agent analysis only, (B) and (C) are in the same positional relationship to create a still image from (B) moving image . Since the image fusion processes of (B) and (C) are at the same position, the positional relationship is always the same.
- Whether (A) and (B) and (C) are in the same positional relationship depends on the device used. There are devices with the same position as the devices with different imaging positions of the natural light moving image and the infrared light moving image. Also, the number M of animations of natural light animations and the number N of animations of animations of fluorescent contrast agents are generally different. Further, it is different depending on the microscope device whether or not the timing at which the natural light moving image was captured and the timing at which the fluorescent contrast agent was captured were captured at the same time. It is not an essential condition of the image fusion process whether or not these are taken at the same time. In the above-described embodiment, the following three types of image fusion processing will be described.
- Image fusion processing I multiplication type image fusion processing: Peak still image data (gray scale image) calculated from moving image data of fluorescent contrast agent and
- C Output parameter still image data of image analysis (color scale image) Image fusion processing I to create image fusion still image data (color image) by image fusion processing. In this process, (one color image) is created from a combination of (one gray scale image) and (one color scale image).
- Image fusion processing II multiplication type image fusion processing: (B) Moving image data of fluorescent contrast agent (gray scale image) and (C) Output parameter of image analysis Still image data (color scale image) image fusion Image fusion processing II that processes and creates image fusion moving image data (color image).
- (N color images) are created from a combination of (N gray scale images) and (one color scale image).
- Image fusion processing III Natural light moving image and image fusion processing: Image fusion moving image data (color image) created by image fusion processing and (A) moving image data of natural light (color image) or (A) still light of natural light Image fusion processing III for creating image fusion moving image data (color image) by image fusion processing of image data (color image).
- (N color images) is created from a combination of (N color images) and (M or 1 color images).
- FIG. 13 shows an example of a processing procedure of image superposition processing (image fusion processing). This processing procedure performs image fusion processing II and image fusion processing III, and generates (N color images) from a combination of (N color images) and (M or 1 color images). It is shown.
- the image fusion processing I and the image fusion processing II perform the same multiplication type image fusion processing.
- the difference between image fusion processing I and image fusion processing II is that (I) (grayscale image) is one sheet, while (II) is (grayscale image) N sheets.
- (C) Output parameter of image analysis Still image data (color scale image) is one.
- the image fusion processing I performs multiplication type image fusion processing only once.
- Image fusion processing II is performed N times while changing the moving image data (gray scale image) of the fluorescent contrast agent.
- the image fusion process I is a still image
- the image fusion process II is a moving image.
- the advantage of multiplication-type image fusion processing is that the colors of both grayscale and color images can be reliably reproduced.
- the addition type image fusion processing can be calculated from the following basic equation.
- Color of color scale image 1 (Red1, Green1, Blue1)
- Color scale image 2 color (Red2, Green2, Blue2)
- Image fusion processing result image color (FusionRed, FusionGreen, FusionBlue) ⁇ : synthesis ratio is a value represented by a number between 0.0 and 1.0.
- FusionRed ⁇ * Red2 + (1.0- ⁇ ) * Red1
- the addition type image fusion processing equation is named as the addition type image fusion processing equation because the colors of the two images are added.
- the addition type image fusion processing is a method that can not reliably reproduce the colors (Red, Green, Blue) of the color scale image.
- the multiplication-type image fusion processing expression is named as a multiplication-type image fusion processing expression in order to multiply the colors of two images.
- the color (Red, Green, Blue) of the color scale image can be reliably reproduced by using the multiplication-type image fusion processing equation.
- the gray scale image is black
- the color scale image after fusion processing can always be black.
- the position where the gray scale image is white makes the color scale image after the fusion process the same as the color scale image color (Red, Green, Blue) of the original image.
- BF, BV, and MTT which could not be grasped conventionally by fluorescence contrast agent analysis, are stably grasped, and further, estimation of blood vessel wall thickness from signal luminance change, natural light and fusion (fusion) Provide anatomical orientation. Anatomical positional relationship can also be easily grasped by fusing the fluorescence contrast agent analysis result with the image captured under natural light.
- BV derived from brain function response
- BF change can also be detected.
- monochrome moving picture editing may be applicable not only to fluorescence contrast agent analysis but also to gray scale moving pictures such as ordinary angiography. It is possible to determine the therapeutic effect immediately after blood vessel surgery by quantitatively comparing the state before blood vessel surgery and the state after blood vessel surgery using quantitative BV, BF, and MTT images.
- the amount and timing of intravenous injection of the fluorescent contrast agent are important, and since the fluorescent contrast agent is metabolized by the liver, it also changes in the decay process of the brightness of the fluorescent contrast agent by the liver function.
- the influence of the shift can be minimized even if the timing of injection of the fluorescent contrast agent is shifted. For this reason, it is an analysis method effective for therapeutic effect determination.
- the method and system according to the present invention can be applied to neurosurgical surgery, orthopedic surgery, and vascular surgery in the field of ophthalmologic surgery where intraoperative microscopy is used, but is not particularly limited thereto, and various vascular surgery Can be applied to
- Reference Signs List 100 infrared light imaging device 102 moving image conversion device 104 image analysis device 106 analysis image (moving image) generation device 108 natural light imaging device 110 image (moving image) fusion device
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Abstract
Description
<CT装置、若しくはMRI装置を利用する方法>
CT装置を用いて撮影する方法をCT Perfusion、MRI装置を用いて撮影する方法をMRI Perfusionと呼ぶ。CT及びMRIを用いたパーフュージョンイメージは、血管を強調して撮影するために造影剤をトレーサとして急速静注し、同一断面画像を連続で撮影を行い、得られた断層画像の個々のピクセルの経時的な濃度変化を表すTDCを算出し、解析することで得られる。CT Perfusion及びMRI Perfusionは共に組織(毛細血管)の解析法である。
CT PerfusionはX線の被曝があり、血液脳関門(Blood Brain Barrier)に異常をみる病態で定量性を求める場合には特別の配慮が必要となるが、標準的なCT装置及び解析ソフトウェアがあれば簡単に測定することが可能である。一方、MRI Perfusionは体内に磁性体を埋め込む手術を行った患者は適応外で、造影剤濃度と信号強度の間の線形性が保証されないため、定量的データは得にくいという欠点がある。また、CT Perfusion、MRI Perfusionは共に造影剤にアレルギーを持った患者には、トレーサを静注することができないため、適応できない。
非放射性Xe(Xenon)ガスをトレーサとして利用する方法で、Xeガスを吸入しCT装置にて断層像を継時的に得るとXeが脳組織に拡散され、CT画像の組織濃度(CT値)が軽度上昇することを利用する。この継時的なCT値の上昇からTDCを算出し血流状態を画像化する。
Xeガスには興奮作用、麻酔作用があり利用しにくく、ガスを供給する閉鎖回路装置が必要で、X線被曝にも配慮が必要である。
放射性同位元素を含んだ薬品(以後RI薬品と呼ぶ)をトレーサとして利用する方法で、RI薬品を抹消静脈に注射若しくは吸入し、RI薬品の体内分布を継時的にSPECT装置(Single Photon Emission Computed Tomography)やPET装置(Positron Emission Tomography)を利用して体外から計測することでTDCを算出し、血流状態を画像化する撮影方法である。
PETを利用した検査は、現在利用可能なパーフュージョンイメージング法で最も定量性に優れており、酸素摂取率やエネルギー代謝率などを同時に測定できる利点がある。しかし、SPECT、PET撮影は共にRI薬品を扱うための核医学設備が必要で、検査による被曝も多い。
鼠径部、肘、手首などの動脈からカテーテルを目的血管に誘導し、造影剤を血管内に注入してX線透視撮影することで、血管の走行や狭窄部位などを観察する方法であり、この手法を用いて治療を同時に行うことができる。デジタル・サブトラクション・アンギオグラフィー法(DSA)で撮影され、造影剤が注入された血管のみを高いコントラストで観察可能となる。撮影されたDSA画像の評価したい血管にROIを設定し、設定されたROI内に存在する血管(造影剤)のTDCを解析することで、血流状態を画像化することができる。
血管造影検査は、血管内手術前後の効果判定を簡単に行うことができるが、X線による被曝があり、さらに、造影剤にアレルギーを持った患者は、検査適応外となる。また、血管内にカテーテルを直接挿入するため、検査室及び検査機器には手術室に準ずる清潔度が要求される。また、術後は止血のため数時間は絶対安静が必要で、基本的には入院が必要な検査である。
超音波検査装置のカラードップラー法(Color Doppler Imaging)を利用すると、リアルタイムに生体内の血行動体に色を付け、2次元断層画像であるBモード画像上に重ね合わせて血行状態を得ることができる。カラードップラー法は、超音波のドップラー効果により、反射した音波の周波数が変化することを利用し、目的の物体(血液)が探触子(プローブ)に近づいているのか、遠ざかっているのかを判定し画像化する技術である。
超音波プローブチップは大きいため小さな血管の評価はできず、血流計測も血管径とプローブサイズが異なると不可能であるが、場所を選ばず簡単に検査ができ、多方向からの観察が可能で、リアルタイムに結果を観察することができる。
磁界中で導体が動くと起電力が発生するフレミングの法則に基づくもので、血流を電流と見なし、血流と磁界の両方の直角方向に起電力が発生することを利用して、瞬時血流量、平均血流量、一回拍出量などを測定する。
電磁血流計を利用した方法は、手術中の血流量計測に用いられ、リアルタイムな計測結果を測定することができる。しかし電磁血流計は、プローブを直接血管に装着する必要があり、目的血管を露出させないと計測ができない。
<術中蛍光血管撮影法を利用した方法>
トレーサとして静脈内投与された蛍光血管造影剤から励起される近赤外領域の蛍光を、手術用顕微鏡の近赤外領域光下でビデオ撮影することで血流を評価する方法である。
血管内の蛍光血管造影剤の状態(血流の有無)を把握することはできるが、血流状態、血流量など詳細に信号変化を解析することは不可能である。撮影には目的血管を手術用顕微鏡装置の近赤外光下でビデオ撮影する必要があるが、術中に血流状態をリアルタイムに確認することが可能である。
本発明では、術中顕微鏡で撮影される蛍光造影剤の動画データに関する解析技術が提供され、BV、BF、MTTなどの情報を推定可能なパーフュージョン(Perfusion)解析方法を蛍光造影剤解析へ応用する事で、蛍光造影剤解析でも、BV、BF、MTTなどの情報、血管壁厚などを推定することを可能とする方法およびシステムを提供することを課題とする。
なお、本発明は以下の実施形態に限定されるものではないことは自明である。
AT: Arrival Time 到達時間 [sec]
TTP: Time To Peak 最大振幅までの時間 [sec]
MTT: Mean Transit Time 平均通過時間 [sec]
MFV: Mean Flow Velocity 定量血流速度 [cm/sec]
BV: Blood Volume 定量血液量 [ml]
BF: Blood Flow 定量血流量 [ml/min]
rMFV: relative Mean Flow Velocity 非定量血流速度
rBV: relative Blood Volume 非定量血液量
rBF: relative Blood Flow 非定量血流量
eBF: 電磁血流計を用いて計測した定量血流量 [ml/min]
Peak: 最大振幅画像
Kbf: 定量化換算係数
S: 血管断面積(内側) [mm*mm]
Fusion: 画像重ね合わせ
ROI: Region of Interest 関心領域
ICG: Indocyanin green インドシアニングリーン
FITC: Fluorescein isothiocyanate フルオレセイン
なお本実施形態において、画像出力とは、画像、動画、あるいは動画のコマから抽出された画像による出力を意味する。
まず、第1実施形態に係る血管内血流動態の画像処理のシステムの構成について説明する。本実施形態に係るシステムは、図1に示すように、血管を赤外光により動画として撮像する赤外光撮像装置100と、赤外光撮像装置100から出力されるビデオ信号を変換して動画ファイルを作成する動画変換装置102と、動画変換装置102によって変換された動画ファイルを解析し、該画像解析結果に基づいて血液量又は血流量の非定量データを算出する画像解析装置104と、画像解析装置104で得られた血液量又は血流量の定量データから解析画像を生成する解析画像生成装置106とを備える。
蛍光造影剤としてインドシアニングリーンを投与する。経静脈、または経動脈経路で投与を行う。例)インドシアニングリーン25mgを10mlに希釈して一回2ml投与する。
上記の蛍光造影剤以外にも、たとえば、特定の波長の光を照射することにより、特定の波長の光を放出するような薬剤であれば適宜用いることができる。
電磁血流計(Electromagnetic Blood Flow Meter)を用いてある1つの特定の血管位置の定量血流値を計測する。この定量計測値をeBF(ROI)と定義する。実際の電磁血流計を用いた計測操作はバイパスグラフトを含む血管構造を電磁血流計プローブで挟んで行う。
赤外光撮像装置100で撮像を行う。赤外光撮像装置100としては、赤外光撮影が可能な一般的な手術中顕微鏡を用いることができる。
赤外光撮像装置100で撮像したアナログ(コンポジット)ビデオ信号を動画変換装置102のビデオキャプチャー装置を用いてビデオ信号のアナログ-デジタル変換する。デジタルビデオ信号はパソコンを用いてローカルディスクに動画ファイルとして取り込む。動画ファイルは、MPEGやMOVなどの汎用動画ファイルであってよい。
画像解析装置104においては、以下の手順により、動画撮像した画像出力の解析を行う。
輝度値時間変化曲線を解析する事で、ICG薬剤が塊で血管を通過する状態を定量分析可能である。図3に示す定量解析を動画画像の全ピクセルで実行する。解析結果が時間(X軸)単位で算出されるAT、TTP、MTTは定量画像データとして求まる。解析結果が輝度値(Y軸)の積分値から算出されるrBV、rBFは非定量画像データとして求まる。
eBF(ROI) = Kbf * rBF(ROI)
eBF(ROI) = Kbf * rBF(ROI)
は、画像空間全***置に対しても成り立つ定量化換算式であると仮定する。
すなわち、下記式のように、Perfusion解析のFirst Moment法計算処理から算出した非定量rBF画像全体に乗じる事で定量BFへ変換することができる。
BF = Kbf * rBF
rBF = rBF / MTT、BF = BV / MTT
と、非定量rBF画像を定量BF画像へ変換する定量化換算式
BF = Kbf * rBF
が成立する事から、下記のような非定量rBV画像を定量BV画像へ変換する定量化換算式が成り立つ。
BV = Kbf * rBV
rBF = rBV / MTT : 非定量関係式
BF = BV / MTT : 定量関係式
eBF(ROI) = Kbf * rBF(ROI) : 特定の血管位置(ROI)で成立する定量化換算式
BF = Kbf * rBF : 画像全体で成立するrBFとBFの間の定量化換算式
BV = Kbf * rBV : 画像全体で成立するrBVとBVの間の定量化換算式
第2実施形態の方法では、第1実施形態の「動画ファイルの定量解析」における計算手法が異なるが、システムの構成、方法に係る他のステップなどは第1実施形態と同様である。
rBF = rBV / MTT
BF[ml/min] = Kbf * rBF : 電磁血流計補正式
ここでBF[ml/min]は「単位組織あたりを流れる」定量血流量(Blood Flow)である。
rMFV = rβ / MTT
関係式が成立している。この実施形態では、前述した図3のrBFがrβに相当する。
MFV[cm/sec] = Kbf * rMFV : 電磁血流計補正式
血管解析法の血管径換算式を考える。最終的に算出したい定量値はBF[ml/min]であるため定量BFを算出する方法を考える。定量MFVと定量BFの間には次の血管径換算式が成立する。
BF[ml/min] = S[mm*mm] * MFV[cm/sec] : 血管径換算式
また、図8に示すように、Sは、ある血管位置での内側血管断面積と定義する。
第3実施形態の方法では、第2実施形態とはBFの算出式が異なるが、システムの構成、方法に係る他のステップなどは第1実施形態と同様である。
第4実施形態として、電磁血流計測定を行わずとも、手術条件を定めることにより、第1から第3実施形態と同様の解析を行うことができる方法について説明する。第4実施形態においては、電磁血流計測定を行わずに手術条件を定めること以外は、上記第1から第3実施形態と同様である。
蛍光造影剤の投与量とは、蛍光造影剤(ICG、FITC)を腕の静脈から注射するときの、注射する薬の量の事である。一般的には、蛍光造影剤を注射しやすいように希釈する。希釈の状態を同じくする事と希釈後の注射薬を同じ量だけ注射する事を意味する。なお手術条件をそろえるための具体的な条件は、例えば病院などの機関ごとに決定されても良い。
脳動脈瘤、頚動脈狭窄病変においては、その厚さ情報は動脈瘤の破れやすさ、狭窄病変からの血栓遊離など手術操作に関わるリスクへの情報を提供できる。
ICGはその蛍光周波数から10mmの深部を透見することができる。血管壁は0.1-10mm程度であり、手術の際にはその血管壁の性状が重要である。ICG輝度は血管壁厚により変化するため、投与量、顕微鏡カメラ感度、観察する対象物までの距離、倍率を一定に保つことで壁厚を推定することができる。
上記の蛍光造影剤解析結果の出力パラメータ画像データのみでは、動脈・静脈、脳溝などの解剖学的位置の関係は不明瞭である。解剖学的画像(動画)データの上に蛍光造影剤解析結果の出力パラメータ画像データを画像重ね合わせ処理(画像フュージョン処理)することで、解剖学的位置の関係を把握することできる。
(A)自然光のM枚動画データ(カラー画像)
(B)蛍光造影剤のN枚動画データ(グレースケール画像)
(C)解析結果の静止画データ(カラースケール画像)[BF、BV、MTTなどの複数のデータを含むものがある]。
(カラースケール画像)とは、レインボーカラー等のカラーテーブルを参照する事で表示色を当てはめるバリュータイプ画像(主に医療画像では核医学で利用)の意味である。
(カラー画像)とは写真のようにカラー色が固定されている画像の意味である。
本実施形態では、次の3種類の画像フュージョン処理を説明する。
この処理では、(1枚のグレースケール画像)と(1枚のカラースケール画像)の組み合わせから(1枚のカラー画像)を作成する。
この処理では、(N枚のグレースケール画像)と(1枚のカラースケール画像)の組み合わせから(N枚のカラー画像)を作成する。
この処理では、(N枚のカラー画像)と(M枚または1枚のカラー画像)の組み合わせから(N枚のカラー画像)を作成する。
画像フュージョン処理Iは掛け算型の画像フュージョン処理を1回だけ行っている。画像フュージョン処理IIは蛍光造影剤の動画データ(グレースケール画像)を変えながらN回分処理する。画像フュージョン処理の結果画像では画像フュージョン処理Iは静止画となり、画像フュージョン処理IIは動画となる。
カラースケール画像1の色=(Red1、Green1、Blue1)
カラースケール画像2の色=(Red2、Green2、Blue2)
画像フュージョン処理結果画像の色=(FusionRed、FusionGreen、FusionBlue)
α:合成比率は、0.0~1.0の間の数字で表される値である。
FusionRed = α*Red2 + (1.0-α)*Red1
FusionGreen = α*Green2 + (1.0-α)*Green1
FusionBlue = α*Blue2 + (1.0-α)*Blue1
足し算型の画像フュージョン処理式は、2つの画像の色を足しているため、足し算型の画像フュージョン処理式と名付けた。
カラースケール画像1の色=(Red1、Green1、Blue1)を
グレースケール画像の色=(Gray、Gray、Gray)へ置き換える。
カラースケール画像2の色=(Red2、Green2、Blue2)を
カラースケール画像の色=(Red、Green、Blue)へ置き換える。
FusionRed = α*Red + (1.0-α)*Gray
FusionGreen = α*Green + (1.0-α)*Gray
FusionBlue = α*Blue + (1.0-α)*Gray
足し算型の画像フュージョン処理式では、カラースケール画像の色(Red、Green、Blue)を再現出来ていない事が解る。
102 動画変換装置
104 画像解析装置
106 解析画像(動画)生成装置
108 自然光撮像装置
110 画像(動画)融合装置
Claims (12)
- 一定量の蛍光造影剤が注入された血管の一部を撮像対象として、赤外光により動画撮像をし、
該動画撮像した画像出力の輝度値時間変化曲線の形状を画像解析し、
該画像解析の結果に基づいて、血液量又は血流量の非定量データを算出することを特徴とする血管内血流動態の画像処理方法。 - 前記非定量データに代えて、前記血液量又は血流量の定量データを算出することを特徴とする請求項1に記載の血管内血流動態の画像処理方法。
- 前記血管の一部を測定対象として、電磁血流量計により血流量を測定し、
この測定結果と前記非定量データとに基づいて、血液量又は血流量の定量データを算出することを特徴とする請求項1に記載の血管内血流動態の画像処理方法。 - 前記血液量又は血流量の定量データから解析画像を生成することを特徴とする請求項1ないし3のいずれかに記載の血管内血流動態の画像処理方法。
- 前記解析画像に代えて、解析動画を生成することを特徴とする請求項4に記載の血管内血流動態の画像処理方法。
- 前記血管の一部を自然光により動画撮像し、該自然光により動画撮像した出力画像と前記解析画像とを融合させることを特徴とする請求項1ないし4のいずれかに記載の血管内血流動態の画像処理方法。
- 前記蛍光造影剤がインドシアニングリーンである請求項1ないし6のいずれかに記載の血管内血流動態の画像処理方法。
- 前記蛍光造影剤がフルオレセインである請求項1ないし7のいずれかに記載の血管内血流動態の画像処理方法。
- 一定量の蛍光造影剤が注入された血管の一部を赤外光により動画として撮像する赤外光撮像装置と、
該撮像装置により撮像された画像出力の輝度値時間変化曲線の形状を画像解析し、該画像解析の結果に基づいて血液量又は血流量の非定量データを算出する画像解析装置と、を備えることを特徴とする血管内血流動態の画像処理システム。 - 前記画像解析装置において、非定量データに代えて、定量データを算出する画像解析装置を備えることを特徴とする請求項9に記載の血管内血流動態の画像処理システム。
- 前記血液量又は血流量の定量データから解析画像を生成する解析画像生成装置をさらに備えることを特徴とする請求項10に記載の血管内血流動態の画像処理システム。
- 前記血管の一部を自然光により動画として撮像する自然光撮像装置と、
該自然光撮像装置の出力画像と前記解析画像生成装置から生成された解析画像とを融合させる画像融合装置と、を備えることを特徴とする請求項11に記載の血管内血流動態の画像処理システム。
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US20210106237A1 (en) | 2021-04-15 |
JPWO2015041312A1 (ja) | 2017-03-02 |
US10898088B2 (en) | 2021-01-26 |
EP3047796A4 (en) | 2017-05-31 |
JP5953437B2 (ja) | 2016-07-20 |
EP3047796A1 (en) | 2016-07-27 |
EP3047796B1 (en) | 2020-11-04 |
CN105705084A (zh) | 2016-06-22 |
US20160262638A1 (en) | 2016-09-15 |
CN105705084B (zh) | 2019-07-12 |
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