Patent Application
20250000438
The present invention relates to an information processing machine for use in diagnosis of epilepsy.
In medical operations for refractory epilepsy (epilepsy where there is no mitigation of seizures and symptoms observed by using medicines), for example, such medical operations have been performed where a part of brain tissue is surgically cut. Various methods have been used to identify a site to be cut, but each method has its own challenges. For example, an electrode has been applied onto a scalp to measure brain waves. Although measuring brain waves as described above is not invasive, and is possible to implement in many facilities, spatial resolution and time resolution are low, and it may not be possible to correctly identify a site that should be cut.
Furthermore, for example, a subdural electrode has been applied and an electrode for depth electroencephalogram has been inserted after performing a craniotomy to measure brain waves. Measuring brain waves as described above is highly invasive, while spatial resolution and time resolution are high, and such intracranial electrodes as described above may result in disease complications. Furthermore, there have been other issues such as it is impossible to place such intracranial electrodes as described above for a long period of time depending on a state of a brain surface and there is only a small number of special medical doctors for neurosurgical operations, resulting in a limited number of facilities in which it is possible to implement such operations.
In recent years, such a technique has been disclosed that provides an electrode in a blood vessel and causes the electrode to sense, in the blood vessel, electrical activity in a part of nerve tissue. Patent Document 1 discloses a technique that causes a stent provided with an electrode to expand in a brain blood vessel, to be put in place on a wall of the blood vessel, and to sense electrical activity in a nearby part of nerve tissue.
Note herein that there is an issue of, to identify a focal point of epilepsy and detect a seizure of epilepsy, how to select a position in a blood vessel for receiving a signal pertaining to an identified part of brain tissue.
In view of the situations described above, an object of the present invention is to provide a technique for properly sensing electrical activity in the brain tissue in diagnosing epilepsy.
To achieve the object described above, an aspect of the present invention is directed to an information processing machine for use in diagnosis of epilepsy, including: a receiving unit that receives identification of a first site that is a target from which an electric signal is to be detected in brain tissue in a subject;
According to the present invention, it is possible to provide a technique for properly sensing electrical activity in the brain tissue in diagnosing epilepsy.
An embodiment will now be described herein with reference to the accompanying drawings.
In the example illustrated in
The brain tissue image BI is, for example, an image of the brain tissue, which is acquired by using magnetic resonance imaging (MRI). Specifically, the brain tissue image BI is an image acquired by utilizing a nuclear magnetic resonance phenomenon to capture tomographic images of the brain tissue, and is tomographic images or a three-dimensional image based on the tomographic images. It is possible, with the brain tissue image BI, to view a target, which is the brain tissue, at various angles. A medical doctor DC is able to understand, with the brain tissue image BI, a shape and a dimension of the brain tissue and a state of the brain tissue (for example, whether or not there is a tumor), for example.
The blood vessel image VI is, for example, a magnetic resonance image (MRA) of blood vessels, which is acquired by using the MRI described above. It is possible, with the blood vessel image VI, to view a target, which is a blood vessel (a blood stream), at various angles. The medical doctor DC is able to understand, with the blood vessel image VI, blood streams in the head, thicknesses of the blood vessels, and states of the blood vessels (for example, whether or not there is a tumor), for example.
The server 1 causes a terminal 2 (a display unit of the terminal 2 and a predetermined display unit) that the medical doctor DC possesses to display the acquired brain tissue image BI and the acquired blood vessel image VI. In the present embodiment, the server 1 performs two types of display in accordance with a setting of a position identification mode (a predetermined mode). For example, the server 1 causes, when the position identification mode is ON, the terminal 2 to display a brain tissue image BI and a blood vessel image VI in parallel to each other. At this time, the server 1 receives identification of a site (hereinafter referred to as a first site DP.) that is a target from which an electric signal is to be detected in the brain tissue. Then, the server 1 identifies a site corresponding to the first site DP described above, that is, a site (hereinafter referred to as a second site CP.) that is suitable for a device to be disposed in the blood vessel, among the blood vessels, to detect an electric signal from the first site DP described above. Furthermore, the server 1 causes the terminal 2 to display the identified second site CP. Furthermore, for example, the server 1 associates, when the position identification mode is OFF, the brain tissue image BI and the blood vessel image VI with each other. Then, the server 1 causes the terminal 2 to display the brain tissue image BI and the blood vessel image VI in an overlapped manner (in a synthesized manner), as a synthesized image FI (a third image). A method for associating a brain tissue image BI and a blood vessel image VI with each other will be described later.
The medical doctor DC refers to the brain tissue image BI and the blood vessel image VI or the synthesized image FI displayed on the terminal 2 to confirm a position (a position in the blood vessel) in which an intravascular device (not illustrated, an epilepsy diagnosis device) is to be disposed. Then, the medical doctor DC delivers the intravascular device into the brain blood vessel in the patient PT in a state where the device is interpolated in a catheter used for a medical operation in the brain blood vessel. At this time, the medical doctor DC causes, as illustrated in
The intravascular device is inserted into a brain blood vessel via a catheter used for a medical operation in the brain blood vessel. The intravascular device is disposed in a blood vessel in an organism, and includes at least one electrode for detecting activity in a part of the biological tissue, which is positioned near and outside the blood vessel. The intravascular device is fixed at a predetermined position in a blood vessel to make it possible to stably measure brain waves. Furthermore, since the intravascular device is inserted into an extremely thin blood vessel, identification of a position of placement in the tissue is important in medical practices.
In the intravascular device, the electrode may be provided to a wire member, offering, in this case, a smaller dilation force, compared with that of a stent, superior ease of sliding with respect to a catheter, higher ease of bending, and superior ease of delivery into a brain blood vessel having a smaller diameter. Furthermore, the wire member is preferable in terms of that, since contact with a blood vessel is suppressed (in particular, a wire member having a bar shape in a natural state rarely comes into contact with a wall of a blood vessel), an adverse event rarely occurs even when placed for a long period of time. Therefore, it is preferable that it be placed in a blood vessel for a day or longer. The intravascular device includes a core body and an insulating body. More specifically, an outer periphery of the core body may be covered with the insulating body. As the core body, an extremely thin wire made of stainless-steel or nickel-titanium alloy may be used, for example, and an example of the extremely thin wire serving as the core body may be one having a diameter ranging from approximately 0.1 mm to approximately 1 mm, for example. An example of the insulating body may be a piece of polyimide tube or a piece of PTFE tube, for example. Note that, although the insulating body itself has a cylindrical body, it is internally filled with the core body, making it possible to regard the intravascular device as a wire member.
Furthermore, the intravascular device may include an intravascular electrode and an intravascular spare electrode, which are provided to an identical wire member but are slightly separated away from each other. Note that, the present invention is not limited to the examples, and a number of electrodes provided to one intravascular device may be one or plural such as three. By using such a thin intravascular device with no dilation force as described above, the intravascular device is easily delivered to a position near a first site even in a periphery portion of a blood vessel. In other words, since the intravascular device of this type offers a high degree of freedom in installation at a site in a blood vessel, it is not necessary to perform a delivery operation while a second site is understood. This feature is in contrast to that of a stent type intravascular device, whose intrinsic size and dilation force naturally constrain installation at a site in a blood vessel.
Note that the intravascular device may have a portion including an X-ray impermeable member (for example, one made of platinum). In this case, similar to a case when using an angio image AI (a fourth image) as described above, for example, it is possible to understand in a real-time manner a position of the intravascular device in a blood vessel. The server 1 acquires information of a potential acquired from the intravascular electrode (the intravascular device, via the terminal 2), and computes a result of measurement of brain waves (brain wave analysis).
The medical doctor DC identifies a site that should be cut (for example, a tumor) based on the result of measurement of brain waves. Then, the medical doctor DC performs a surgical operation of cutting an identified part of the brain tissue. The image display and the brain wave analysis will now be described herein in detail.
The server 1 cooperates with the terminal 2 and the image acquisition machine IM in operation to execute various types of processing. The terminal 2 may display a clinical record of the patient PT.
The CPU 11 executes various types of processing in accordance with programs recorded in the ROM 12 or programs loaded from the storage unit 18 to the RAM 13. The RAM 13 appropriately stores, for example, data necessary for the CPU 11 when executing various types of processing. The CPU 11, the ROM 12, and the RAM 13 are coupled to each other via the bus 14. The bus 14 is further coupled to the input-and-output interface 15.
The input-and-output interface 15 is coupled to the output unit 16, the input unit 17, the storage unit 18, the communication unit 19, and the drive 20. The output unit 16 includes a display and a loud-speaker to output various types of information in the form of image and audio, for example. The input unit 17 includes a keyboard and a mouse to accept various types of information, for example. The storage unit 18 includes a hard disk and a dynamic random access memory (DRAM) to store various types of data, for example. The communication unit 19 performs communication with other machines via the network N including the Internet.
The drive 20 is appropriately attached with a removable medium 21 such as a magnetic disk, an optical disk, a magnetic optical disk, or a semiconductor memory. A program read from the removable medium 21 by the drive 20 is installed into the storage unit 18 as required. Furthermore, the removable medium 21 is able to store various types of data stored in the storage unit 18, similar to the storage unit 18.
Note that, although not illustrated, the terminal 2 has a hardware configuration illustrated in
When the CPU 11 in the server 1 operates, an image acquisition unit 31, an identification receiving unit 32, a position identification unit 33, an association unit 34, a brain wave acquisition unit 35, a brain wave analysis unit 36, and a display control unit 37 function. Furthermore, the storage unit 18 in the server 1 is provided with an image database (DB) 41 and a brain wave information DB 42.
The image acquisition unit 31 acquires a brain tissue image BI and a blood vessel image VI pertaining to the patient PT, which are acquired by the image acquisition machine IM. Information of various types of images acquired by the image acquisition unit 31 is stored in the image DB 41.
The identification receiving unit 32 (a receiving unit) receives, from the medical doctor DC, identification of a first site DP on the brain tissue image BI. In the present embodiment, the identification receiving unit 32 receives identification of a first site DP, which is provided by the medical doctor DC, in a state where the terminal 2 is displaying the brain tissue image BI. It is possible to regard the first site DP as a portion in the brain tissue (for example, a temporal lobe, a hippocampus, an amygdaloid nucleus, or a cortical node), which the medical doctor DC desires to measure brain waves. Note that a method for identifying a first site DP is not particularly limited, and, for example, the identification receiving unit 32 may receive, instead of an image, selection of a portion in the brain tissue from the medical doctor DC to receive identification of a first site DP. In this case, the storage unit 18 may be prepared beforehand with an association table (
The position identification unit 33 (an identification unit) identifies a second site CP corresponding to the first site DP described above on the blood vessel image VI. Note herein that a first site DP is a site in the brain tissue, and a second site CP is a site corresponding to the first site DP in a blood vessel (a stream). It is desirable that a second site CP be a site in a blood stream, which lies at a shortest distance (for example, an Euclidean distance) to the first site DP in the brain tissue. A reason of this is that it makes it possible to further accurately acquire, at the second site CP in the blood vessel, brain waves generated at the first site DP. Note that an identification method is not particularly limited, and it is possible to apply one of various types of methods. For example, the position identification unit 33 may use the association table described above to identify a second site CP corresponding to a first site DP. Furthermore, when a brain tissue image BI and a blood vessel image VI are three-dimensional images, for example, the position identification unit 33 may perform matching in positional relationship between the brain tissue image BI and the blood vessel image VI based on their positions of centers of gravity and cross-sectional directions, respectively, to identify a second site CP corresponding to a first site DP described above. Furthermore, when a synthesized image FI has been manually synthesized by the medical doctor DC, for example, the synthesized image FI may be used to identify a second site CP corresponding to a first site DP described above.
Note that the position identification unit 33 may identify a second site CP based on information about the intravascular device (the device). Examples of the information about the intravascular device include information regarding ease of delivery of the intravascular device into a blood vessel and information regarding a size and/or dilation force of the intravascular device. For example, when a wire is used, information about the intravascular device (wire information) includes its effective length and its diameter (when released) and a diameter of a catheter suitable for combined use (interpolation). For example, the position identification unit 33 acquires a position at which it is possible to dispose the intravascular device in accordance with the ease of delivery into a blood vessel, the size, and the dilation force of the intravascular device. Specifically, the position identification unit 33 acquires a position or a region in a blood vessel (for example, a blood vessel that is greater in blood vessel diameter than a superior sagittal sinus), at which it is possible to dispose the intravascular device, in accordance with the size of the intravascular device, for example. Then, the position identification unit 33 identifies, as a second site CP, a site in a blood stream in the blood vessel, which lies at a shortest distance to the first site DP, and at which it is possible to make the disposition. Note herein that the ease of delivery into a blood vessel is an index indicating ease of sliding with respect to a catheter. The higher the ease of sliding, the superior the ease of delivery into a blood vessel. Furthermore, the ease of expansion is an index indicating dilation force of a blood vessel. By causing an intravascular device provided with an electrode to expand in a brain blood vessel and to be put in place on a wall of the blood vessel to sense electrical activity in a nearby part of nerve tissue, it is necessary that, when the intravascular device being used has higher ease of expansion, for example, a diameter of a blood vessel, in which the intravascular device is to be put in place, must be greater (thicker) to some extent. Note that a method for acquiring information about an intravascular device is not particularly limited, and, for example, information about an intravascular device may be received by a non-illustrated receiving unit (a device receiving unit) or acquired from a DB stored in the storage unit 18 beforehand.
The association unit 34 associates the brain tissue image BI and the blood vessel image VI with each other. For example, when a brain tissue image BI and a blood vessel image VI are three-dimensional images, the association unit 34 may associate the brain tissue image BI and the blood vessel image VI with each other in positional relationship based on their positions of centers of gravity and cross-sectional directions, respectively. Note that the association unit 34 may associate a brain tissue image BI and a blood vessel image VI with each other to generate a synthesized image FI.
The brain wave acquisition unit 35 acquires brain waves from the intravascular device inserted into the brain blood vessel in the patient PT by the medical doctor DC.
Specifically, the brain wave acquisition unit 35 acquires information about a potential acquired from the intravascular electrode in the intravascular device. The acquired brain waves are stored in the brain wave information DB 42.
The brain wave analysis unit 36 analyzes the brain waves acquired by the brain wave acquisition unit 35. For example, the brain wave analysis unit 36 applies Fourier transformation on the brain waves described above to generate information for use by the medical doctor DC for performing diagnosis.
The display control unit 37 (a display control unit) causes the terminal 2 to display various types of information. For example, the display control unit 37 causes the terminal 2 to display a brain tissue image BI and a blood vessel image VI. Then, the display control unit 37 causes the terminal 2 to display items indicating a first site DP on the brain tissue image BI and a second site CP on the blood vessel image VI. Note herein that the items are icons such as dots and frames indicating the first site DP and the second site CP. Note that the display control unit 37 may cause the terminal 2 to not display a brain tissue image BI (a first image), but to display a blood vessel image VI (a second image) and an item indicating a second site CP. Furthermore, for example, the display control unit 37 causes the terminal 2 to display, as the brain wave analysis unit 36 has performed analysis, a result of the analysis.
In step S1, the image acquisition unit 31 acquires and stores, in the image DB 41, a brain tissue image BI acquired by the image acquisition machine IM. The brain tissue image BI is, for example, an image of the brain tissue, which is acquired by using MRI.
In step S2, the image acquisition unit 31 acquires and stores, in the image DB 41, a blood vessel image VI acquired by the image acquisition machine IM. The blood vessel image VI is, for example, a magnetic resonance image (MRA) of the blood vessels, which is acquired by using the MRI described above.
In step S3, the identification receiving unit 32 receives identification of a first site DP on the brain tissue image BI. For example, the identification receiving unit 32 receives identification of a first site DP as the medical doctor DC selects a part on the brain tissue image BI or selects a partial portion in the brain tissue.
In step S4, the position identification unit 33 identifies, as described above, a position of a second site CP on the blood vessel image VI, which corresponds to the first site DP on the brain tissue image BI, which is identified in step S4.
The position identification unit 33 uses the association table illustrated in
In step S5, the display control unit 37 causes the terminal 2 to display the brain tissue image BI and the blood vessel image VI in parallel to each other. It is to be noted that, in the present embodiment, providing parallel display includes displaying a brain tissue image BI and a blood vessel image VI on a single display unit in a non-overlapped manner or on a plurality of display units in a separated manner and displaying a brain tissue image BI and a blood vessel image VI on a display unit in a partially or fully overlapped manner. An example of displaying a brain tissue image BI and a blood vessel image VI in a partially overlapped manner may be displaying the blood vessel image VI that has been shrunk at an end of the brain tissue image BI. An example of displaying a brain tissue image BI and a blood vessel image VI in a fully overlapped manner may be adjusting a degree of permeability of one or both of the images to display the images in an overlapped manner. Furthermore, when a brain tissue image BI and a blood vessel image VI are displayed in parallel to each other, and a display angle or a display mode is changed (to a cross-sectional 2D display mode or a 3D display mode, for example) for one of the images, the display control unit 37 may change a display angle or a display mode for the other one of the images in accordance with (in line with) the change. Note that the display control unit 37 may cause the display unit of the terminal 2 to display a synthesized image described above.
In step S6, the display control unit 37 causes an item indicating the second site CP to be displayed on the blood vessel image VI. Note that the display control unit 37 may cause an item indicating the first site DP to be displayed on the brain tissue image BI.
Since steps S11 and S12 are similar or identical to steps S1 and S2 described above, their descriptions are omitted.
In step S13, the association unit 34 associates the brain tissue image BI and the blood vessel image VI with each other, as described above. Furthermore, the association unit 34 generates a synthesized image FI in which the brain tissue image BI and the blood vessel image VI, which are associated with each other, are synthesized with each other. As described above, when a brain tissue image BI and a blood vessel image VI are three-dimensional images, for example, the association unit 34 may associate the brain tissue image BI and the blood vessel image VI with each other in positional relationship based on their positions of centers of gravity and cross-sectional directions, respectively. Note that the association unit 34 may acquire a synthesized image FI in which a brain tissue image BI and a blood vessel image VI are manually synthesized with each other by a person such as the medical doctor DC. In a method for generating a synthesized image FI, for example, the medical doctor DC acquires a piece of data of the brain tissue and a piece of data of blood vessels, which are acquired through MRI. Then, the medical doctor DC uses predetermined software, and causes the piece of data of the brain tissue and the piece of data of the blood vessels to be overlapped with each other to generate a synthesized image FI. Note that, when a machine for MRI synthesizes a brain tissue image BI and a blood vessel image VI with each other, for example, the association unit 34 may acquire a synthesized image FI that has been synthesized through MRI.
In step S14, the display control unit 37 causes the terminal 2 to display the synthesized image FI in which the brain tissue image BI and the blood vessel image VI have been synthesized with each other.
According to the present embodiment described above, for example, it is possible to use proper disposition of the intravascular devices according to the present invention at sites in brain blood vessels near a left brain and a right brain, respectively, to detect brain waves for identifying a focal point of epilepsy and for detecting a seizure of epilepsy. Associating the brain tissue and a blood vessel with each other to indicate a second site in the blood vessel, which corresponds to a first site in the brain tissue, makes it possible to allow a medical doctor to easily understand a site at which the intravascular electrode is to be disposed to properly sense electrical activity in biological tissue that generates an electric signal. Furthermore, according to the present embodiment described above, displaying a synthesized image of a brain tissue image and a blood vessel image makes it possible to allow a medical doctor to easily understand a site at which the intravascular electrode is to be disposed to properly sense electrical activity in biological tissue that generates an electric signal. Thereby, it is possible to achieve higher spatial resolution and higher time resolution in measuring brain waves at a first site in the brain tissue. Furthermore and thereby, since it is possible to place the intravascular electrode in a blood vessel for a long period of time, compared with a case when placing an intracranial electrode, it is possible to continuously measure brain waves. Furthermore and thereby, since a medical doctor who is able to perform intravascular medical operations is at least required, instead of a special medical doctor for neurosurgical operations, it is possible to increase a number of facilities in which it is possible to implement such operations, compared with a case when applying a subdural electrode or inserting an electrode for depth electroencephalogram.
Furthermore, according to the present embodiment described above, performing the analysis processing on brain waves acquired from the intravascular electrode makes it possible to allow a state of the brain waves to be understood in a real-time manner.
Furthermore, according to the present embodiment described above, by indicating a thinner portion of a blood vessel as a second site, the intravascular electrode can be implanted even in a peripheral portion that is difficult to reach with a conventional intravascular device but can be reached, for example, by using a thinner (approximately 0.25 millimeters) intravascular device with a smaller dilation force, thereby making it possible to perform various types of diagnoses. Since such an intravascular device as described above is extremely minimally invasive, compared with an intracranial electrode, there are less side effects and less risk of disease complications even when the intravascular device is used. Furthermore, although an intracranial electrode only measures a potential on a brain surface, the intravascular device described above is able to acquire a potential deep inside the brain, making it possible to monitor the brain region in a wider range. Furthermore, an intracranial electrode requires a craniotomy, limiting an area onto which application is possible. On the other hand, the intravascular devices described above are able to be easily placed even at portions separated away at a greater distance, such as the forehead and the back of the head.
Although the embodiment of the present invention has been described, the present invention is not limited to the embodiment described above. The present invention still includes amendments and modifications, for example, that fall within the scope of the present invention, as long as it is possible to achieve the object of the present invention.
Although, in the present embodiment described above, described is an example where an image of the brain tissue and a blood vessel image are displayed in an examination for a surgical operation for refractory epilepsy, an image of the brain tissue and a blood vessel image may be displayed in a similar manner to those described above, as long as its purpose is for diagnosis of epilepsy.
Although, in the present embodiment described above, an example has been described where an image of the brain tissue and a blood vessel image are displayed in parallel to each other or a synthesized image is displayed in accordance with a mode (the position identification mode), the present invention is not limited to the example. For example, when one or more events such as when an intravascular device has approached, reached, and passed a second site are detected based on information indicating a second site and information of an angio image, the detection may be notified (displayed) in a real-time manner. Furthermore, for example, no mode may be provided, but an image of the brain tissue and a blood vessel image may be displayed. Furthermore, for example, no mode may be provided, but a synthesized image may be displayed. Furthermore, for example, an image of the brain tissue, a blood vessel image, and a synthesized image may be displayed in parallel to each other.
Although, in the present embodiment described above, described is an example where MRI is used to acquire an image of the brain tissue, the present invention is not limited to the example. An image of the brain tissue may be acquired by using computed tomography (CT) or magneto encephalography (MEG).
Although, in the present embodiment described above, MRA has been used to acquire a blood vessel image, a method for acquiring a blood vessel image is not particularly limited, and such an image may be acquired by using one of various types of methods.
Although, in the present embodiment described above, described is an example where the intravascular electrode senses an electric signal generated in biological tissue (measures brain waves), the present invention is not limited to the example, and the intravascular electrode may be used for various types of purposes.
Furthermore, for example, it is possible to use hardware or software to execute the series of processing described above. In other words, the functional configuration described above is a mere example, and the present invention is not particularly limited to the functional configuration. That is, it is enough that the system described above has functions that make it possible to wholly execute the series of processing described above, and functional blocks used to realize the functions are not particularly limited to the functional blocks illustrated in the examples described above. Furthermore, locations at which the functional blocks are present are not particularly limited to the locations illustrated in
To execute, with software, the series of processing, a program configuring the software is installed into a computer from a network or a recording medium, for example. The computer may be such a computer incorporated in special hardware. Furthermore, the computer may be such a computer installed with various programs used to execute various functions, such as, in addition to servers, general-purpose smart phones and personal computers.
A recording medium storing such programs as described above may not only be a non-illustrated removable medium distributed separately from a machine main body to provide the programs to each user, for example, but also be a recording medium provided to each user, for example, in a state where the recording medium is assembled beforehand in the machine main body, for example.
Note that, in the present specification, steps describing programs recorded in a recording medium include not only processes sequentially executed in a chronological order, but also processes that may not necessarily be executed in a chronological order, but may be executed in parallel or separately. Furthermore, in the present specification, the term system means a generic apparatus including a plurality of machines and a plurality of unit, for example.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2021-199978 | Dec 2021 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2022/037157 | 10/4/2022 | WO |
