Patent Application
20240202919
This application is based upon and claims the benefit of priority from Japanese Patent Application No. 2022-199516, filed on Dec. 14, 2022; the entire contents of which are incorporated herein by reference.
Embodiments disclosed in the present specification and drawings relate to a medical image processing apparatus, a method, and a storage medium.
One of methods for treating mitral regurgitation, which is one of valvular heart disease, is mitral valvuloplasty. Mitral valvuloplasty is an operation for reducing regurgitation occurring near the mitral valve by resection and suturing the mitral valve, connecting the mitral valve and the papillary muscle with artificial chordae tendineae, or reducing the valve annulus of the mitral valve with a thread or the like. In recent years, mitral valvuloplasty by catheter surgery, which is less invasive than surgery involving thoracotomy, has attracted attention.
Since valvuloplasty is a complex procedure, careful treatment planning is required. At the time of treatment planning, a treatment team including a doctor, an anesthesiologist, an ultrasound specialist, and the like is formed, and the type of procedure to be performed and the specific method of procedure are discussed in the team on the basis of clinical images and findings of the patient. For example, a plan is prepared in which catheter treatment called MitraClip treatment is selected as a type of procedure to be performed, a type called NTW is selected as a treatment device to be used, and a central portion of a valve is selected as a placement position of the device.
The preparation of such a treatment plan is difficult, and is mainly performed by a skilled specialist on the basis of experience in actual clinical practice. In order to support planning of a treatment plan, a virtual treatment simulator (simulator) that uses data before treatment as an input and estimates a condition of a patient after operation has attracted attention.
Examples of the simulation technique required for such a simulator include a finite element method (FEM), a finite volume method (FVM), a particle method, and the like. For example, in the FEM, a shape of a target structure is divided into a plurality of elements, a motion equation is applied to each element, and deformation of the shape of the target structure is calculated. Here, in order to solve the equation applied to the element, information such as an expression (typically represented by a strain energy function) representing the shape, physical property value, and deformation of the target structure is required.
For example, a simulator for the purpose of estimating the therapeutic effect of treatment (e.g., valvuloplasty) for mitral valve valvular disease typically acquires the shape of a mitral valve complex including a mitral valve and chordae tendineae from a medical image. Further, the information such as an expression representing the physical property value and deformation uses literature values or estimated values by a parameter estimation method to be described later is used.
The mitral valve simulator simulates the dynamics of the mitral valve and changes in the hemodynamics around the mitral valve based on the treatment. A doctor selects an optimal treatment method with reference to the simulation result. Here, the optimal treatment is a treatment in which the condition of a patient after the treatment is optimal. MR grade is known as an index indicating the condition of a patient in mitral valve valvular disease. MR grade is an index defined in guidelines for valvular heart disease and the like, and the state of the mitral valve is classified into three stages from a plurality of measured values such as a regurgitant orifice area and the regurgitant volume. Of the plurality of measured values, the regurgitant orifice area is an indicator related to shape, and thus when the mitral valve simulator simulates the morphology of the mitral valve, the doctor selects an appropriate treatment from among the simulation results on the basis of the degree of change in the regurgitant orifice area due to the treatment. In addition, since the regurgitant volume is an indicator related to hemodynamics, and thus when the mitral valve simulator simulates the hemodynamics around the mitral valve, the doctor selects an appropriate treatment from among the simulation results on the basis of the degree of change in the regurgitant volume due to the treatment.
The simulator is required to have high prediction accuracy. In order to improve the accuracy, there is a parameter estimation method called data assimilation in which a unique physical property value (parameter) of a target structure is identified such that a difference between the dynamics of the target structure estimated by a simulator and actual dynamics becomes small by solving an inverse problem. The specific physical property value in the mitral valve simulator is, for example, the Young's modulus of the mitral valve or the chordae tendineae specific to each patient.
The parameter estimation method in the mitral valve simulator typically acquires the shape of the mitral valve at different two time points from a medical image such as a CT image. Then, from a mitral valve shape at one time point, a mitral valve shape at another time point is estimated by the mitral valve simulator, and simulation parameters with which the mitral valve shape estimated by the simulator approximately matches the mitral valve shape acquired from the medical image such as the CT image are searched by solving the optimization problem. The difference in “a mitral valve shape estimated by a simulator and a mitral valve shape acquired from a medical image such as a CT image” in the example illustrated here is referred to as a loss, and a function for calculating the loss is referred to as a loss function. As a method for solving the optimization problem (hereinafter, optimization method), examples include a Nelder-Mead method, a Kalman filter method, and the like. In an optimization method such as the Nelder-Mead method, a multi-start optimization method is employed in which a plurality of parameter sets are prepared in advance, a loss is calculated with each parameter set, and a parameter set with the minimum loss is adopted as a solution.
As described above, in surgery on a patient with mitral valve regurgitation, since the index that the doctor wants to check is the valve orifice area, it is particularly important for the mitral valve simulator to accurately calculate the valve orifice area. Therefore, the loss function of the optimization method is often configured by the entire shape of the mitral valve and the valve orifice area. As a result, it is possible to estimate patient-specific simulation parameters with which the shape of the mitral valve and the valve orifice area can be accurately estimated.
A medical image processing apparatus according to an embodiment includes processing circuitry. The processing circuitry acquires first medical image data and second medical image data scanned at least at the first timing and at the second timing different from the first timing. The processing circuitry acquires first feature data related to the structure of interest on the basis of the first medical image data and second feature data related to the structure of interest on the basis of the second medical image data. The processing circuitry estimates the third feature data by estimating the structure of interest at the second timing by simulation on the basis of the first feature data. The processing circuitry calculates a first feature value and a second feature value that is a local feature value more than the first feature value from the second feature data and the third feature data. The processing circuitry specifies a plurality of parameter sets related to simulation on the basis of optimization calculation having a loss function including the first feature value. The processing circuitry determines a parameter set of interest from the plurality of parameter sets based on the second feature value.
Hereinafter, embodiments of a medical image processing apparatus, a method, and a program will be described in detail with reference to the drawings. Note that the medical image processing apparatus, the method, and the program according to the present application are not limited to the following embodiments. In the following description, the same components are denoted by the same reference numerals, and redundant description is omitted.
The medical image diagnosis apparatus 1 images a subject and generates a medical image. Then, the medical image diagnosis apparatus 1 transmits the generated medical image to various apparatuses on the network. For example, the medical image diagnosis apparatus 1 is an X-ray diagnostic apparatus, an X-ray computed tomography (CT) apparatus, a magnetic resonance imaging (MRI) apparatus, an ultrasonic diagnostic apparatus, a single photon emission computed tomography (SPECT) apparatus, a positron emission computed tomography (PET) apparatus, or the like.
The medical image storage apparatus 2 stores various medical images related to the subject. Specifically, the medical image storage apparatus 2 receives a medical image from the medical image diagnosis apparatus 1 via the network, and stores and keep the medical image in a storage circuit in the apparatus. For example, the medical image storage apparatus 2 is realized by a computer device such as a server or a workstation. Furthermore, for example, the medical image storage apparatus 2 is realized by a picture archiving and communication system (PACS) or the like, and stores medical images in a format conforming to digital imaging and communications in medicine (DICOM).
The medical image processing apparatus 3 performs various types of information processing on the subject. Specifically, the medical image processing apparatus 3 receives a medical image from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the network, and performs various types of information processing using the medical image. For example, the medical image processing apparatus 3 is realized by a computer device such as a server or a workstation.
For example, the medical image processing apparatus 3 includes a communication interface 31, an input interface 32, a display 33, storage circuitry 34, and processing circuitry 35.
The communication interface 31 controls transmission and communication of various data transmitted and received between the medical image processing apparatus 3 and another apparatus connected via a network. Specifically, the communication interface 31 is connected to the processing circuitry 35, and transmits data received from another apparatus to the processing circuitry 35 or transmits data transmitted from the processing circuitry 35 to another apparatus. For example, the communication interface 31 is realized by a network card, a network adapter, a network interface controller (NIC), or the like.
The input interface 32 receives various instructions and input operations of various types of information from a user. Specifically, the input interface 32 is connected to the processing circuitry 35, converts an input operation received from the user into an electric signal, and transmits the electric signal to the processing circuitry 35. For example, the input interface 32 is realized by a trackball, a switch button, a mouse, a keyboard, a touch pad that performs an input operation by touching an operation surface, a touch screen which is an assembly of a display screen and the touch pad, a non-contact input interface using an optical sensor, a voice input interface, and the like. Note that, in the present specification, the input interface 32 is not limited to ones with physical operation components such as a mouse and a keyboard. For example, an electric signal processing circuit that receives an electric signal corresponding to an input operation from an external input device provided separately from the apparatus and transmits the electric signal to the control circuit is also included in the example of the input interface 32.
The display 33 displays various types of information and various types of data. Specifically, the display 33 is connected to the processing circuitry 35 and displays various types of information and various types of data received from the processing circuitry 35. For example, the display 33 is realized by a liquid crystal display, a cathode ray tube (CRT) display, a touch panel, or the like.
The storage circuitry 34 stores various data and various programs. Specifically, the storage circuitry 34 is connected to the processing circuitry 35, stores the data received from the processing circuitry 35, or reads the stored data and transmits the data to the processing circuitry 35. For example, the storage circuitry 34 is realized by a semiconductor memory element such as a random access memory (RAM) or a flash memory, a hard disk, an optical disk, or the like.
The processing circuitry 35 controls the entire medical image processing apparatus 3. For example, the processing circuitry 35 performs various types of processing in response to an input operation received from the user via the input interface 32. For example, the processing circuitry 35 receives data transmitted from another apparatus via the communication interface 31, and stores the received data in the storage circuitry 34. Furthermore, for example, the processing circuitry 35 transmits the received data from the storage circuitry 34 to the communication interface 31, thereby transmitting the data to another apparatus. In addition, for example, the processing circuitry 35 displays data received from the storage circuitry 34 on the display 33.
The configuration example of the medical image processing apparatus 3 according to the present embodiment has been described above. For example, the medical image processing apparatus 3 according to the present embodiment is installed in a medical facility such as a hospital or a clinic, and supports various diagnoses and planning of a treatment plan performed by a user such as a doctor. For example, the medical image processing apparatus 3 executes various types of processing for appropriately performing simulation.
As described above, in a mitral valve simulator used in surgery for a patient with mitral valve regurgitation, it is important to accurately calculate the valve orifice area, and the loss function of the optimization method is often configured by the overall shape of the mitral valve and the valve orifice area. However, it takes time to calculate the valve orifice area. Therefore, in a case where the loss function includes the valve orifice area, it is necessary to calculate the valve orifice area every time the parameter is updated, and the number of times of updating the parameter is enormous, from several thousands of times to several tens of thousands of times, thereby taking much time for optimization calculation.
Therefore, the medical image processing apparatus 3 according to the present embodiment performs the parameter estimation method with a two-stage algorithm, thereby suppressing the time required for optimization calculation and enabling simulation to be appropriately performed. Hereinafter, the medical image processing apparatus 3 having such a configuration will be described in detail.
For example, as illustrated in
The control function 351 controls to generate various graphical user interfaces (GUIs) and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 351 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 351 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 352.
The image data acquisition function 352 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 352 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 352 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. For example, the image data acquisition function 352 acquires a first medical image and a second medical image scanned at least at a first timing and at a second timing different from the first timing.
The image data acquisition function 352 acquires a CT image, an ultrasound image, an MRI image, an X-ray image, an Angio image, and the like as the plurality of medical images described above. By executing the image data acquisition function 352 described above, the processing circuitry 35 receives a medical image of the subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2, and stores the received medical image in the storage circuitry 34.
The feature data acquisition function 353 acquires feature data for the medical image acquired by the image data acquisition function 352. Specifically, the feature data acquisition function 353 acquires first feature data related to the structure of interest on the basis of the first medical image and second feature data related to the structure of interest on the basis of the second medical image data. Note that the processing by the feature data acquisition function 353 will be described in detail later.
The estimation function 354 estimates the feature data of the structure of interest by performing simulation using the medical image acquired by the image data acquisition function 352. Specifically, the estimation function 354 estimates the third feature data by estimating the structure of interest at the second timing by simulation on the basis of the first feature data. Note that the processing by the estimation function 354 will be described in detail later.
The calculation function 355 calculates a feature value related to the structure of interest on the basis of the feature data acquired by the feature data acquisition function 353 and the feature data estimated by the estimation function 354. Specifically, the calculation function 355 calculates a first feature value and a second feature value that is a local feature value more than the first feature value from the second feature data and the third feature data. Here, the first feature value is a feature value of the entire structure of interest. Note that the processing by the calculation function 355 will be described in detail later.
The specifying function 356 specifies a plurality of parameter sets related to simulation on the basis of the feature value calculated by the calculation function 355. Specifically, the specifying function 356 specifies a plurality of parameter sets related to simulation on the basis of optimization calculation having a loss function including the first feature value. Note that the processing by the specifying function 356 will be described in detail later.
The determination function 357 determines a parameter set of interest from the plurality of parameter sets specified by the specifying function 356. Specifically, the determination function 357 determines the parameter set of interest from the plurality of parameter sets based on the second feature value. Note that the processing by the determination function 357 will be described in detail later.
The processing circuitry 35 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 35 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 35 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3 will be described with reference to
For example, as illustrated in
Subsequently, the feature data acquisition function 353 extracts, for the acquired medical image, a structure of an anatomical structure (structure of interest) at two time points included in the medical image (step S102). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the feature data acquisition function 353 from the storage circuitry 34.
Subsequently, the estimation function 354 sets parameters to be estimated among the simulation parameters (step S103). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the estimation function 354 from the storage circuitry 34.
Subsequently, the estimation function 354, the calculation function 355 and the specifying function 356 estimate parameter candidates of the anatomical structure by an optimization method using an entire feature value as a loss function (step S104). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the estimation function 354, the calculation function 355 and the specifying function 356 from the storage circuitry 34.
Subsequently, the calculation function 355 and the determination function 357 calculate a loss for each parameter candidate due to the local feature value and estimate the parameter of the anatomical structure (step S105). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the calculation function 355 and the determination function 357 from the storage circuitry 34.
Subsequently, the estimation function 354 performs a simulation of the treatment input by the doctor (step S106). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the estimation function 354 from the storage circuitry 34.
Subsequently, the control function 351 displays a result of the simulation on the display 33 (step S107). This processing is realized, for example, by the processing circuitry 35 calling and executing a program corresponding to the control function 351 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3 will be described. Note that, in the following, a description will be given on an example of processing in a case where the mitral valve is a structure of interest, the shape deviation of the mitral valve is an entire feature value (first feature value), and the deviation of the valve orifice area of the mitral valve is a local feature value (second feature value). Note that the target of the processing described in the present embodiment is not limited thereto, and for example, an aortic valve, a tricuspid valve, a blood vessel, a left ventricle, or the like may be the structure of interest. In addition, the effective height, the geometric height, the valve annulus length, and the like may be used as the local feature value.
As described in step S101 of
Then, the image data acquisition function 352 selects an image captured (first medical image data) in the phase in which the mitral valve is opened (first timing) and an image captured (second medical image data) in the phase in which the mitral valve is closed (second timing) from the 20-phase CT images. For example, the image data acquisition function 352 acquires first medical image data and second medical image data scanned at least during systole and diastole of the heart. As an example, the image data acquisition function 352 selects the phase at the point of time when 70% elapses from the start of the R wave at the R-R interval (70% cycle) as the open phase, and selects the 20% cycle as the closed phase.
Note that the method of selecting the open phase and the closed phase is not limited to the above, and other methods may be used. For example, any phase of mid-diastolic phases (60% to 80% cycle) may be selected as the open phase. Furthermore, any one of mid-systolic phases (10% to 30% cycle) may be selected as the closed phase.
The image data acquisition function 352 can also acquire images of a phase manually selected by a doctor by visual judgment, and can also automatically select a phase based on information described in the DICOM header.
Here, for a patient with mitral valve regurgitation, there is likely no image of the phase in which the mitral valve is completely closed. Therefore, in that case, it is conceivable to select the phase in which the blood flow around the mitral valve is in regurgitation, the phase in which the aortic valve is open, and the phase in which the left ventricle contracts. Hereinafter, a case where these are selected will be described.
The phase in which the blood flow around the mitral valve is in regurgitation may be selected on the basis of the corresponding ultrasound image or may be selected on the basis of the shape of the mitral valve. For example, the image data acquisition function 352 specifies the phase of the ultrasound image in which regurgitation of blood flow occurs in the Doppler image collected by the electrocardiographic synchronization, and selects the CT image having substantially the same phase as the specified phase. Furthermore, for example, the image data acquisition function 352 selects a CT image of a phase in which a part of the mitral valve is turned up to the left atrium (LA) side or a phase in which the valve is not in contact in the mitral valve included in the CT image.
The phase in which the aortic valve is open may be determined by obtaining the shape of the aortic valve from the CT image or the ultrasound image. In this case, the acquisition of the shape of the aortic valve may be performed manually, or may be performed automatically using a known segmentation method (machine learning, image processing). Here, the determination as to whether the aortic valve is open is performed, for example, by determining whether the area is completely separated between the left ventricular (LV) side and the aortic arch side across the aortic valve. That is, the image data acquisition function 352 performs the above determination, specifies the phase in which the aortic valve is opened on the basis of the determination result, and selects the CT image of the specified phase.
The phase in which the left ventricle contracts may be determined based on a change in volume of the left ventricle and a moving direction of the left ventricular wall (when the left ventricle contracts, the left ventricular wall moves in the center direction of the left ventricle) by acquiring the shape of the left ventricle from the CT image or the ultrasound image. For example, the image data acquisition function 352 calculates the volume of the left ventricle in each of the 20-phase CT images, and determines that the left ventricle is contracting in a phase in which the calculated volume of the left ventricle is reduced as compared to the previous phase. In addition, the image data acquisition function 352 sets points at equal intervals inside the left ventricular wall on a short axis cross section (for example, a plane that is horizontal to the approximate plane of the mitral annulus and through the center of gravity of the left ventricular wall) of the left ventricle, and defines the total distance between each point and the center of gravity of the left ventricle as the left ventricular wall centroid distance. Then, the image data acquisition function 352 determines that the left ventricle is contracting when the difference between the left ventricular wall centroid distance one phase before and the current phase is positive. The shape of the left ventricle may be acquired manually or automatically using a known segmentation method (machine learning, image processing).
Note that, in a case where there is no image of a phase corresponding to the condition, an image of a phase having a condition closest to the condition may be selected. For example, when there is no phase at the mid-diastolic phase, the phase at the early-diastolic phase or the end-diastolic phase may be used.
In addition, in a case where the mitral valve does not appear clear, the phase at the early-diastolic phase or the end-diastolic phase may be used. Here, the case where the mitral valve does not appear clear is, for example, a case where there is no pixel determined to be a mitral valve with a likelihood of 60% or more as a result of executing pixel-wise mitral valve segmentation according to Deep Learning, or a case where there is a pixel determined to be a mitral valve with a likelihood of 60% or more at a position not in contact with the left ventricular lumen and the left atrial lumen. That is, the image data acquisition function 352 determines whether or not the mitral valve appears clear as described above and determines the phase to use based on the determination result.
Also, if there is no diastolic data, the phase furthest from the phase selected as the phase in which the mitral valve is open may be selected instead of the open phase.
Here, the image data acquisition function 352 may determine a newly stored medical image based on a preset acquisition condition, and execute the acquisition processing in a case where the medical image satisfies the acquisition condition. For example, an acquisition condition under which the state of the medical image can be determined is stored in the storage circuitry 34, and the image data acquisition function 352 determines the newly stored medical image based on the acquisition condition stored in the storage circuitry 34.
As an example, the storage circuitry 34 stores, as the acquisition condition, “acquisition of a medical image captured in an imaging protocol for the heart”, “acquisition of an enlarged and reconstructed medical image”, or a combination thereof. The image data acquisition function 352 acquires a medical image satisfying the above-described acquisition condition.
As described in step S102 of
In addition, for example, the feature data acquisition function 353 can extract a structure of interest based on an anatomical structure rendered in a CT image by a known region extraction technique. For example, the feature data acquisition function 353 extracts a structure of interest in the CT image by using segmentation of pixel-wise by Deep learning, fitting of a template shape based on an energy function, Otsu's binarization method based on a CT value, a region expansion method, a snake method, a graph cut method, a mean shift method, or the like.
As described in step S103 in
The estimation function 354 sets a parameter to be estimated (a parameter to be subjected to data assimilation) among predefined parameters (groups). For example, the estimation function 354 sets a parameter to be estimated by specifying a parameter that does not undergo data assimilation among predefined parameters (groups). As an example, the estimation function 354 specifies a parameter having a small influence on the regurgitant orifice area based on the evaluation result of the magnitude of the influence of each parameter on the regurgitant orifice area, and specifies the parameter as a parameter that does not undergo data assimilation. The magnitude of the influence of each parameter on the regurgitant orifice area is evaluated in advance and stored in the storage circuitry 34.
In addition, the parameter that does not undergo data assimilation may be set on the basis of an empirical rule or may be set on the basis of known knowledge such as literature. In addition, the values of the parameter that does not undergo data assimilation may be determined on the basis of known knowledge such as literature, may be determined on the basis of empirical rules, or may be randomly determined from a range set on the basis of known knowledge or empirical rules.
The estimation function 354 sets parameters to be estimated by the above-described processing. Here, the parameter to be estimated is, for example, the Young's modulus of the valve, the hardness of chordae tendineae, the valve-specific physical property value such as the number of chordae tendineae, the physical property value of the object strongly affecting the movement of the valve, and the like.
As described in step S104 of
Here, the specifying function 356 estimates a plurality of parameter sets using a difference in the overall shape of the mitral valve, which is the entire feature value, as a loss function of optimization. Specifically, the specifying function 356 specifies a plurality of parameter sets having a relatively small first feature value. In normal optimization, one parameter set having the smallest loss function is estimated, but the specifying function 356 according to the present embodiment estimates a predetermined number of parameter sets in ascending order of the loss function. For example, the specifying function 356 estimates 16 parameter sets.
The number of parameter sets to be estimated is not limited to 16, and may be 8 or 2, or may be dynamically determined. In the case of dynamic determination, for example, it may be changed according to an object to be estimated by simulation. In this case, for example, the number may be 10 in the case of the mitral valve simulation, 8 in the case of the aortic valve simulation, and the like.
Furthermore, in the case of dynamic determination, for example, it may be changed according to the state of the mitral valve. In this case, for example, the number may be ten when the classification of mitral regurgitation is “type I”, twelve when the classification is “type II”, and the like. In addition, the number may be sixteen when there is calcification, ten when there is no calcification, and the like.
In addition, in the case of dynamically determining, for example, it may be set according to the value of loss. In this case, for example, a parameter set included within 10% of the loss value of the parameter set whose loss reduced the most may be selected. Alternatively, a parameter set below a preset loss value may be selected. The above 10% may also be changed according to the state of the mitral valve.
Note that, in the data assimilation described above, the case where the shape of the mitral valve in the phase in which the mitral valve is closed is estimated using the shape of the mitral valve in the phase in which the mitral valve is open as an input has been described, however, the embodiment is not limited thereto, and the shape of the mitral valve in the phase in which the mitral valve is open may be estimated using the shape of the mitral valve in the phase in which the mitral valve is closed as an input.
In addition, the difference in the overall shape of the mitral valve is calculated as follows, for example. For example, the calculation function 355 calculates, as the difference in the overall shape of the mitral valve, the sum of distances between a certain point on the mitral valve shape obtained by simulation and the nearest neighbor point on the mitral valve shape obtained from the image, calculated at all nodes. That is, the calculation function 355 sets node points for the mitral valve obtained by the simulation and the mitral valve obtained from the image, and calculates and adds the distances between the nearest node points to obtain a total value as the difference in the overall shape of the mitral valve.
Note that not all the nodes on the mitral valve obtained by the simulation but the sum of the calculated values at several representative points may be used. Here, the representative point may be set in advance or may be set randomly. In addition, not only the “Sum of distances between a certain point on the mitral valve shape obtained by simulation and the nearest neighbor point on the mitral valve shape obtained by measurement, calculated at all nodes” but also the “Sum of distances between a certain point on the mitral valve shape obtained by measurement and the nearest neighbor point on the mitral valve shape obtained by simulation, calculated at all nodes” may be calculated together and the two may be added up.
As described in step S105 in
Here, the calculation function 355 calculates the difference (loss) of the valve orifice area as follows. For example, the calculation function 355 calculates the center of gravity of a point group belonging to the valve tip of the mitral valve (a point group of tips of the anterior leaflet and the posterior leaflet), and calculates the area of a triangle having two adjacent points of the center of gravity and the point belonging to the valve tip as vertices at all points constituting the valve orifice. Then, the calculation function 355 calculates the total area of the calculated triangles as the valve orifice area. The calculation function 355 calculates the valve orifice area in the mitral valve shape obtained by the simulation and the mitral valve shape obtained from the image, and calculates the difference in the valve orifice area by taking the difference between the calculated values.
The determination function 357 determines a parameter set of interest from the plurality of parameter sets based on the feature value related to the difference of the valve orifice area in the cardiac valve. Specifically, the determination function 357 determines a parameter set having a relatively small corresponding second feature value among the plurality of parameter sets as the parameter set of interest. For example, the determination function 357 determines a parameter set having the smallest difference (loss) of the valve orifice area among the plurality of parameter sets (a predetermined number of parameter sets).
For example, as illustrated in
As described in step S106 of
As described in step S107 of
In the above-described embodiment, in step S105, the final parameter is estimated using the local feature value (valve orifice area). However, the embodiment is not limited thereto, and for example, not only the local feature value but also the entire feature value may be used. For example, the determination function 357 determines the final parameter from the value of the local feature value and the value of the entire feature value. Here, different weights may be set for the value of the local feature value and the value of the entire feature value. In this case, for example, the reciprocals of the representative values of the local feature value and the entire feature value calculated in advance may be set as weights. Alternatively, in order to place more importance on the local feature value, the weight for the value of the local feature value may be set to be large.
In the method of the above-described embodiment, after the parameter candidates are estimated by the optimization method using the entire feature value as the loss function, the parameter set is determined using the local feature value, however, a method of determining the parameter set by performing optimization using the entire feature value and the local feature value as the loss function from the beginning may also be selectable. In such a case, for example, in step S104, the medical image processing apparatus 3 estimates approximate values of the calculation times in the two methods, and displays the estimated results on the display 33. The doctor selects which method to use with reference to the displayed calculation times. Note that, for the approximate value, for example, both parameter estimation methods are performed with available data in advance, and the time taken is displayed. Alternatively, the approximate value displayed may be changed depending on the case of interest. For example, if the shape of the mitral valve is significantly larger or smaller than usual, it may take time to search the parameter set, and thus a value obtained by multiplying the previous approximate value by 1.2 may be displayed.
As described above, according to the first embodiment, the image data acquisition function 352 acquires first medical image data and second medical image data scanned at least at the first timing and at the second timing different from the first timing. The feature data acquisition function 353 acquires the first feature data related to the structure of interest on the basis of the first medical image data and the second feature data related to the structure of interest on the basis of the second medical image data. The estimation function 354 estimates the third feature data by estimating the structure of interest at the second timing by simulation on the basis of the first feature data. The calculation function 355 calculates the first feature value and the second feature value that is a local feature value more than the first feature value from the second feature data and the third feature data. The specifying function 356 specifies a plurality of parameter sets related to simulation on the basis of optimization calculation having a loss function including the first feature value. The determination function 357 determines a parameter set of interest from the plurality of parameter sets based on the second feature value. Therefore, the medical image processing apparatus 3 according to the first embodiment can estimate a parameter without including a local feature value requiring a calculation time in a loss function in a case of performing a simulation using a parameter (physical property value) unique to an individual, and can appropriately perform the simulation while suppressing an increase in calculation time required for optimization.
Furthermore, according to the first embodiment, the first feature value is a feature value of the entire structure of interest. Therefore, the medical image processing apparatus 3 according to the first embodiment can perform optimization using a feature value that does not take much calculation time, and can suppress an increase in calculation time required for optimization.
In addition, according to the first embodiment, the specifying function 356 specifies a plurality of parameter sets based on the first feature value calculated by the loss function from the parameter set group obtained based on the multi-start optimization calculation. Therefore, the medical image processing apparatus 3 according to the first embodiment makes it possible to extract a candidate for selecting an appropriate parameter set from among parameter sets obtained by optimization using the entire feature value.
In addition, according to the first embodiment, the specifying function 356 specifies a plurality of parameter sets having a relatively small first feature value. Therefore, the medical image processing apparatus 3 according to the first embodiment enables selection of an appropriate parameter candidate in the entire feature value.
In addition, according to the first embodiment, the determination function 357 determines a parameter set having a relatively small corresponding second feature value among the plurality of parameter sets as the parameter set of interest. Therefore, the medical image processing apparatus 3 according to the first embodiment makes it possible to determine an appropriate parameter in the local feature value from among appropriate parameter candidates in the entire feature value.
In addition, according to the first embodiment, the image data acquisition function 352 acquires first medical image data and second medical image data scanned at least during systole and diastole of the heart. Therefore, the medical image processing apparatus 3 according to the first embodiment enables acquisition of a medical image with an appropriate phase in simulation of a cardiac valve.
In addition, according to the first embodiment, the feature data acquisition function 353 acquires the shape data of the cardiac valve in the systole of the heart based on the first medical image data, and acquires the shape data of the cardiac valve in the diastole of the heart based on the second medical image data. The estimation function 354 estimates the shape data of the cardiac valve in the diastole of the heart by simulation based on the shape data of the cardiac valve in the systole of the heart acquired based on the first medical image data. The calculation function 355 calculates a feature value regarding a difference in the shape of the cardiac valve and a feature value regarding a difference in the valve orifice area in the cardiac valve based on the shape data of the cardiac valve based on the second medical image data and the shape data of the cardiac valve estimated by simulation. The specifying function 356 specifies a plurality of parameter sets based on the optimization calculation having a loss function including the feature value related to a difference in the shape of the cardiac valve. The determination function 357 determines a parameter set of interest from the plurality of parameter sets based on the feature value related to the difference of the valve orifice area in the cardiac valve. Therefore, the medical image processing apparatus 3 according to the first embodiment enables simulation of the cardiac valve to be appropriately performed.
In a second embodiment, a method of selecting a phase when selecting a medical image to be used for simulation will be described. As described in the first embodiment, at the time of data assimilation, typically, the mitral valve shape in two phases is acquired from a CT image or the like, the mitral valve shape in one phase is predicted from the mitral valve shape in the other phase by the mitral valve simulator, and an optimization problem for searching for a parameter with which the simulation result in the same phase approximately matches the actual shape is solved. Here, in a case where there is no phase selection criterion, the phase selected by an operator varies, and as a result, a variation may occur in the estimated parameter.
Therefore, in the second embodiment, by providing a selection criterion of determining whether or not there is an abnormality in the cardiac valve and selecting the phase on the basis of the determination result and the shape of the cardiac valve, it is possible to suppress variation due to dependence on operators and appropriately perform simulation.
For example, when a simulation of the mitral valve is performed, the classification (type I or type III, or type II) of mitral regurgitation is determined from the shape of the mitral valve, and in the case of type II, the phase having the largest regurgitant orifice area in the systole is selected as the “closed phase”. In the case of type I or type III, the phase having the smallest valve orifice area in the systole is selected as the “closed phase”. Further, regardless of type II, type I or type III, the phase in which the mitral valve shape is most uniformly open in the end-diastolic phase is selected as the “open phase”. By selecting two phases of the “closed phase” and the “open phase” based on such a criterion, it is possible to select a phase suitable for data assimilation without depending on the operator.
Here, the second embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 401 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 401 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 401 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 402.
In addition, the control function 401 can estimate parameters for the simulation by data assimilation and perform the simulation using the estimated parameters.
The image data acquisition function 402 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 352 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 402 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. For example, the image data acquisition function 402 acquires a first medical image and a second medical image scanned at least at a first timing and at a second timing different from the first timing. Note that the image data acquisition function 402 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The specifying function 403 specifies a structure of interest for the medical image acquired by the image data acquisition function 402. Specifically, the specifying function 403 identifies the structure of interest on the basis of the first medical image data and the second medical image data. Here, the structure of interest is a cardiac valve. Note that the processing by the specifying function 403 will be described in detail later.
The determination function 404 determines the presence or absence of abnormality of the structure of interest on the basis of the shape of the structure of interest. Note that the processing by the determination function 404 will be described in detail later.
The calculation function 405 calculates a first feature value on the basis of the shape of the structure of interest. Note that the processing by the calculation function 405 will be described in detail later.
The selection function 406 selects a phase on the basis of the determination result on the presence or absence of abnormality of the structure of interest and the first feature value. Note that the processing by the selection function 406 will be described in detail later.
The processing circuitry 40 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 40 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 40 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3a will be described with reference to
For example, as illustrated in
Subsequently, the specifying function 403 extracts, for the plurality of acquired medical images, a structure of an anatomical structure (structure of interest) in all phases (step S202). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the specifying function 403 from the storage circuitry 34.
Subsequently, the determination function 404 determines disease classification of the specified structure of interest (step S203). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the determination function 404 from the storage circuitry 34.
Subsequently, the calculation function 405 calculates the valve orifice area (step S204). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the calculation function 405 from the storage circuitry 34.
Subsequently, the specifying function 403 specifies the shape of the valve orifice (step S205). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the specifying function 403 from the storage circuitry 34.
Subsequently, the selection function 406 selects the closed phase from the valve orifice area in the systole (step S206). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the selection function 406 from the storage circuitry 34.
Subsequently, the selection function 406 selects the open phase from the shape of the valve orifice in the diastole (step S207). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the selection function 406 from the storage circuitry 34.
Subsequently, the control function 401 estimates parameters of the simulation by data assimilation using the closed/open phase mitral valve shape (step S208), performs the simulation (step S209), and displays the result (step S210). This processing is realized, for example, by the processing circuitry 40 calling and executing a program corresponding to the control function 401 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3a will be described. Note that, in the following, processing in a case where the mitral valve is set as the structure of interest and the phase in which the mitral valve is closed and the phase in which the mitral valve is open are selected will be described as an example. Note that the target of the processing described in the present embodiment is not limited thereto, and for example, an aortic valve, a tricuspid valve, a blood vessel, a left ventricle, or the like may be the structure of interest.
As described in step S201 of
As described in step S202 of
As described in step S203 of
The determination function 404 executes determination processing on the basis of the above classification. Specifically, the determination function 404 determines whether the mitral valve is type II mitral regurgitation. That is, the determination function 404 determines whether there is an abnormality in the mitral valve itself. Here, a method of determining whether the type is type II or not, for example, determines “whether a part of the valve tip of the mitral valve is positioned above the valve annulus of the mitral valve”, and if it is true, determines that the type is type II. Here, “above” means the upward direction directing from the LV side to the LA side in the vertical vector of the approximate plane of the valve annulus of the mitral valve. That is, the determination function 404 calculates an approximate plane of the valve annulus of the mitral valve specified in the CT image, and determines whether or not a part of the leaflet of the mitral valve is in the upward direction with respect to the approximate plane, thereby determining whether or not the type is type II.
Note that the method for determining type II or other than type II is not limited to the above-described method, and other methods may be used. For example, the determination function 404 can also make a determination by acquiring a classification described in medical records or the like. Furthermore, the determination function 404 can also make a determination by acquiring a result determined by a doctor who has observed the CT image.
In addition, the determination of classification is not limited to determining whether it is type II or other than type II, and classification may be determined based on whether it is primary MR or secondary MR. In such a case, the determination function 404 classifies the mitral valve as primary MR or secondary MR based on whether there is a cleft in the shape of the segmented mitral valve, whether a part of the mitral valve is flipped over to the LA side, or whether there is a rupture of the papillary muscle.
As described in step S204 of
As described in step S205 of
As described in step S206 of
For example, when it is determined that there is an abnormality in the structure of interest, the selection function 406 selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is maximized as the phase in which the cardiac valve is closed. That is, when the disease of the mitral valve is type II in which the mitral valve itself is abnormal, the selection function 406 selects the phase that is in the systole and in which the valve orifice area is maximized as the “closed phase”.
Here, the selection function 406 selects the phase in which regurgitation occurs as the systole. That is, when it is determined that there is an abnormality in the structure of interest, the selection function 406 selects the phase in which regurgitation of blood occurs as the systole of the heart, and selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is maximized as the phase in which the cardiac valve is closed.
Whether or not regurgitation has occurred can be estimated, for example, from the shape of the segmented mitral valve. In such a case, for example, the selection function 406 determines that regurgitation has occurred in a case where a part of the mitral valve is turned up toward the LA side, or in a case where the mitral valve is near the boundary between LA and LV but the valve is not completely closed. Note that the phase in which regurgitation has occurred may be selected using an ultrasound image collected by transesophageal echocardiography (TEE). In addition, whether or not regurgitation has occurred may be estimated by an ultrasound image collected by a color Doppler method. Furthermore, the phase in which regurgitation has occurred may be selected by a doctor.
On the other hand, when it is determined that there is no abnormality in the structure of interest, the selection function 406 selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is minimized as the phase in which the cardiac valve is closed. That is, when the disease of the mitral valve is other than type II, the selection function 406 selects the phase that is the systole and in which the valve orifice area is minimized as the “closed phase”.
Further, as in the case type II, the selection function 406 selects the phase in which regurgitation occurs as the systole. That is, when it is determined that there is no abnormality in the structure of interest, the selection function 406 selects the phase in which regurgitation of blood occurs as the systole of the heart, and selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is minimized as the phase in which the cardiac valve is closed.
As described in step S207 of
For example, in the mitral valve in the end-diastolic phase of the heart, the selection function 406 determines a phase in which the coefficient of determination (R2) specified by the specifying function 403 is the highest or a phase in which the variance is the smallest as the phase in which the mitral valve is most uniformly open and selects the phase as the “open phase”.
Here, for example, the selection function 406 estimates the diastole of the heart from the electrocardiogram, and specifies the last section when the diastole is divided into three as the end-diastolic phase. Note that the diastole may be estimated not only by the electrocardiogram, but may also be estimated by the phase in which the aortic valve is closed, the phase in which the left ventricle is dilated, or the like. In addition, the diastole may also be specified by a doctor.
It should be noted that if the mitral valve is more uniformly open immediately after being closed compared to the end-diastolic phase, the time point may be selected as the “open phase”. In addition, in a case where there is no end-diastolic phase, the selection function 406 performs selection from the mid-diastolic phase. In addition, in a case where there is no mid-diastolic phase, the selection function 406 performs selection from the early-diastolic phase. In addition, the valve orifice area or the length of the valve annulus may be used as an index for selecting the “open phase”.
As described in step S208 of
As described in step S209 of
As described in step S210 of
In the above embodiment, the case of selecting the “closed phase” and the “open phase” has been described. However, the embodiment is not limited thereto, and for example, different phases may be selected for each parameter for performing data assimilation. In such a case, for example, the selection function 406 preferentially selects the phase in which the valve is clearly depicted when estimating the parameter related to the valve. In addition, the selection function 406 selects two phases in which valve deformation is large when estimating the parameter related to the chordae tendineae.
As described above, according to the second embodiment, the image data acquisition function 402 acquires first medical image data and second medical image data scanned at least at the first timing and at the second timing different from the first timing. The specifying function 403 identifies the structure of interest on the basis of the first medical image data and the second medical image data. The determination function 404 determines the presence or absence of abnormality of the structure of interest on the basis of the shape of the structure of interest. The calculation function 405 calculates a first feature value on the basis of the shape of the structure of interest. The selection function 406 selects a phase on the basis of the determination result on the presence or absence of abnormality of the structure of interest and the first feature value. Therefore, the medical image processing apparatus 3a according to the second embodiment can select the phase of the image to be used for simulation on the basis of the determined criterion, and can suppress the occurrence of variation due to dependence on operators and appropriately perform the simulation.
According to the second embodiment, the structure of interest is a cardiac valve. Therefore, the medical image processing apparatus 3a according to the second embodiment enables simulation of the cardiac valve to be appropriately performed.
In addition, according to the second embodiment, when it is determined that there is an abnormality in the structure of interest, the selection function 406 selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is maximized as the phase in which the cardiac valve is closed. Therefore, the medical image processing apparatus 3a according to the second embodiment enables selection of a closed phase according to a disease.
Furthermore, according to the second embodiment, when it is determined that there is an abnormality in the structure of interest, the selection function 406 selects the phase in which regurgitation of blood occurs as the systole of the heart, and selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is maximized as the phase in which the cardiac valve is closed. Therefore, the medical image processing apparatus 3a according to the second embodiment enables appropriate selection of the systole of the heart.
In addition, according to the second embodiment, when it is determined that there is no abnormality in the structure of interest, the selection function 406 selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is minimized as the phase in which the cardiac valve is closed. Therefore, the medical image processing apparatus 3a according to the second embodiment enables appropriate selection of the phase in which the cardiac valve is closed.
In addition, according to the second embodiment, when it is determined that there is no abnormality in the structure of interest, the selection function 406 selects the phase in which regurgitation of blood occurs as the systole of the heart, and selects the phase that is the systole of the heart and in which the valve orifice of the cardiac valve is minimized as the phase in which the cardiac valve is closed. Therefore, the medical image processing apparatus 3a according to the second embodiment enables appropriate selection of the systole of the heart.
Furthermore, according to the second embodiment, the selection function 406 selects the phase that is the diastole of the heart and in which the cardiac valve is uniformly open as the phase in which the cardiac valve is open. Therefore, the medical image processing apparatus 3a according to the second embodiment enables appropriate selection of the phase in which the cardiac valve is open.
In a third embodiment, a method of correcting the length of a cardiac valve will be described. As described in the first embodiment, at the time of data assimilation, the mitral valve shape in two phases is acquired from the CT image or the like, and the mitral valve shape in one on the phases is predicted from the mitral valve shape in the other phase by the mitral valve simulator. However, the mitral valve is a thin object having a thickness of about 0.5 mm, and the resolution of CT and ultrasonography is almost the same as the thickness of the mitral valve. In addition, since the mitral valve moves at a high speed at the time of opening and closing, it is difficult to accurately segment the mitral valve on a CT image or an ultrasound image. Furthermore, although the anterior leaflet and the posterior leaflet overlap when the mitral valve is closed, it is difficult to determine whether two valves overlap or it is only one valve by resolution of CT and ultrasonography.
Therefore, when data assimilation is performed using a mitral valve shape including an error in segmentation, parameter estimation accuracy may be deteriorated. Therefore, it is necessary to correct the shape of the mitral valve based on knowledge, but there has been no valve correction method for the purpose of data assimilation so far.
Therefore, in the third embodiment, by correcting the length when the mitral valve is open by the length when the mitral valve is closed, the accuracy of the estimation of the simulation parameter is improved, and the simulation can be appropriately performed.
Here, in the present embodiment, the length of the valve is corrected in consideration of the following points. (1) The valve should be approximately equal in length when the valve is open and closed. However, since the pressure applied to the valve is larger when the valve is closed, it is assumed that the length is slightly longer when the valve is closed than the length when the valve is opened. (2) The area with which the valve is in contact when the valve is closed is not made too short, since it will not be in contact if the length of the valve when opened is too short. On the other hand, if the length of the valve is too long, the area that is not in contact with the valve is brought into contact with the valve. Therefore, the area that is not in contact with the valve is not made too long.
Here, the third embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 411 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 411 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 411 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 412.
In addition, the control function 411 can estimate parameters for the simulation by data assimilation and perform the simulation using the estimated parameters.
The image data acquisition function 412 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 412 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 412 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. For example, the image data acquisition function 412 acquires a first medical image and a second medical image scanned at least at a first timing and at a second timing different from the first timing. Note that the image data acquisition function 412 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The shape acquisition function 413 acquires a shape data for the medical image acquired by the image data acquisition function 412. Specifically, the shape acquisition function 413 acquires first shape data related to the structure of interest from the first medical image data and second shape data related to the structure of interest from the second medical image data. Here, the structure of interest is a cardiac valve. Note that the processing by the shape acquisition function 413 will be described in detail later.
The shape correction function 414 corrects the first shape data based on the second shape data. Specifically, the shape correction function 414 corrects the first shape data based on the mechanical field in the first phase and the second phase and the contact state of the shape of the structure of interest in the second phase. Here, the first phase is an open phase of the cardiac valve and the second phase is a closed phase of the cardiac valve. The shape correction function 414 calculates a third length obtained by correcting the second length that is the length of the valve leaflet in the first phase based on the first length that is the length of the valve leaflet in the second phase. Note that the processing by the shape correction function 414 will be described in detail later.
The processing circuitry 41 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 41 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 41 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3b will be described with reference to
For example, as illustrated in
Subsequently, the shape acquisition function 413 extracts, for the plurality of acquired medical images, a structure of an anatomical structure (structure of interest) at two time points included in the medical image (step S302). This processing is realized, for example, by the processing circuitry 41 calling and executing a program corresponding to the shape acquisition function 413 from the storage circuitry 34.
Subsequently, the control function 411 estimates parameters of the simulation by data assimilation using the closed/open phase mitral valve shape (step S303), performs the simulation (step S304). This processing is realized, for example, by the processing circuitry 41 calling and executing a program corresponding to the control function 411 from the storage circuitry 34.
Subsequently, the shape correction function 414 determines the contact state of the mitral valve in the open phase (step S305). This processing is realized, for example, by the processing circuitry 41 calling and executing a program corresponding to the shape correction function 414 from the storage circuitry 34.
Subsequently, the shape correction function 414 compares the length of the mitral valve in the open phase with the length of the mitral valve in the closed phase (step S306), estimates the length (size) of the mitral valve in the shape of the mitral valve in the closed phase obtained from the shape data in the open phase by simulation (step S307), and corrects the length of the mitral valve in the open phase (step S308). This processing is realized, for example, by the processing circuitry 41 calling and executing a program corresponding to the shape correction function 414 from the storage circuitry 34.
Subsequently, the control function 411 estimates parameters of the simulation by data assimilation using the open phase mitral valve shape with the corrected shape and the closed phase mitral valve shape (step S309), performs the simulation (step S310), and displays the result (step S311). This processing is realized, for example, by the processing circuitry 41 calling and executing a program corresponding to the control function 411 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3b will be described. Note that, in the following, processing in a case where the mitral valve is set as the structure of interest and the shape of the mitral valve in the open phase is corrected from the shape of the mitral valve in the closed phase will be described as an example. Note that the target of the processing described in the present embodiment is not limited thereto, and for example, an aortic valve, a tricuspid valve, or the like may be the structure of interest. In the following description, a case where a CT image is used will be described as an example, but an MR image or an ultrasound image may be used as a medical image.
As described in step S301 of
As described in step S302 of
As described in step S303 of
Determining Processing of Contact State of Valve As described in step S305 of
Here, the shape correction function 414 can change the determination method for each area. For example, for a region empirically known that the valve is thick, it may be determined whether or not the distance between the node points of the anterior leaflet and the posterior leaflet is within 2 mm, and for a region empirically known that the valve is thin, it may be determined whether or not the distance is within 1 mm. Further, when the contact state of the valve is determined, the determination may be made only by the node as described above, or the determination may be made using other than the node (such as a line segment connecting the node and the node).
In addition, the determination of the contact state of the valve may be made on the basis of whether or not regurgitation has occurred using the ultrasound image, or may be made when a result determined by a doctor is acquired.
As described above, the shape correction function 414 determines the contact state of the mitral valve and corrects the length of the valve according to the contact state.
As described in step S306 in
Here, the shape correction function 414 uses the length of one point on the valve annulus and the node of the valve leaflet end as the length of the valve.
The shape correction function 414 calculates the correct (closed) length from the shape of the mitral valve in the open phase and calculates the correct (closed) length from the shape of the mitral valve in the closed phase. Then, the shape correction function 414 compares the calculated lengths. Here, the shape correction function 414 compares lengths of the anterior leaflet and the posterior leaflet at the same node number at the valve leaflet end.
Note that the comparison of the lengths is not limited to the case of comparing with the same node number described above, and may be performed in other points. For example, the shape correction function 414 may register the mitral valve in the open phase and the mitral valve in the closed phase to specify points at corresponding positions and compare the specified points. The shape correction function 414 can also remesh the mesh representing the valve to specify corresponding points and compare the specified points.
As described in step S307 of
Then, the shape correction function 414 calculates a personalized parameter a reflecting the difference between the correct (closed) size and the simulation (closed) size. For example, the shape correction function 414 calculates “a=simulation (closed) size/correct (closed) size”. That is, a is larger than 1 in the case of “simulation (closed) size>correct (closed) size”, and a is less than 1 in the case of “simulation (closed) size<correct (closed) size”. Note that the personalized parameter a is optimized similarly to other parameters (pressure applied to valve, Young's modulus of valve, etc.) at the time of data assimilation.
As described in step S308 of
First, correction processing in the valve contact portion will be described. The shape correction function 414 corrects the correct (open) length (second length) of the valve contact portion in contact with the valve in the mitral valve in the open phase to a length obtained by converting the correct (closed) length (first length) by a ratio based on the mechanical field. For example, as illustrated in
Here, the direction in which the valve is stretched is a direction perpendicular to the approximate plane of the valve annulus and directed from LA to LV.
Note that the direction in which the valve is stretched is not limited to the above-described direction, and the valve may be stretched in other directions. For example, the shape correction function 414 can stretch the tip of the valve in a reverse vector direction opposite to a vector facing the LA direction among vectors formed by a node to be stretched and a node joined to the node. In addition, the shape correction function 414 can stretch the tip of the valve in a reverse vector direction of a vector obtained by acquiring and averaging a plurality of vectors formed by a node to be stretched and a node joined to the node. The shape correction function 414 can also stretch the valve randomly.
Next, correction processing in the non-valve contact portion will be described. The shape correction function 414 corrects the correct (open) length (second length) of the non-valve contact portion with which the valve is not in contact in the mitral valve in the open phase using the ratio between the size of the mitral valve in the shape of the mitral valve in the closed phase (second shape data) and the size of the mitral valve in the shape of the mitral valve obtained by simulation (third shape data).
For example, as illustrated in
On the other hand, in the case of “a<1”, the shape correction function 414 compares the size relationship between the correct (open) length and a×correct (closed) length. Here, in the case of “correct (open) length>a×correct (closed) length”, the shape correction function 414 keeps the correct (open) length as it is. On the other hand, in the case of “correct (open) length<a×correct (closed) length”, the shape correction function 414 converts the correct (open) length into “a×correct (closed) length”.
As described in step S309 of
As described in step S311 of
The stretching magnification described in the above embodiment may be dynamically changed according to the disease classification of the valve, the simulation result, the state of the valve, the type of medical image, the type of surgery, the condition of the simulation, and the like. For example, the valve may be 1.2 times in the case of type II, and 1.1 times in the case of type I. In addition, for example, in a case where the valve is not joined in the shape of the mitral valve in the closed phase, it may be 1.2 times. Alternatively, the tension of the chordae tendineae may be estimated, and the length of the valve may be multiplied by M according to the estimated tension of the chordae tendineae. Further, when the vertical stress applied to the valve exceeds the threshold value, the vertical stress may be multiplied by 1.1. In addition, in a case where there is calcification, it may be 1.2 times, and in a case where the valve is wobbled, it may be 1.1 times. Alternatively, the magnification may be changed according to the size of the mesh in the simulation. In addition, for example, a region in which the valve is not stretched, such as a region in which the valve is not stretched in the vicinity of the commissure, may be set.
As described above, according to the third embodiment, the image data acquisition function 412 acquires first medical image data and second medical image data scanned at least at the first timing and at the second timing different from the first timing. The shape acquisition function 413 acquires first shape data related to the structure of interest from the first medical image data and second shape data related to the structure of interest from the second medical image data. The shape correction function 414 corrects the first shape data based on the second shape data. The shape correction function 414 corrects the first shape data based on the mechanical field in the first phase and the second phase and the contact state of the shape of the structure of interest in the second phase. Therefore, the medical image processing apparatus 3b according to the third embodiment can appropriately correct shape data, improve parameter estimation accuracy, and appropriately perform simulation.
In addition, according to the third embodiment, the first phase is the open phase of the cardiac valve and the second phase is the closed phase of the cardiac valve, and the shape correction function 414 calculates the third length obtained by correcting the second length that is the length of the valve leaflet in the first phase based on the first length that is the length of the valve leaflet in the second phase. Therefore, the medical image processing apparatus 3b according to the third embodiment can appropriately correct shape data of a cardiac valve, and appropriately perform simulation of the cardiac valve.
In addition, according to the third embodiment, the shape correction function 414 corrects the second length of the contact portion with which the valve is in contact in the cardiac valve in the open phase to a length obtained by converting the first length by a ratio based on the mechanical field. Therefore, the medical image processing apparatus 3b according to the third embodiment makes it possible to appropriately correct the length of the contact portion in the cardiac valve.
In addition, according to the third embodiment, the control function 411 acquires the third shape data regarding the structure of interest in the closed phase by simulation using the first shape data. The shape correction function 414 corrects the second length of the non-contact portion with which the valve is not in contact in the cardiac valve in the open phase using the ratio between the size of the cardiac valve in the second shape data and the size of the cardiac valve in the third shape data. Therefore, the medical image processing apparatus 3b according to the third embodiment makes it possible to appropriately correct the length of the non-contact portion in the cardiac valve.
In a fourth embodiment, a method for distributing the tension of the chordae tendineae of the cardiac valve and making the shape of the cardiac valve appropriate will be described. As described in the first embodiment, the simulator predicts, for example, a treatment result by a treatment method input by a doctor. As a result, the doctor can accurately predict the result after the treatment, and can improve the accuracy of the treatment plan. For example, a mitral valve simulator for the purpose of predicting the prognosis of a valve replacement operation or a valvuloplasty typically cites or predicts a formula representing a physical property value and a deformation from a literature value for a shape including a mitral valve and chordae tendineae as an object.
Here, the chordae tendineae are thin threads joined to the mitral valve and strongly affect the movement of the valve. The chordae tendineae join the mitral valve and the papillary muscle, and are made of a material having almost no extension, so that the mitral valve is prevented from rolling up to the LA side. There are several types of chordae tendineae, and they differ in junction position, thickness, and the like. Typical examples of the chordae tendineae include a marginal chord, a strut chord, and a basal chord.
As described above, chordae tendineae strongly affect the dynamics of the mitral valve, but it is difficult to completely capture the chordae tendineae in a CT image or an ultrasound image due to their thinness. Thus, data assimilation may estimate where in the mitral valve and how much chordae tendineae are joined. However, since the number of chordae tendineae is considerably large and the number varies depending on the patient, there is a disadvantage that it is difficult to completely model the chordae tendineae and it takes time to estimate the chordae tendineae. Therefore, in existing studies, a representative chordae tendineae model that collectively represents the effects of a plurality of chordae tendineae is often introduced.
However, strong tension is applied to the connection position between the representative chordae tendineae and the valve, and no tension is applied to the non-connection position. Therefore, since the chordae tendineae installation position is strongly pulled by the chordae tendineae, the shape of the valve forms a zigzag pattern, and an error occurs between the simulation result and the actual shape of the mitral valve.
Therefore, in the fourth embodiment, when the tension of the chordae tendineae is calculated, force is distributed to several pixels around the connection position between the representative chordae tendineae and the valve, so that the accuracy of the estimation of the shape of the cardiac valve is improved and the simulation can be appropriately performed.
Here, the fourth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 421 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 421 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 421 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 422.
The image data acquisition function 422 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 422 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 422 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. Note that the image data acquisition function 422 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The specifying function 423 specifies shape data related to the structure of interest included in the medical image. Specifically, the specifying function 423 specifies the shape data of the cardiac valve included in the medical image. Note that the processing by the specifying function 423 will be described in detail later.
The providing function 424 provides data regarding a structure simulating a predetermined anatomical feature to the shape data. Specifically, the providing function 424 provides data related to the chordae tendineae to the shape data of the cardiac valve. Note that the processing by the providing function 424 will be described in detail later.
The calculation function 425 calculates deformation of the shape data based on the mechanical condition caused by the structure. In addition, the calculation function 425 calculates the deformation of the shape data on the basis of the mechanical conditions dispersed by the reconfiguring function 426. Specifically, the calculation function 425 calculates the deformation of the shape data of the cardiac valve on the basis of dispersion points set by the reconfiguring function 426. More specifically, the calculation function 425 can estimate parameters for simulation by data assimilation using dispersion points and perform the simulation using the estimated parameters. Note that the processing by the calculation function 425 will be described in detail later.
The reconfiguring function 426 reconfigures the conditions so as to disperse the mechanical conditions caused by the structure in the vicinity of the junction between the structure and the shape data. Specifically, the reconfiguring function 426 sets the dispersion points so as to disperse the mechanical conditions caused by the chordae tendineae in the vicinity of the junction between the chordae tendineae and the shape data of the cardiac valve. Note that the processing by the reconfiguring function 426 will be described in detail later.
The processing circuitry 42 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 42 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 42 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3c will be described with reference to
For example, as illustrated in
Subsequently, the specifying function 423 extracts, for the plurality of acquired medical images, a structure of the cardiac valve (structure of interest) at two time points (step S402). This processing is realized, for example, by the processing circuitry 42 calling and executing a program corresponding to the specifying function 423 from the storage circuitry 34.
Subsequently, the providing function 424 installs the representative chordae tendineae in the open phase based on the shape of the cardiac valve (step S403). This processing is realized, for example, by the processing circuitry 42 calling and executing a program corresponding to the providing function 424 from the storage circuitry 34.
Subsequently, the reconfiguring function 426 sets dispersion points of force in the open phase (step S404). This processing is realized, for example, by the processing circuitry 42 calling and executing a program corresponding to the reconfiguring function 426 from the storage circuitry 34.
Subsequently, the calculation function 425 estimates parameters by data assimilation using dispersion points (step S405), and performs simulation (step S406). This processing is realized, for example, by the processing circuitry 42 calling and executing a program corresponding to the calculation function 425 from the storage circuitry 34. Subsequently, the control function 421 displays the result (step S407). This processing is realized, for example, by the processing circuitry 42 calling and executing a program corresponding to the control function 421 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3c will be described. Note that, hereinafter, processing in a case where the mitral valve is the structure of interest will be described as an example. Note that the target of the processing described in the present embodiment is not limited thereto, and for example, an aortic valve, a tricuspid valve, or the like may be the structure of interest. In the following description, a case where a CT image is used will be described as an example, but an MR image or an ultrasound image may be used as a medical image.
As described in step S401 of
Note that the image data acquisition function 422 can estimate the mid-diastolic phase or the mid-systolic phase, for example, from an electrocardiogram or the like. Further, the image data acquisition function 422 can estimate the mid-diastolic phase or the mid-systolic phase from the shape of the aortic valve or the shape of the LV. Furthermore, the mid-diastolic phase and the mid-systolic phase are merely examples, and the phase in which the mitral valve is closed needs only to be not the diastole. In addition, the phase in which the mitral valve is open needs only to be not the systole.
As described in step S402 of
As described in step S403 of
Note that the method of setting the chordae tendineae may be designated by a doctor in addition to the method described above. In addition, a portion to which chordae tendineae should not be attached (valve annulus portion or the like) may be set, and the chordae tendineae may be set in other regions randomly. The valve may also be divided into several regions based on the area, and chordae tendineae designated may be set randomly in the regions. In addition, the type of chordae tendineae (basal chordae, marginal chordae, etc.) may be classified, and the physical property value may be changed according to the type of chordae tendineae. In addition, the position of the chordae tendineae may be subject to data assimilation.
As described in step S404 of
The number of dispersion points is not limited to the number described above. For example, the number of vicinities may be determined according to the area of the valve. As an example, the number of dispersion points may be increased as the area of the valve is increased. Further, the position to be dispersed may be changed based on the structure of the valve. For example, when the nearby valve is greatly deviated from the position of the chordae tendineae due to the valve being cut, the dispersion point of the chordae tendineae does not need to be set. In addition, the number of vicinities may be determined according to the stress applied to the valve. For example, when the stress applied to the valve exceeds a threshold value, the dispersion range may be expanded. In addition, the point (node) to be dispersed is not limited to the neighboring point, and may be installed by skipping one point.
In addition, data assimilation may be performed on how many vicinities are set, and data assimilation may be performed on how much dispersion is performed. In addition, the direction of the force may be the direction of the chordae tendineae of the dispersion source, or a vector directed from the dispersion point to the position of the papillary muscle may be used as the direction vector of the force assuming the position of the papillary muscle.
As described in step S405 of
The parameter that does not undergo data assimilation may be a value cited from a literature value or the like, or may be set by an empirical rule. In addition, a possible range of the parameter may be set on the basis of a literature value or an empirical rule, and may be randomly set within the range.
The calculation function 425 simulates the mitral valve in the closed phase from the mitral valve in the open phase in which the representative chordae tendineae, dispersion points, and tension are set by the reconfiguring function 426, and performs data assimilation to estimate parameters such that the shapes of the extracted closed phase match.
As described in step S406 in
As described in step S407 of
As described above, according to the fourth embodiment, the image data acquisition function 422 acquires medical image data. The specifying function 423 specifies shape data related to the structure of interest included in the medical image data. The providing function 424 provides data regarding a structure simulating a predetermined anatomical feature to the shape data. The calculation function 425 calculates deformation of the shape data based on the mechanical condition caused by the structure. The reconfiguring function 426 reconfigures the conditions so as to disperse the mechanical conditions caused by the structure in the vicinity of the junction between the structure and the shape data. The calculation function 425 calculates the deformation of the shape data on the basis of the mechanical conditions dispersed by the reconfiguring function 426. Therefore, the medical image processing apparatus 3c according to the fourth embodiment can disperse the force applied to the shape data, and smooths the shape of the shape data to enable simulation to be appropriately performed.
Furthermore, according to the fourth embodiment, the specifying function 423 specifies the shape data of the cardiac valve included in the medical image data. The providing function 424 provides data related to the chordae tendineae to the shape data of the cardiac valve. The reconfiguring function 426 sets the dispersion points so as to disperse the mechanical conditions caused by the chordae tendineae in the vicinity of the junction between the chordae tendineae and the shape data of the cardiac valve. The calculation function 425 calculates the deformation of the shape data of the cardiac valve on the basis of dispersion points set by the reconfiguring function 426. Therefore, the medical image processing apparatus 3c according to the fourth embodiment can disperse the force applied to the cardiac valve from the chordae tendineae, and enables simulation of the cardiac valve to be appropriately performed.
In a fifth embodiment, a method of introducing an offset error representing a dependent error into a loss function for performing data assimilation will be described. In a simulator of mitral regurgitation, a circuit model is one of the low computational cost approaches. The circuit model is a calculation method specialized for simply modeling blood flow, and represents blood flow as current, blood pressure as voltage, phase difference of blood flow as coil, blood flow resistance as resistance, dilation of blood vessel as compliance, and valve as diode. As a result, for example, the left ventricle can be represented as three components of a resistor, a coil, and a capacitor, or the veins of the whole body can be represented as two components of a resistor and a coil, so that the whole body blood flow can be calculated at a high speed.
Circuit models in the treatment of mitral regurgitation typically represent the mitral valve with a diode and often also represent the resistance of the diode as a function of the valve orifice area. As a result, as the valve orifice area increases, the resistance decreases, and as a result, the blood flow flows.
The simulator can predict the flow volume of the mitral valve at that time, for example, by a doctor predicting the postoperative valve orifice area and inputting the postoperative valve orifice area into the model. As a result, the doctor can accurately predict the result after the treatment, and can improve the accuracy of the treatment plan. Such a simulator is required to have high prediction accuracy. In order to improve the prediction accuracy, data assimilation is performed to identify physical property values unique to the patient so as to match the data by an inverse problem. In the mitral valve simulator, for example, the density of blood flow, the resistance of the left ventricle, and the like apply to the physical property values unique to the patient.
When such a parameter is estimated, values such as a pressure and flow volume in a certain region are measured, and the parameter is optimized so that a simulation result becomes the pressure and the flow volume. Such data assimilation is a technique widely applied to weather prediction, car navigation, and the like. As a parameter update method, there are methods such as a Nelder-Mead method and a Kalman filter. Typically, a CT image of one heartbeat or an ultrasound image of one heartbeat is acquired, and values of volume changes of heart lumens (LV, LA, RV) obtained by segmentation from these images is often used as a measurement value. In addition, the pressures of the maximum value and the minimum value of the aorta are acquired by the cuff pressure, and are also used as measurement values. In addition, the blood flow of the upper arm or the lower limb is acquired by the Doppler, and is also used as a measurement value.
Here, while the cuff pressure can be measured at two time points of the upper and lower points, the measurement values of the volumes of LV, LA and RV, the blood flow of the upper arm and the lower limb, and the like can be measured at a plurality of points in one heartbeat (typically, about 20 points), and thus the measurement points are different. Therefore, in the related art, a loss function is designed using a reciprocal of the number of measurement points of data as a weight. However, in this method, since all errors are treated as independent errors, there is a problem that calculation time is required.
Therefore, in the fifth embodiment, by introducing the offset error represented by the dependent component into the configuration of the loss function, the convergence time is shortened as compared with the case where only the independent component is handled, and the simulation can be appropriately performed.
Here, the fifth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 431 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 431 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 431 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 432. In addition, the control function 431 can acquire clinical information of the subject from various external apparatuses connected to the network in response to an operation via the input interface 32. For example, the control function 431 acquires the third feature value from the clinical information. Here, the third feature value is, for example, a cuff pressure.
The image data acquisition function 432 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 432 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 432 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. Note that the image data acquisition function 432 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The feature value acquisition function 433 acquires a first feature value for each phase from multi-phase medical image data. Specifically, the feature value acquisition function 433 acquires the lumen volume of the heart for each phase from the multi-phase medical image data. Note that the processing by the feature value acquisition function 433 will be described in detail later.
The estimation function 434 estimates time-series data of the second feature value related to the first feature value by simulating the multi-phase medical image data. Specifically, the estimation function 434 estimates time-series data indicating a change in the lumen volume of the heart by simulation. Here, the loss function for data assimilation in the simulation includes an offset error and an independent error regarding a change in lumen volume. Alternatively, the loss function includes an offset error, an independent error related to a change in the lumen volume, and an independent error related to the cuff pressure. Note that the processing by the estimation function 434 will be described in detail later.
The calculation function 435 calculates an offset error based on multi-phase data on the basis of the first feature value and the second feature value for each phase. Specifically, the calculation function 435 calculates the offset error based on the lumen volume acquired from each of the multi-phase medical image data and the lumen volume estimated by simulation. Note that the processing by the calculation function 435 will be described in detail later.
The processing circuitry 43 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 43 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 43 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3d will be described with reference to
For example, as illustrated in
Subsequently, the feature value acquisition function 433 extracts a lumen of the heart (structure of interest) for the acquired multi-phase medical images (step S502), and acquires a change in lumen volume on the basis of the extracted lumen (step S503). This processing is realized, for example, by the processing circuitry 43 calling and executing a program corresponding to the feature value acquisition function 433 from the storage circuitry 34.
Subsequently, the control function 431 acquires the cuff pressure from the clinical information (step S504). This processing is realized, for example, by the processing circuitry 43 calling and executing a program corresponding to the control function 431 from the storage circuitry 34.
Subsequently, the calculation function 435 calculates an offset error of the change in the lumen volume, and sets the offset error, and a loss function including the change in the lumen volume and the error in the cuff pressure (step S505). This processing is realized, for example, by the processing circuitry 43 calling and executing a program corresponding to the calculation function 435 from the storage circuitry 34.
Subsequently, the estimation function 434 estimates parameters by data assimilation using the loss function that has been set (step S506), and performs simulation (step S507). This processing is realized, for example, by the processing circuitry 43 calling and executing a program corresponding to the estimation function 434 from the storage circuitry 34.
Subsequently, the control function 431 displays the result (step S508). This processing is realized, for example, by the processing circuitry 43 calling and executing a program corresponding to the control function 431 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3d will be described. Additionally, although a case where the lumen of the heart is extracted from the CT image will be described below, the medical image may be an MR image or an ultrasound image. In addition, a case where the lumen volume is used as the first feature value acquired from the image will be described, but the first feature value is not limited thereto, and a flow rate of blood flow at a predetermined position may be used.
As described in step S501 of
As described in step S502 of
As described in step S503 of
As described in step S504 of
As described in step S505 of
Therefore, in the calculation function 435, as illustrated in
The loss function includes at least an error of the measured value of the lumen volume and an error of the cuff pressure in addition to the offset error representing the dependent component. These errors are independent components, and optimization is performed so that the points coincide with each other. Here, the loss function includes an offset error of each lumen (LV, LA, RV, etc.) of the heart and an error in each phase of the lumen (LV, LA, RV, etc.) of the heart.
As described in step S506 of
As described in step S507 of
As described in step S508 of
In the above embodiment, the case where the offset error is set for each lumen of the heart has been described. However, the embodiment is not limited thereto, and for example, one offset error may be set for all the lumens of the heart.
The offset error can be appropriately set according to the situation. For example, when the measured modalities are different, different offset errors may be set. In addition, in a case where the number of measurement points is different, the offset error may be set in a case where there are two times or more of the minimum number of measurement points. Furthermore, in a case where the imaging date and time are different or the segmentation algorithm is different, different offset errors may be set.
As described above, according to the fifth embodiment, the image data acquisition function 432 acquires multi-phase medical image data. The feature value acquisition function 433 acquires a first feature value for each phase from multi-phase medical image data. The estimation function 434 estimates time-series data of the second feature value related to the first feature value by simulating the multi-phase medical image data. The calculation function 435 calculates an offset error based on multi-phase data on the basis of the first feature value and the second feature value for each phase. The loss function of the estimation unit includes an offset error and an independent error related to the first feature value. Therefore, the medical image processing apparatus 3d according to the fifth embodiment can accelerate convergence of optimization, and enables simulation to be appropriately performed.
In addition, according to the fifth embodiment, the feature value acquisition function 433 acquires the lumen volume of the heart for each phase from the multi-phase medical image data. The estimation function 434 estimates time-series data indicating a change in the lumen volume of the heart by simulation. The calculation function 435 calculates the offset error based on the lumen volume acquired from each of the multi-phase medical image data and the lumen volume estimated by simulation. Therefore, the medical image processing apparatus 3d according to the fifth embodiment enables simulation related to the cardiac valve appropriately to be performed.
In addition, according to the fifth embodiment, the control function 431 acquires the third feature value from the clinical information. The loss function of the estimation unit includes an offset error, an independent error related to the first feature value, and an independent error related to the third feature value. Therefore, the medical image processing apparatus 3d according to the fifth embodiment enables simulation including clinical information to be appropriately performed.
In addition, according to the fifth embodiment, the control function 431 acquires the cuff pressure as the third feature value. Therefore, the medical image processing apparatus 3d according to the fifth embodiment can reduce the error of the lumen volume by the loss function including the offset error, reduce the imbalance between the error of the cuff pressure and the error of the lumen volume due to the data amount, and enable simulation to be appropriately performed.
In a sixth embodiment, a method of estimating an error of a simulation prediction result will be described. As described in the fifth embodiment, in a simulator of mitral regurgitation, a circuit model is one of the low computational cost approaches.
Circuit models in the treatment of mitral regurgitation typically represent the mitral valve with a diode and often also represent the resistance of the diode as a function of the valve orifice area. As a result, as the valve orifice area increases, the resistance is reduced, and a phenomenon in which a blood flow (current) flows more can be represented. In addition, the temporal change of the valve orifice area is represented by, for example, a maximum value and a minimum value of the valve orifice area, and an index indicating how the valve orifice area changes during one heartbeat. Thus, the change in the valve orifice area of one beat in various states of various patients can be represented by three variables.
As described in the fifth embodiment, the simulator can predict the flow volume of the mitral valve at that time, for example, by a doctor predicting the postoperative valve orifice area and inputting the postoperative valve orifice area into the model. As a result, the doctor can accurately predict the result after the treatment, and can improve the accuracy of the treatment plan. In such a simulator, in order to improve the prediction accuracy, data assimilation is performed to identify physical property values unique to the patient so as to match the data by an inverse problem.
Here, data assimilation is a method capable of estimating a parameter of a patient, but it is known in principle that errors are included or estimation results vary due to various factors. For example, when an error is included in the measured value, the estimation accuracy of the parameter decreases. Further, the optimization has initial value dependency, and different initial values may cause different parameter estimation results. In addition, parameters that do not undergo data assimilation are cited from literature values and the like, but since the values vary depending on the cited literature, it is conceivable that different parameter estimation results can be obtained depending on the cited values.
As described above, since the parameters obtained by the data assimilation include errors and variations, the mitral valve passing flow volume calculated using the parameters obtained by the data assimilation also has errors and variations. However, in the conventional simulation method, the prediction value is given at one point, and an error or variation is not considered.
In addition, in clinical practice, MR grade is known as a classification representing the degree of mitral regurgitation. MR grade is set in ESC guidelines and the like, and the severity of mitral valve regurgitation is classified into three stages (mild, moderate, severe) based on a plurality of measured values including the regurgitant orifice area and the regurgitant volume. However, there is no method of representing an estimation result estimated with an error or variation using MR grade.
Therefore, in the sixth embodiment, the reliability of the prediction result can be presented by estimating the error of the prediction result of the simulation, and the simulation can be appropriately performed.
Here, the sixth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 441 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 441 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 441 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 442. In addition, the control function 441 displays display information indicating an overall error in the first feature value. In addition, the control function 441 displays display information indicating the disease classification determined on the basis of the first feature value including the overall error. Note that the processing by the control function 441 will be described in detail later.
The image data acquisition function 442 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 442 acquires a medical image including morphology information of a three-dimensional anatomical structure (structure of interest) of a region of interest to be processed. Here, the image data acquisition function 442 can also acquire a plurality of medical images obtained by capturing a plurality of images in a three-dimensional time direction. Note that the image data acquisition function 442 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The extraction function 443 extracts the structure of interest on the basis of the medical image data. Specifically, the extraction function 443 extracts the lumen volume of the heart or the cardiac valve for each phase from the multi-phase medical image data. Note that the processing by the extraction function 443 will be described in detail later.
The parameter acquisition function 444 acquires a plurality of parameters to be input to the prediction model of the structure of interest. Specifically, the parameter acquisition function 444 acquires a plurality of predetermined measurement values and an initial value of optimization. Here, the plurality of predetermined measurement values are parameters whose numerical values are fixed in the optimization of the prediction model. In addition, the initial value of the optimization is a parameter whose numerical value is optimized in the optimization of the prediction model. That is, the parameter acquisition function 444 acquires a parameter that does not undergo data assimilation and a parameter that performs data assimilation. Note that the processing by the parameter acquisition function 444 will be described in detail later.
The estimation function 445 estimates a first feature value related to the structure of interest by inputting a plurality of parameters to the prediction model. Specifically, the estimation function 445 sets a numerical range for at least two of a plurality of predetermined measurement values, an initial value of optimization, and an extraction result of a structure of interest, and estimates the first feature value using a prediction model optimized under each condition in which a numerical value is changed in the set numerical range. Note that the processing by the estimation function 445 will be described in detail later.
The error calculation function 446 calculates an error of the first feature value. Specifically, the error calculation function 446 calculates at least two errors among an error based on a plurality of predetermined measurement values, an optimization initial value error and an extraction error of the structure of interest by the extraction function 443, and calculates an overall error based on the at least two errors. Note that the processing by the error calculation function 446 will be described in detail later.
The processing circuitry 44 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 44 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 44 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3e will be described with reference to
For example, as illustrated in
Subsequently, the extraction function 443 extracts the lumen of the heart for the acquired multi-phase medical images (step S602) and extracts the cardiac valve (step S603). This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the extraction function 443 from the storage circuitry 34.
Subsequently, the parameter acquisition function 444 specifies a parameter that does not undergo data assimilation (step S604). This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the parameter acquisition function 444 from the storage circuitry 34.
Subsequently, the estimation function 445 sets a level of a parameter that does not undergo data assimilation (step S605), specifies an extraction error of the lumen (step S606), and specifies an extraction error of the cardiac valve (step S607). This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the estimation function 445 from the storage circuitry 34.
Subsequently, the estimation function 445 estimates the parameters by data assimilation using the set parameter level, the extraction error of the lumen/cardiac valve, and the initial value having leeway (step S608). This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the estimation function 445 from the storage circuitry 34.
Subsequently, the estimation function 445 performs a simulation using each parameter (step S609), and the error calculation function 446 calculates an error on the basis of a plurality of simulation results. This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the estimation function 445 and the error calculation function 446 from the storage circuitry 34.
Subsequently, the control function 441 displays the result (step S610). This processing is realized, for example, by the processing circuitry 44 calling and executing a program corresponding to the control function 441 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3e will be described. Additionally, although a case where the lumen of the heart and the cardiac valve are extracted from the CT image will be described below, the medical image may be an MR image or an ultrasound image.
As described in step S601 of
As described in step S602 of
In addition, the blood flow rate of the brachial artery, the artery of the lower limb, or the carotid artery may be acquired by the Doppler echocardiographic method. Regarding the blood flow rate, it is conceivable to acquire measured values by time-discrete points at equal intervals in one heartbeat.
As described in step S603 of
As described in step S604 of
As described in step S605 of
Then, the estimation function 445 sets a level for the parameter for changing the level. For example, when the literature describes an average and a variance of parameter values, the estimation function 445 sets three levels of “average−variance”, “average”, and “average+variance”. Further, in a case where there is no description of average and variance in the literature, the estimation function 445 sets a level of “literature value ±10%”. Furthermore, the estimation function 445 can also set a level of “literature value×2” or “literature value×3” depending on the parameter. Alternatively, three levels of “average−variance”, “average”, and “average+variance” may be set using a value and a variance set on the basis of an empirical rule. Note that the level to be changed is not limited to three levels.
The estimation function 445 sets a level to be changed for the above-described parameters that do not undergo data assimilation. Further, the estimation function 445 sets a plurality of initial simplexes for parameters to be subjected to data assimilation. Here, an initial simplex is an initial value of a parameter group to be estimated when a multi-start optimization method such as a Nelder-Mead method is performed. For example, in a case where three parameters to be predicted are {a, b, c}, each of the initial values {a1, b1, c1} of a, b, and c is referred to as an initial simplex. Normally, about 10 to 20 initial simplexes are prepared for performing optimization.
For example, when setting the initial simplexes, a range of possible values of each parameter is set in advance from literature values or the like. The estimation function 445 randomly select the plurality of initial simplexes for parameters from the set range. Alternatively, the estimation function 445 divides the possible range into three, and sets any of the initial simplexes to be necessarily included in each of the three classifications. Alternatively, the estimation function 445 sets a Gaussian distribution in which the center of the range of possible values is an average and half of the range of possible values is 3σ, and select the plurality of initial simplexes for parameters based on the Gaussian distribution. Alternatively, the estimation function 445 can change the range of possible values of the parameter according to the patient. For example, since it is conceivable that the artery becomes harder as the age increases, the compliance of the blood vessel may be set to be small.
As described in steps S606 and S607 in
Here, the estimation function 445 can also change the value of the error according to the modality. For example, the estimation function 445 can also set the error in the case of CT as ±1 pixel and the error in the case of ultrasonography as ±2 pixel. Note that an error may be designated by a doctor. In addition, the value of the error may be changed according to the segmentation method. In addition, an error may be set on the basis of an empirical rule. In addition, the error may be changed depending on the phase. For example, the error may be set to be large in a phase in which the left ventricle moves at a high speed. Furthermore, it may be changed depending on the image quality or the contrast density.
When the error is set as described above, the estimation function 445 sets volume of the lumen and valve orifice areas within a range of the error in plural times.
As described in step S608 of
As described in step S609 of
The error calculation function 446 calculates an error using the simulation result predicted by the estimation function 445. For example, the error calculation function 446 calculates an average and a variance of the prediction result of the regurgitant volume. As an example, the error calculation function 446 calculates an error due to variation of an initial simplex, an error due to segmentation, an error due to a parameter that does not perform data assimilation, and the like from a simulation result under each condition.
As described in step S610 of
In addition, the control function 441 can collectively display some errors in the same color coding. For example, the control function 441 can color the segmentation error as a whole. In addition, the control function 441 can also display a level when the maximum value is taken and a level when the minimum value is taken side by side.
The control function 441 can also display the classification of the disease based on the error. Specifically, the control function 441 represents MR grade in five classifications of mild, mild-moderate, moderate, moderate-severe, and severe based on the calculated error. For example, the control function 441 determines which one of the five classifications the simulation result applies to, based on the classification to which the minimum value and the maximum value belong, among the plurality of calculated regurgitant volume results.
For example, when the minimum value of the obtained regurgitant volume is mild and the maximum value of the obtained regurgitant volume is moderate, the control function 441 classifies the obtained regurgitant volume as mild-moderate. When both the minimum value and the maximum value of the obtained regurgitant volume are moderate, the control function 441 classifies the obtained regurgitant volume as moderate. When the diseases are classified, the control function 441 can display not only the error bars but also the classifications.
In the above embodiment, the case where the parameters are estimated for all the levels has been described, but the embodiment is not limited thereto, and the parameter does not need to be estimated for a level at which it is known that the result of the simulation is not minimum or maximum.
In a case where the minimum value is mild and the maximum value is severe, it may be displayed that the error is too large. Furthermore, an error that can be reduced may be displayed. For example, the segmentation error can be reduced by changing the modality or manually segmenting. In addition, the size of the error bar after the error is reduced may be displayed.
As described above, according to the sixth embodiment, the image data acquisition function 442 acquires medical image data. The extraction function 443 extracts the structure of interest on the basis of the medical image data. The parameter acquisition function 444 acquires a plurality of parameters to be input to the prediction model of the structure of interest. The estimation function 445 estimates a first feature value related to the structure of interest by inputting a plurality of parameters to the prediction model. The error calculation function 446 calculates an error of the first feature value. The error calculation function 446 calculates at least two errors among an error based on a plurality of predetermined measurement values, an optimization initial value error and an extraction error of the structure of interest by the extraction unit, and calculates an overall error based on the at least two errors. Therefore, the medical image processing apparatus 3e according to the sixth embodiment can estimate an error for each factor, and enables simulation to be appropriately performed.
In addition, according to the sixth embodiment, the estimation function 445 sets a numerical range for at least two of a plurality of predetermined measurement values, an initial value of optimization, and an extraction result of a structure of interest, and estimates the first feature value using a prediction model optimized under each condition in which a numerical value is changed in the set numerical range. The error calculation function 446 calculates at least two errors based on the first feature value under each condition. Therefore, the medical image processing apparatus 3e according to the sixth embodiment can estimate an error for each factor.
Further, according to the sixth embodiment, the plurality of predetermined measurement values are parameters whose numerical values are fixed in the optimization of the prediction model. Therefore, the medical image processing apparatus 3e according to the sixth embodiment enables an error due to a parameter that does not undergo data assimilation to be estimated.
In addition, according to the sixth embodiment, the initial value of the optimization is an initial value of a parameter whose numerical value is optimized in the optimization of the prediction model. Therefore, the medical image processing apparatus 3e according to the sixth embodiment enables an error due to an initial simplex to be estimated.
In addition, according to the sixth embodiment, the control function 441 displays display information indicating an overall error in the first feature value. Therefore, the medical image processing apparatus 3e according to the sixth embodiment enables error information to be provided.
In addition, according to the sixth embodiment, the control function 441 displays display information indicating the disease classification determined on the basis of the first feature value including the overall error. Therefore, the medical image processing apparatus 3e according to the sixth embodiment enables the prediction result with an error to be represented using the disease classification.
In a seventh embodiment, a method for simply estimating the flow volume of the mitral valve will be described. As described in the fifth embodiment, in a simulator of mitral regurgitation, a circuit model is one of the low computational cost approaches.
Circuit models in the treatment of mitral regurgitation typically represent the mitral valve with a diode and often also represent the resistance of the diode as a function of the valve orifice area. As a result, as the valve orifice area increases, the resistance is reduced, and a phenomenon in which a blood flow (current) flows more can be represented. In addition, the temporal change of the valve orifice area is represented by, for example, a maximum value and a minimum value of the valve orifice area, and an index indicating how the valve orifice area changes during one heartbeat. Thus, the change in the valve orifice area of one beat in various states of various patients can be represented by three variables.
The simulator can predict the flow volume of the mitral valve at that time, for example, by a doctor predicting the postoperative valve orifice area and inputting the postoperative valve orifice area into the model. As a result, the doctor can accurately predict the result after the treatment, and can improve the accuracy of the treatment plan. However, it is not always possible to acquire the measurement value used for the circuit model, and there is no method for simply estimating the regurgitant volume even with a small amount of data.
Therefore, in the seventh embodiment, by assuming the flow volume of the mitral valve in the early-systolic phase, the valve orifice area in the early-systolic phase, the time when the maximum pressure occurs, and the pressure gradient between the left ventricle and the left atrium, it is possible to estimate the regurgitant volume of the mitral valve from the measurement value of the valve orifice area in the open phase, the measurement value of the valve orifice area in the closed phase, and the measurement value of the cuff pressure.
Here, the seventh embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 451 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 451 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 451 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 452.
The image data acquisition function 452 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 452 acquires medical images of at least two phases. Note that the image data acquisition function 452 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The specifying function 453 specifies first feature value in medical image data of at least two phases. Specifically, the specifying function 453 specifies the valve orifice area in the medical image data of the open phase of the mitral valve and the valve orifice area in the medical image data of the closed phase of the mitral valve. Note that the processing by the specifying function 453 will be described in detail later.
The acquisition function 454 acquires the second feature value from the clinical information. Specifically, the acquisition function 454 acquires the cuff pressure from the clinical information. Note that the processing by the acquisition function 454 will be described in detail later.
The calculation function 455 calculates a third feature value based on the first feature value and the second feature value. Specifically, the calculation function 455 calculates a pressure gradient between the left atrium and the left ventricle based on the second feature value, calculates the flow rate in the early-systolic phase and a valve orifice area in the early-systolic phase based on the first feature value and the second feature value, and calculates a third feature value based on the pressure gradient, the first feature value, the second feature value, the flow volume in the early-systolic phase, and the valve orifice area in the early-systolic phase. More specifically, the calculation function 455 calculates the flow volume in the mitral valve based on the pressure gradient, the valve orifice area in the open phase, the valve orifice area in the closed phase, the flow volume in the early-systolic phase, and the valve orifice area in the early-systolic phase. Note that the processing by the calculation function 455 will be described in detail later.
The processing circuitry 45 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 45 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 45 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3f will be described with reference to
For example, as illustrated in
Subsequently, the image data acquisition function 452 acquires a medical image of the subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 (step S702). Specifically, the image data acquisition function 452 acquires medical images of at least two phases. This processing is realized, for example, by the processing circuitry 45 calling and executing a program corresponding to the image data acquisition function 452 from the storage circuitry 34.
Subsequently, the specifying function 453 extracts the mitral valve from the acquired medical image of two phases, and acquires values of the valve orifice area (closed) which is the valve orifice area in the closed phase and the valve orifice area (open) which is the valve orifice area in the open phase (step S703). This processing is realized, for example, by the processing circuitry 45 calling and executing a program corresponding to the specifying function 453 from the storage circuitry 34.
Subsequently, the calculation function 455 calculates the time evolution by the circuit model (step S704). Specifically, the calculation function 455 calculates the flow volume of the mitral valve. This processing is realized, for example, by the processing circuitry 45 calling and executing a program corresponding to the calculation function 455 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3f will be described. Additionally, although a case where the lumen of the heart and the cardiac valve are extracted from the CT image will be described below, the medical image may be an MR image or an ultrasound image.
As described in step S701 of
As described in step S702 of
As described in step S703 of
As described in step S704 of
Here, “Qvalve” in Formula (1) is the mitral valve passing flow volume, “PP” is the left ventricular pressure, “Pd” is the left atrial pressure, “βbl” is the blood density (constant), “leff”, “KVO”, and “KVC” are constants (obtained from literature values), “ζ” is a variable (when ζ=1, the mitral valve opens the most, and when ζ=0, the mitral valve closes the most) taken between 0 and 1 and related to the opening degree of the valve opening of the mitral valve, “Aeff” is the valve orifice area of the mitral valve, “Lvalve” is a function of “Aeff”, “leff”, and “ρbl”, and “Bvalve” is a function of “ρbl” and “Aeff”.
As shown in Formula (1), the pressure difference between the left atrium and the left ventricle is determined by the square value of the flow volume and the time change of the flow volume. The calculation function 455 calculates the regurgitant volume by substituting a numerical value into the time evolution equation of Formula (1). As described above, in the present embodiment, the calculation is performed assuming the valve orifice area at the early-systolic phase, the flow volume in the early-systolic phase, the time when the LA-LV pressure gradient is maximized, and the time change in the LA-LV pressure gradient. That is, the calculation function 455 calculates the flow volume of the mitral valve in order from the flow volume in the early-systolic phase to the late-systolic phase due to time evolution based on Formula (1), and specifies the maximum regurgitant volume.
For example, the calculation function 455 calculates “Lvalve” and “Bvalve” using “18%” of the valve orifice area in the open phase calculated by the specifying function 453 as the valve orifice area in the early-systolic phase, and calculates the mitral valve passing flow volume at the next time point in the early-systolic phase by solving Formula (1) using the flow volume “Qvalve” in the early-systolic phase as “−5 ml” and “PP−Pd” as the value obtained from the quadratic curve of the upper value of the cuff pressure. The calculation function 455 further calculates the mitral valve passing flow volume at the next time point using the calculated mitral valve passing flow volume at the next time point. At this time, the valve orifice area and the function “ζ” at each time point are obtained by each equation included in Formula (1).
As described above, the calculation function 455 calculates the mitral valve passing flow volume in order from the early-systolic phase, and specifies the flow volume at which the flow volume to the left atrium side becomes the maximum (the numerical value of - becomes the maximum) as the maximum regurgitant volume.
In the above example, the valve orifice area at the early-systolic phase is set to “18%” of the valve orifice area of the open phase, but may be changed according to the clinical state. For example, “A %” may be set in a case where there is a cardiac arrhythmia. Further, in the example described above, the flow volume in the early-systolic phase is set to “−5 ml”, but may be changed according to the clinical state. For example, “B×(valve size) ml” may be set according to the size of the shape of the valve. Furthermore, for example, “C ml” may be used according to MR grade. Furthermore, for example, in a case where the regurgitant volume at the early-systolic phase can be acquired by an ultrasound image, the value may be adopted. Furthermore, for example, “(body weight)×D ml” may be set according to the physique.
In the example described above, the time at which the LA-LV pressure gradient is maximized is “0.13 seconds” from the early-systolic phase, but may be changed according to the clinical condition. In addition, the time change of the LA-LV pressure gradient is a quadratic curve of the upper value of the cuff pressure, but may be changed according to the clinical condition. For example, “E seconds” may be set in a case where there is a cardiac arrhythmia. In addition, for example, an F-th order curve may be used in a case where there is a cardiac arrhythmia.
As described in step S705 of
In the above embodiment, an example in which “leff”, “KVO”, and “KVC” are constants has been described, but the embodiment is not limited thereto, and for example, may be changed according to a patient. As an example, in a case where there is calcification, the “KVC” may be multiplied by 0.9.
As described above, according to the seventh embodiment, the image data acquisition function 452 acquires medical image data of at least two-phases. The specifying function 453 specifies first feature value in medical image data of at least two phases. The acquisition function 454 acquires the second feature value from the clinical information. The calculation function 455 calculates a third feature value based on the first feature value and the second feature value. The calculation function 455 calculates a pressure gradient between the left atrium and the left ventricle based on the second feature value, calculates the flow volume in the early-systolic phase and a valve orifice area at the early-systolic phase based on the first feature value and the second feature value, and calculates a third feature value based on the pressure gradient, the first feature value, the second feature value, the flow volume in the early-systolic phase, and the valve orifice area at the early-systolic phase. Therefore, the medical image processing apparatus 3f according to the seventh embodiment enables a feature value to be calculated easily from small data.
In addition, according to the seventh embodiment, the specifying function 453 specifies the valve orifice area in the medical image data of the open phase of the mitral valve and the valve orifice area in the medical image data of the closed phase of the mitral valve. The acquisition function 454 acquires the cuff pressure from the clinical information. The calculation function 455 calculates the flow volume in the mitral valve based on the pressure gradient, the valve orifice area in the open phase, the valve orifice area in the closed phase, the flow volume in the early-systolic phase, and the valve orifice area in the early-systolic phase. Therefore, in the medical image processing apparatus 3f according to the seventh embodiment, the values of the cuff pressure and the valve orifice area enable the flow volume in the mitral valve to be estimated easily.
In an eighth embodiment, a method for simply calculating the regurgitant orifice area of the mitral valve will be described. The mitral valve simulator simulates how the dynamics of the mitral valve changes when a treatment is performed. A doctor determines which treatment method improves the symptom of mitral regurgitation most based on the simulation result, and MR grade is one of the determination indices. MR grade is set in ESC guidelines and the like, and is classified into three stages from a plurality of measured values including a regurgitant orifice area, a regurgitant volume, and the like. Since the quantitative index related to the shape among the plurality of measured values is the valve orifice area, the doctor determines which treatment method is most suitable based on the rate of reducing the regurgitant orifice area among the simulation results.
However, there are not many methods for easily calculating the regurgitant orifice area of the mitral valve. Although there is also a method of obtaining the regurgitant orifice area from a geometric shape, the calculated valve orifice area has a weak correlation with the mitral regurgitant volume, and thus may have a value different from the regurgitant orifice area measured in actual clinical practice.
Therefore, in the eighth embodiment, it is possible to obtain a surface indicating the valve orifice and the valve orifice area value by the same simple calculation method regardless of the complexity of the shape.
Here, the eighth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 461 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 461 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 461 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 462.
The image data acquisition function 462 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 462 acquires medical images including a cardiac valve. Note that the image data acquisition function 462 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The specifying function 463 specifies the structure of interest included in the medical image data. Specifically, the specifying function 463 specifies the cardiac valve included in the medical image. Note that the processing by the specifying function 463 will be described in detail later.
The calculation function 464 calculates an index value related to the structure of interest. Specifically, the calculation function 464 sets a first region including a structure of interest therein, divides a surface of the first region on the basis of a shape of the structure of interest, sets a second region connecting a feature line of a region of interest and a boundary line dividing the surface of the first region, sets a different value in a predetermined physical quantity to each of surfaces divided in the first region, calculates a spatial field of the predetermined physical quantity in the first region on the basis of the predetermined physical quantity, and calculates an index value regarding the structure of interest on the basis of an isosurface of the physical quantity.
More specifically, the calculation function 464 sets the second region connecting the annular-side end portion of the cardiac valve and the boundary line dividing the surface of the first region, sets heat sources having different temperatures for each of the surfaces divided in the first region, calculates a temperature distribution in the first region, and calculates the valve orifice area of the cardiac valve on the basis of the isothermal surface in the temperature distribution. For example, the calculation function 464 calculates, as the valve orifice area of the cardiac valve, the area of the isothermal surface that is in contact with the cardiac valve and has the smallest area in the isothermal surface of the temperature distribution. Note that the processing by the calculation function 464 will be described in detail later.
The processing circuitry 46 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 46 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 46 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3g will be described with reference to
For example, as illustrated in
Subsequently, the specifying function 463 extracts the mitral valve from the acquired medical image (step S802). This processing is realized, for example, by the processing circuitry 46 calling and executing a program corresponding to the specifying function 463 from the storage circuitry 34.
Subsequently, the calculation function 464 sets a virtual region (first region) including the mitral valve (step S803), and sets a virtual partition in contact with the mitral valve (step S804). Furthermore, the calculation function 464 sets two different virtual heat sources on the surface of the region (step S805), and analyzes the temperature distribution in the region (step S806). Then, the calculation function 464 sets an isosurface (step S807) and calculates a minimum isosurface (step S808). This processing is realized, for example, by the processing circuitry 46 calling and executing a program corresponding to the calculation function 464 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3g will be described. Additionally, although a case where the mitral valve is extracted from the CT image will be described below, the medical image may be an MR image or an ultrasound image.
As described in step S801 of
As described in step S802 of
As described in step S803 of
Then, the calculation function 464 divides the surface of the region into two. For example, as illustrated in
Then, the calculation function 464 sets a heat source in one of the two divided regions and sets a different heat source in the other. For example, the calculation function 464 sets a high-temperature heat source (330 K) in region A, and sets a low-temperature heat source (300 K) in region B. Although the value of the heat source can be arbitrarily set, for example, the value may be set according to the ratio of the surface area.
Then, the calculation function 464 calculates a temperature distribution in the virtual region. Note that the valve and the virtual partition are made of a heat insulating material. Here, the calculation function 464 assumes that the temperature change at Δt is 10-6 K or less as a steady state, and calculates an isosurface of the temperature distribution. For example, the calculation function 464 extracts a temperature at each position in the virtual region, and sets a region having a temperature with a temperature range of 1 K (1 K or more and less than 2 K, or the like) as the isosurface.
Note that the temperature range of the isosurface can be arbitrarily set, but may be changed according to the difference between the heat sources. For example, the temperature range may be increased when the difference between the heat sources is large. In addition, the temperature range of the isosurface may be determined according to the number of calculation trials of calculation that becomes steady. In addition, the temperature range of the isosurface may be determined according to the size of the mesh.
When the isosurface is set in the virtual space as described above, the calculation function 464 calculates the area that comes into contact with the valve and has the smallest area of the isosurface as the valve orifice area. By calculating the valve orifice area in this manner, it is possible to calculate the valve orifice area in which the size of the area is reflected in the regurgitant volume. That is, when the heat source is regarded as pressure, the isosurface (isothermal surface) can be considered as an isokinetic surface in a steady state. Therefore, on the isosurface, the flow rate at “(flow volume)=(flow rate)×(valve orifice area)” is constant, and the magnitude of the valve orifice area is accurately reflected on the magnitude of the regurgitant volume.
The control function 461 displays the result on the display 33. For example, the control function 461 can color and display the region of the isosurface having the smallest area. In addition, for example, the control function 461 can smooth the region or display the region as a surface element. The control function 461 can also display a virtual partition or a virtual region. The control function 461 can also display a difference from other valve orifice area calculation methods.
As described above, according to the eighth embodiment, the image data acquisition function 462 acquires medical image data. The specifying function 463 specifies the structure of interest included in the medical image data. The calculation function 464 calculates an index value related to the structure of interest. The calculation function 464 sets the first region including a structure of interest therein, divides a surface of the first region on the basis of a shape of the structure of interest, sets the second region connecting a feature line of a region of interest and a boundary line dividing the surface of the first region, sets a different value in a predetermined physical quantity to each of surfaces divided in the first region, calculates a spatial field of the predetermined physical quantity in the first region on the basis of the predetermined physical quantity, and calculates an index value regarding the structure of interest on the basis of an isosurface of the physical quantity. Therefore, the medical image processing apparatus 3g according to the eighth embodiment makes it possible to calculate the index value of the structure of interest by a simple calculation method.
In addition, according to the eighth embodiment, the region of interest is a cardiac valve, and the calculation function 464 sets the second region connecting the annular-side end portion of the cardiac valve and the boundary line dividing the surface of the first region, sets heat sources having different temperatures for each of the surfaces divided in the first region, calculates a temperature distribution in the first region, and calculates the valve orifice area of the cardiac valve on the basis of the isothermal surface in the temperature distribution. Therefore, the medical image processing apparatus 3g according to the eighth embodiment makes it possible to calculate the valve orifice area of the cardiac valve by a simple calculation method.
In addition, according to the eighth embodiment, the calculation function 464 calculates, as the valve orifice area of the cardiac valve, the area of the isothermal surface that is in contact with the cardiac valve and has the smallest area in the isothermal surface of the temperature distribution. Therefore, the medical image processing apparatus 3g according to the eighth embodiment makes it possible to calculate the valve orifice area of the cardiac valve accurately.
In a ninth embodiment, a method of simply comparing a valve shape after treatment with a valve shape according to a simulation result will be described. Since valvuloplasty is a complicated procedure, it is sometimes desired to consider whether the performed procedure was appropriate later. For example, in a case where the procedure performed is Mitraclip, there is a case where it is desired to consider how it would have been if it had been placed in another size or in another position.
In such examination, a virtual therapy simulator (simulator) may be used. The simulator predicts, for example, a treatment result by a treatment method input by a doctor. As a result, the doctor can compare the actually performed procedure with another procedure to examine which is more appropriate.
However, it is difficult to easily compare the mitral valve shape after the treatment actually performed with the mitral valve shape according to the simulation result. Therefore, in the ninth embodiment, the cardiac valve is projected in the blood flow direction and compared two-dimensionally, so that it is possible to easily compare the mitral valve shape after the treatment actually performed with the mitral valve shape according to the simulation result. This also makes it possible to simply compare the position of the clip with the contact width.
Here, the ninth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 471 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 471 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 471 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 472.
In addition, the control function 471 can perform simulation to estimate the shape of the cardiac valve.
The image data acquisition function 472 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 472 acquires a first medical image collected at a first time point and a second medical image collected at a second time point. More specifically, the image data acquisition function 472 acquires a preoperative medical image and a postoperative medical image. Note that the image data acquisition function 472 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The extraction function 473 extracts a first anatomical structure from the first medical image and a second anatomical structure from the second medical image. Specifically, the extraction function 473 specifies the cardiac valve included in the medical image. Note that the processing by the specifying function 463 will be described in detail later.
The device information acquisition function 474 acquires information of a medical device included in the medical image. For example, the device information acquisition function 474 specifies the position of a medical device such as a clip based on shape data of the cardiac valve.
The processing function 475 performs alignment of the second anatomical structure with a third anatomical structure estimated based on the first anatomical structure. Specifically, the processing function 475 projects the second anatomical structure and the third anatomical structure onto a predetermined cross-section, obtains feature points and feature vectors from the projected second anatomical structure and the projected third anatomical structure, respectively, and performs a parallel translation for substantially matching the positions of the feature points and a rotational translation for translating the feature vectors in the projected second anatomical structure and the projected third anatomical structure.
For example, the processing function 475 projects the postoperative cardiac valve and the postoperative estimated cardiac valve in the blood flow direction, acquires line segments connecting the center of gravity and the commissure from the postoperative cardiac valve and the postoperative estimated cardiac valve, respectively, and performs a parallel translation for substantially matching the positions of the centers of gravity and a rotational translation for making the line segments connecting the commissures parallel in the postoperative cardiac valve and the postoperative estimated cardiac valve. Note that the processing by the processing function 475 will be described in detail later.
The designation function 476 designates the position of the device based on the result of the alignment by the processing function 475. For example, the designation function 476 receives designation of the position of the device in the simulation after the alignment by the processing function 475. When the position of the device is designated by the designation function 476, the control function 471 performs simulation based on the designated position of the device.
The processing circuitry 47 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 47 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 47 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3h will be described with reference to
For example, as illustrated in
Subsequently, the extraction function 473 extracts the mitral valve from the acquired preoperative medical image, and the control function 471 performs a simulation of the postoperative mitral valve (step S902). This processing is realized, for example, by the processing circuitry 47 calling and executing a program corresponding to the control function 471 and the extraction function 473 from the storage circuitry 34.
Subsequently, the image data acquisition function 472 acquires a postoperative medical image from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 (step S903). This processing is realized, for example, by the processing circuitry 47 calling and executing a program corresponding to the image data acquisition function 472 from the storage circuitry 34.
Subsequently, the extraction function 473 extracts the mitral valve from the acquired postoperative medical image (step S904). This processing is realized, for example, by the processing circuitry 47 calling and executing a program corresponding to the control function 471 and the extraction function 473 from the storage circuitry 34.
Subsequently, the processing function 475 calculates the center of gravity of the mitral valve obtained by the simulation and the postoperative mitral valve (step S905), and aligns the centers of gravity (step S906). Then, the processing function 475 rotates the mitral valve obtained by the simulation such that the line segments of the commissure of the mitral valve are parallel (step S907). This processing is realized, for example, by the processing circuitry 47 calling and executing a program corresponding to the processing function 475 from the storage circuitry 34.
Subsequently, the control function 471 displays the result (step S908) This processing is realized, for example, by the processing circuitry 47 calling and executing a program corresponding to the control function 471 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3h will be described. Additionally, although a case where the mitral valve is extracted from the ultrasound image will be described below, the medical image may be a CT image or an MR image. The target cardiac valve is not limited to the mitral valve, but may be an aortic valve or a tricuspid valve.
As described in step S901 and step S903 of
As described in step S902 and step S904 of
As described in step S902 of
As described in step S905 of
As described in step S906 of
As described in step S907 of
Then, the processing function 475 acquires line segments connecting the positions of the commissures for the mitral valve of the simulation result and the actual postoperative mitral valve. Note that not only the line segment connecting the commissures but also a cut of the valve compartment (P1, P2, etc.), the same chordae tendineae, or the like may be used as a reference. In addition, the reference line segment may be defined with variations.
As described above, acquiring the line segment of the commissures, the processing function 475 rotates the mitral valve obtained by the simulation such that the line segments of the commissure are parallel.
As illustrated in
The control function 471 displays the result on the display 33. For example, the control function 471 displays the mitral valve of the simulation result on which the alignment has been performed and the actual postoperative mitral valve. Here, the control function 471 can also display the clip position. In addition, the control function 471 can display the clip position actually placed and the clip position of the simulation result in different colors.
As described above, according to the ninth embodiment, the image data acquisition function 472 acquires the first medical image collected at the first time point and the second medical image collected at the second time point. The extraction function 473 extracts a first anatomical structure from the first medical image and a second anatomical structure from a second medical image. The processing function 475 performs alignment of the second anatomical structure with a third anatomical structure estimated based on the first anatomical structure. The processing function 475 projects the second anatomical structure and the third anatomical structure onto a predetermined cross-section, acquires feature points and feature vectors from the projected second anatomical structure and the projected third anatomical structure, respectively, and performs a parallel translation for substantially matching the positions of the feature points and a rotational translation for translating the feature vectors in the projected second anatomical structure and the projected third anatomical structure. Therefore, the medical image processing apparatus 3h according to the ninth embodiment makes it possible to easily compare the anatomical structure in the actual image with the anatomical structure obtained by simulation.
In addition, according to the ninth embodiment, the image data acquisition function 472 acquires the first medical image collected before operation and the second medical image collected after operation. The extraction function 473 extracts a preoperative cardiac valve from the first medical image and a postoperative cardiac valve from the second medical image. The processing function 475 projects the postoperative cardiac valve and the postoperative estimated cardiac valve in the blood flow direction, acquires line segments connecting the center of gravity and the commissure from the postoperative cardiac valve and the postoperative estimated cardiac valve, and performs a parallel translation for substantially matching the positions of the centers of gravity and a rotational translation for making the line segments connecting the commissures parallel in the postoperative cardiac valve and the postoperative estimated cardiac valve. Therefore, the medical image processing apparatus 3h according to the ninth embodiment makes it possible to easily compare the actual cardiac valve with the cardiac valve obtained by simulation.
In a tenth embodiment, a method of correcting the measurement value of the mitral regurgitant volume by ultrasonography will be described. Mitral valve regurgitation, which is one of valvular heart diseases, is a disease in which regurgitation occurs due to a gap formed without a part of the mitral valve being completely closed during systole. One of the indices for measuring the degree of mitral regurgitation is the regurgitant volume passing through the mitral valve, and one of the methods for measuring this regurgitant volume is the PISA (Proximal isovelocity surface are) method. This is an index measured by an ultrasonic Doppler method, and is a method of adjusting the aliasing velocity of the Doppler so that the aliasing region of the regurgitant velocity becomes a hemisphere, and then performing calculation based on the radius of the hemisphere and the aliasing velocity. This measurement method is a measurement method derived from a continuous equation on the assumption that the regurgitation spreads concentrically.
The PISA method is a method that is often used clinically, but since it has an assumption that “regurgitation spreads concentrically”, which is deviates from the reality, the regurgitant volume may take an abnormal value. Therefore, in the tenth embodiment, the mitral regurgitant volume acquired by the PISA method is corrected based on the blood passing volume in the aortic valve.
Here, the tenth embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 481 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 481 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 481 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 482.
The image data acquisition function 482 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 482 acquires first medical image data and second medical image data scanned at least at a first timing and at a second timing different from the first timing. Note that the image data acquisition function 482 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The extraction function 483 extracts a first feature value based on the first medical image data and a second feature value based on the second medical image data. Here, the first feature value is a regurgitant volume of blood flow in the mitral valve, and the second feature value is passing volume of blood flow in the aortic valve. Note that the processing by the extraction function 483 will be described in detail later.
When the first feature value is larger than the second feature value, the change function 484 changes the value of the first feature value to the value of the second feature value. Note that the processing by the change function 484 will be described in detail later.
The processing circuitry 48 described above is realized by, for example, a processor. In that case, each processing function described above is stored in the storage circuitry 34 in the form of a program executable by a computer. Then, the processing circuitry 48 reads and executes each program stored in the storage circuitry 34 to implement a function corresponding to each program. In other words, the processing circuitry 48 has each processing function illustrated in
Next, a procedure of processing by the medical image processing apparatus 3i will be described with reference to
For example, as illustrated in
Subsequently, the extraction function 483 calculates the aortic valve passing flow volume from the acquired CT image (step S1002). This processing is realized, for example, by the processing circuitry 48 calling and executing a program corresponding to the extraction function 483 from the storage circuitry 34.
Subsequently, the image data acquisition function 482 acquires an ultrasound image from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 (step S1003). This processing is realized, for example, by the processing circuitry 48 calling and executing a program corresponding to the image data acquisition function 482 from the storage circuitry 34.
Subsequently, the extraction function 483 acquires the mitral regurgitant volume from the acquired ultrasound image (step S1004). This processing is realized, for example, by the processing circuitry 48 calling and executing a program corresponding to the extraction function 483 from the storage circuitry 34.
Subsequently, the change function 484 compares the aortic valve passing flow volume with the mitral regurgitant volume (step S1005) and corrects the mitral regurgitant volume (step S1006). This processing is realized, for example, by the processing circuitry 48 calling and executing a program corresponding to the change function 484 from the storage circuitry 34.
Subsequently, the control function 481 displays the result (step S1007) This processing is realized, for example, by the processing circuitry 48 calling and executing a program corresponding to the control function 481 from the storage circuitry 34.
Hereinafter, details of each processing executed by the medical image processing apparatus 3i will be described.
As described in step S1001 and step S1003 of
As described in step S1002 of
As described in step S1004 of
As described in step S1005 and step S1006 of
As described in step S1007 of
As described above, according to the tenth embodiment, the image data acquisition function 482 acquires first medical image data and second medical image data scanned at least at the first timing and at the second timing different from the first timing. The extraction function 483 extracts a first feature value based on the first medical image data and a second feature value based on the second medical image data. When the first feature value is larger than the second feature value, the change function 484 changes the value of the first feature value to the value of the second feature value. Therefore, the medical image processing apparatus 3i according to the tenth embodiment can perform control such that the first feature value does not exceed the second feature value, and can suppress the first feature value from becoming an unrealistic value.
In addition, according to the tenth embodiment, the first feature value is a regurgitant volume of blood flow in the mitral valve, and the second feature value is passing volume of blood flow in the aortic valve. Therefore, the medical image processing apparatus 3i according to the tenth embodiment can suppress the mitral regurgitant volume from becoming an unrealistic value.
In an eleventh embodiment, similarly to the tenth embodiment, a method of correcting the measurement value of the mitral regurgitant volume by ultrasonography will be described. Here, in the tenth embodiment, the case of performing correction to change the mitral regurgitant volume to the aortic valve passing flow volume has been described. In the eleventh embodiment, a case of correcting the mitral regurgitant volume using the aortic valve passing flow volume and the volume change of the left ventricle will be described.
Here, the eleventh embodiment is different from the first embodiment in processing contents by processing circuitry. Hereinafter, an explanation will be given mainly on this point. As illustrated in
As illustrated in
The control function 491 controls to generate various GUIs and various display information in response to operations via the input interface 32 and display the generated information on the display 33. For example, the control function 491 causes the display 33 to display a result of processing by each function and the like. Furthermore, the control function 491 can also generate and display various display images on the basis of the medical image acquired by the image data acquisition function 492.
The image data acquisition function 492 acquires a medical image of a subject from the medical image diagnosis apparatus 1 or the medical image storage apparatus 2 via the communication interface 31. Specifically, the image data acquisition function 492 acquires first medical image data scanned at the early-systolic phase and second medical image data scanned at the end-systolic phase. Note that the image data acquisition function 492 can acquire various medical images and store the acquired medical images in the storage circuitry 34, similarly to the image data acquisition function 352 described in the first embodiment.
The extraction function 493 extracts a first feature value based on the first medical image data and a second feature value based on the second medical image data. Here, the first feature value is a left ventricular lumen volume at an early-systolic phase, and the second feature value is a left ventricular lumen volume at an end-systolic phase. Note that the processing by the extraction function 483 will be described in detail later.
The acquisition function 494 acquires the passing volume of blood flow in the aortic valve. Note that the processing by the change function 484 will be described in detail later.
The calculation function 495 calculates the regurgitant volume of blood flow in the mitral valve based on the difference between the first feature value and the second feature value and the passing volume of blood flow in the aortic valve. Specifically, the calculation function 495 calculates the regurgitant volume of blood flow in the mitral valve by subtracting the passing volume of blood flow in the aortic valve from the difference between the left ventricular lumen volume in the early-systolic phase and the left ventricular lumen volume in the end-systolic phase.
Hereinafter, details of each processing executed by the medical image processing apparatus 3j will be described.
The image data acquisition function 492 acquires the CT image and the ultrasound image in response to the acquisition operation of the medical image via the input interface 32. Here, the image for calculating the aortic valve passing flow volume is not limited to the CT image, and may be an MR image or an ultrasound image.
The extraction function 493 acquires a change in the lumen volume of the left ventricle based on the CT image acquired by the image data acquisition function 492. Specifically, the extraction function 493 extracts the left ventricle from the CT image and calculates the difference between the maximum value and the minimum value of the extracted lumen volume of the left ventricle, thereby acquiring the amount of change in the lumen volume of the left ventricle. Additionally, similarly to the feature data acquisition function 353 described in the first embodiment, the extraction function 483 can extract the left ventricle by various methods.
The extraction function 493 acquires the mitral regurgitant volume from the ultrasound image. Specifically, the extraction function 493 acquires the mitral regurgitant volume from the PISA method of the ultrasound image. Note that the measurement by the PISA method uses, for example, measurement by a doctor.
The acquisition function 494 calculates the aortic valve passing flow volume on the basis of the ultrasound images acquired by the image data acquisition function 492. Specifically, the acquisition function 494 extracts the aortic valve from the ultrasound image and calculates the valve orifice area of the extracted aortic valve. Then, the acquisition function 494 calculates the aortic valve passing flow volume based on the calculated valve orifice area and the flow velocity of the blood during one heartbeat. Note that the valve orifice area may be acquired from a CT image or an MR image. In addition, the aortic valve passing flow volume may be passing volume per unit time or may be an amount passing in a certain time. Additionally, similarly to the feature data acquisition function 353 described in the first embodiment, the acquisition function 494 can extract the aortic valve by various methods.
The calculation function 495 compares the mitral regurgitant volume with the change in the lumen volume of the left ventricle, and when the mitral regurgitant volume is large, a value obtained by subtracting the aortic valve passing flow volume from the left ventricular lumen volume change is set as the mitral regurgitant volume.
The control function 491 displays the result on the display 33. For example, the control function 491 displays the mitral regurgitant volume. Here, the control function 491 displays a corrected value when the mitral regurgitant volume is corrected. The control function 491 can also display the mitral regurgitant volume before correction.
As described above, according to the eleventh embodiment, the image data acquisition function 492 acquires the first medical image data scanned at the early-systolic phase and the second medical image data scanned at the end-systolic phase. The extraction function 493 extracts a first feature value based on the first medical image data and a second feature value based on the second medical image data. The acquisition function 494 acquires the passing volume of blood flow in the aortic valve. The calculation function 495 calculates the regurgitant volume of blood flow in the mitral valve based on the difference between the first feature value and the second feature value and the passing volume of blood flow in the aortic valve. Therefore, the medical image processing apparatus 3j according to the eleventh embodiment can obtain the mitral regurgitant volume with high accuracy.
In addition, according to the eleventh embodiment, the first feature value is the left ventricular lumen volume at the early-systolic phase, the second feature value is the left ventricular lumen volume at the end-systolic phase, and the calculation function 495 calculates the regurgitant volume of the blood flow in the mitral valve by subtracting the passing volume of the blood flow in the aortic valve from the difference between the left ventricular lumen volume at the early-systolic phase and the left ventricular lumen volume at the end-systolic phase. Therefore, the medical image processing apparatus 3j according to the eleventh embodiment can obtain the mitral regurgitant volume with high accuracy, and enable the accuracy of data assimilation to be improved.
The processing by the medical image processing apparatus 3 to the medical image processing apparatus 3j described in each embodiment can be arbitrarily integrated. That is, the medical image processing apparatus can be configured such that the processing described in each embodiment is executed by one medical image processing apparatus, or the medical image processing apparatus can be configured such that arbitrarily selected processing among the processing described in each embodiment is executed by one medical image processing apparatus.
Note that the processing circuitry described in each of the above embodiments may be configured by combining a plurality of independent processors, and each processor may implement each processing function by executing a program. In addition, each processing function of the processing circuitry may be realized by being appropriately distributed or integrated into a single or a plurality of processing circuits. In addition, each processing function of the processing circuitry may be realized by mixing hardware such as a circuit and software. Furthermore, here, an example of a case where the program corresponding to each processing function is stored in the single storage circuitry 34 has been described, but the embodiment is not limited thereto. For example, a plurality of storage circuits may dispersedly store programs corresponding to each processing function, and the processing circuitry may read and execute each program from each storage circuit.
Note that, in the above-described embodiment, an example in which each unit in the present specification is realized by each function of the processing circuitry has been described, but the embodiment is not limited thereto. For example, each unit in the present specification may be realized by each function described in the embodiment, and also realize the same function by only hardware, only software, or a mixture of hardware and software.
Furthermore, the term “processor” used in the description of the above-described embodiment means, for example, a central processing unit (CPU), a graphics processing unit (GPU), or a circuit such as an application specific integrated circuit (ASIC) or a programmable logic device (for example, a simple programmable logic device (SPLD), a complex programmable logic device (CPLD), and a field programmable gate array (FPGA)). Here, instead of storing the program in the storage circuit, the program may be directly incorporated in the circuit of the processor. In this case, the processor realizes the function by reading and executing the program incorporated in the circuit. In addition, each processor of the present embodiment is not limited to a case where each processor is configured as a single circuit, and a plurality of independent circuits may be combined to be configured as one processor to realize the function.
Here, the medical image processing program executed by the processor is provided by being incorporated in advance in a read only memory (ROM), a storage circuit, or the like. Note that the medical image processing program may be provided by being recorded in a non-transitory computer-readable storage medium such as a compact disk (CD)-ROM, a flexible disk (FD), a CD-recordable (CD-R), or a digital versatile disk (DVD) as a file in a format installable or executable in these apparatuses. Furthermore, the medical image processing program may be provided or distributed by being stored on a computer connected to a network such as the Internet and downloaded via the network. For example, the medical image processing program is configured by a module including each processing function described above. As actual hardware, the CPU reads the medical image processing program from the storage medium such as the ROM and executes the medical image processing program, whereby each module is loaded on the main storage apparatus and generated on the main storage apparatus.
In addition, in the above-described embodiment and modifications, each component of each apparatus illustrated in the drawings is functionally conceptual, and does not necessarily need to be physically configured as illustrated in the drawings. That is, a specific form of distribution or integration of each apparatus is not limited to the illustrated form, and all or a part thereof can be functionally or physically distributed or integrated in an arbitrary unit according to various loads, usage conditions, and the like. Furthermore, all or an arbitrary part of each processing function performed in each apparatus can be realized by a CPU and a program analyzed and executed by the CPU, or can be realized as hardware by wired logic.
In addition, among the processing described in the above-described embodiments and modifications, all or a part of the processing described as being performed automatically can be manually performed, or all or a part of the processing described as being performed manually can be automatically performed by a known method. In addition, the processing procedure, the control procedure, the specific name, and the information including various data and parameters illustrated in the document and the drawings can be arbitrarily changed unless otherwise specified.
According to at least one of the embodiments described above, simulation can be appropriately performed.
Regarding the above embodiments, the following supplementary notes are disclosed as one aspect and selective features of the invention.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 1, in which the first feature value is a feature value of the entire structure of interest.
The medical image processing apparatus according to supplementary note 1 or supplementary note 1-1, in which the specifying unit specifies a plurality of parameter sets on the basis of the first feature value calculated by the loss function from a parameter set group obtained on the basis of the multi-start optimization calculation.
The medical image processing apparatus according to supplementary note 1-2, in which the specifying unit specifies a plurality of parameter sets in which the first feature value is relatively small.
The medical image processing apparatus according to any one of supplementary note 1 to supplementary note 1-3, in which the determination unit determines a parameter set in which the corresponding second feature value is relatively small among the plurality of parameter sets as the parameter set of interest.
The medical image processing apparatus according to any one of supplementary note 1 to supplementary note 1-4, in which the medical image data acquisition unit acquires first medical image data and second medical image data scanned at least during systole and diastole of a heart.
The medical image processing apparatus according to supplementary note 1-5, in which
A method including:
A program for causing a computer to execute each processing of:
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 2, in which the structure of interest is a cardiac valve.
The medical image processing apparatus according to supplementary note 2-1, in which in a case where it is determined that there is an abnormality in the structure of interest, the selection unit selects a phase that is systole of a heart and in which a valve orifice of the cardiac valve is maximized as a phase in which the cardiac valve is closed.
The medical image processing apparatus according to supplementary note 2-1, in which in a case where it is determined that there is an abnormality in the structure of interest, the selection unit selects a phase in which regurgitation of blood occurs as systole of a heart, and selects a phase that is systole of the heart and in which a valve orifice of the cardiac valve is maximized as a phase in which the cardiac valve is closed.
The medical image processing apparatus according to supplementary note 2-1, in which in a case where it is determined that there is no abnormality in the structure of interest, the selection unit selects a phase that is systole of a heart and in which a valve orifice of the cardiac valve is minimized as a phase in which the cardiac valve is closed.
The medical image processing apparatus according to supplementary note 2-1, in which in a case where it is determined that there is no abnormality in the structure of interest, the selection unit selects a phase in which regurgitation of blood occurs as systole of a heart, and selects a phase that is systole of a heart and in which a valve orifice of the cardiac valve is minimized as a phase in which the cardiac valve is closed.
The medical image processing apparatus according to any one of supplementary note 2-1 to supplementary note 2-5, in which the selection unit selects a phase that is diastole of a heart and in which the cardiac valve is uniformly open as a phase in which the cardiac valve is open.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 3, in which
The medical image processing apparatus according to supplementary note 3-1, in which the shape correction unit corrects the second length of a contact portion with which a valve is in contact in the cardiac valve in the open phase to a length obtained by converting the first length at a ratio based on the mechanical field.
The medical image processing apparatus according to supplementary note 3-1, further including
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 4, in which
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 5, in which
The medical image processing apparatus according to supplementary note 5 or supplementary note 5-1, further including
The medical image processing apparatus according to supplementary note 5-2, in which the clinical information acquisition unit acquires a cuff pressure as the third feature value.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 6, in which
The medical image processing apparatus according to supplementary note 6 or supplementary note 6-1, in which the plurality of predetermined measurement values are parameters whose numerical values are fixed in optimization of the prediction model.
The medical image processing apparatus according to supplementary note 6 or supplementary note 6-1, in which an initial value of the optimization is an initial value of parameters whose numerical values are optimized in optimization of the prediction model.
The medical image processing apparatus according to any one of supplementary notes 6 to 6-3, further including a control unit configured to cause display information indicating the overall error to be displayed in the first feature value.
The medical image processing apparatus according to any one of supplementary notes 6 to 6-4, further including a control unit configured to cause display information indicating disease classification determined on the basis of the first feature value including the overall error to be displayed.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 7, in which
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary Note 8, in which
The medical image processing apparatus according to supplementary Note 8-1, in which the calculation unit calculates, as a valve orifice area of the cardiac valve, an area of the isothermal surface that is in contact with the cardiac valve and has the smallest area in an isothermal surface of the temperature distribution.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 9, in which
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 10, in which the first feature value is a regurgitant volume of blood flow in a mitral valve, and the second feature value is passing volume of blood flow in an aortic valve.
A medical image processing apparatus including:
The medical image processing apparatus according to supplementary note 11, in which
While certain embodiments have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of the inventions. Indeed, the novel embodiments described herein may be embodied in a variety of other forms; furthermore, various omissions, substitutions and changes in the form of the embodiments described herein may be made without departing from the spirit of the inventions. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the inventions.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2022-199516 | Dec 2022 | JP | national |
