Patent Application
20240077564
The invention relates to methods of generate pelvic veins images and measure rate of blood flow and more particularly to a method of using non-contrast magnetic resonance angiography (NC-MRA) to generate pelvic veins images and measure rate of blood flow so that it is possible to evaluate pelvic veins diseases and locations of abnormal blood vessels without using developer or other medicine at a non-radiation condition, thereby increasing safety of a patient and correctness of diagnosis.
Pelvic congestion syndrome may cause chronic pain, such as a constant dull ache. About 30% of women of reproductive age are affected by pelvic congestion syndrome. Pelvic congestion syndrome is believed to be due to blood flowing back into pelvic veins as a result of faulty valves in the veins or enlarged veins in the lower abdomen. It may be caused by venous insufficiency initially or compressed veins subsequently. In addition to chronic pain, pelvic congestion syndrome can be worsened by standing. Thus, it is important to diagnose pelvic congestion syndrome. Currently, ultrasonography, contrast-enhanced magnetic resonance angiography (CE-MRA), computed tomographic angiography (CTA) or NC-MRA is used for the diagnosis. Regarding ultrasonography, as the diagnostic tool most commonly used for diagnosing pelvic congestion syndrome, it provides dynamic information of blood flow in pelvic veins. However, ultrasonography is not capable of diagnosing specific anatomical pathology such as growth of collateral vessels. Further, its reading is subject to obesity of a patient, edema, or hip joint replacement which can adversely affect its precision. While transvaginal ultrasound can correctly diagnose pelvic congestion syndrome, it may cause pain to a patient undergoing the diagnosis. Furthermore, the examination and subsequent image reading can only be done by a professional.
Regarding CE-MRA and CTA, they can generate clear images of pelvic veins but a large amount of contrast agent is required. Further, it may have side effect or cause complication. Regarding computed tomographic, its ionizing radiation may accumulate and the accumulation may increase the risk of causing cancer to the patient. Thus, above diagnosis tools are prohibited from being used on children, pregnant women or patients having kidney disease.
Regarding NC-MRA, blood flow information can be obtained using Magnetic resonance technology without contrast agent. Thus, there is no risk of excessive ionizing radiation to the human body. However, NC-MRA is only applicable to analyses of intracranial arteries, intracranial veins, and partial examination of heart and aorta. NC-MRA has limited applications to generate pelvic veins images to evaluate pelvic congestion syndrome.
Thus, the need for improvement still exists.
It is therefore one object of the invention to provide a method of using non-contrast magnetic resonance angiography (NC-MRA) to generate pelvic veins images and measure rate of blood flow, comprising the steps of subjecting a lay patient to undergo magnetic resonance scan in cooperation with an electrocardiogram (ECG) monitor and a respiration monitor; scanning coronary sections and transverse sections of kidney veins, lower cavity veins, common iliac veins, and external iliac veins to generate two-dimensional images wherein the two-dimensional images use balanced turbo field echo wave sequence; scanning coronary sections of common cardinal veins of abdominal cavity to generate three-dimensional images wherein the three-dimensional images use fast spin-echo short tau inversion recovery wave sequence and sample signals when the ECG monitor monitors myocardial contractility; and using quantification phase-contrast analysis to measure blood flowing through the transverse sections of the veins in a two-dimensional scan.
The invention has the following advantages and benefits in comparison with the conventional art: It is a non-invasive method. Both contrast agent and ionizing radiation are not required for imaging. The generated images are useful in understanding pelvic veins and can be taken as blood dynamics information. The two-dimensional images help a medical employee to ascertain relative relationship of blood anatomy. The three-dimensional images help the medical employee to evaluate locations of abnormal blood vessels and diagnose anatomical pathology. By analyzing the measured blood flowing through the transverse sections of the veins, it is possible to determine whether the assumed symptom is true or not. Thus, a medical examination is safer and diagnosis is more precise. As an end, a medical examination of pelvic congestion syndrome and other diseases of pelvic veins are more precise, more convenient and safer.
The above and other objects, features and advantages of the invention will become apparent from the following detailed description taken with the accompanying drawings
Referring to
S1: subjecting a lay patient to undergo magnetic resonance scan in cooperation with an electrocardiogram (ECG) monitor and a respiration monitor;
S2: scanning coronary sections and transverse sections of kidney veins, lower cavity veins, common iliac veins and external iliac veins to generate two-dimensional images. The two-dimensional images use balanced turbo field echo wave sequence. Time for scanning coronary sections and transverse sections of kidney veins, lower cavity veins, common iliac veins and external iliac veins is about 3 minutes and 45 seconds.
S3: scanning coronary sections of common cardinal veins of abdominal cavity to generate three-dimensional images. The three-dimensional images use fast spin-echo short tau inversion recovery wave sequence and sample signals when the ECG monitor monitors myocardial contractility. Time for scanning coronary sections of common cardinal veins of abdominal cavity is about 2 minutes and 39 seconds.
S4: using quantification phase-contrast analysis to measure blood flowing through the transverse sections of the veins in a two-dimensional scan. Two planes are scanned in the two-dimensional scan and time for each scan is about 1 minute and 6 seconds.
Total scanning time is 8 minutes and 36 seconds and a complete computed tomographic angiography (CTA) is about 30 minutes.
Parameters of the two-dimensional images using the balanced turbo field echo wave sequence include multi-lens two-dimensional mode, echo time=the shortest, repetition time=the shortest, pixel size=1.4×1 mm, slice thickness=7 mm, gap=3.5 mm, average number of the signals=1, and fat inhibition. The balanced turbo field echo wave sequence is a gradient echo pulse sequence having balanced gradient waveshape and data is sampled after initial ready pulses in order to increase contrast. Fat tissues and water are separated by means of fat inhibition. As a result, images having a background of low signals and having both blood vessels and body fluids of high signals are generated.
Clinical advantages of the wave sequence include generating magnetic resonance images of high signal-to-noise ratio (SNR) in a short imaging time, the images showing clear arteries and veins, helping a medical employee to understand relative relationship of blood anatomy, and also helping a medical employee to diagnose vein congestion syndrome.
Parameter of the three-dimensional images using fast spin-echo short tau inversion recovery wave sequence include multi-lens three-dimensional mode, echo time=85 ms, repetition time=1 heart beat, turbo spin echo factor=37, reverse recovery delay time=160 ms, and voxel size=1.7×1.9×4 mm, using the ECG monitor to sample signals in myocardial contractility, the scanning surface is a coronary surface, and the scanning area including common cardinal veins of the whole abdominal cavity.
Parameters of using quantification phase-contrast analysis to measure blood flowing through the transverse sections of the veins in a two-dimensional scan include two-dimensional quantification, echo time=the shortest, repetition time=the shortest, inverse angle=20 degrees, pixel size=1.6×2.1 mm, slice thickness=6 mm, and encoding speed=120 mm/sec. Fluid flow toward the head is encoded as positive and fluid flow toward the feet is encoded as negative. The quantification phase-contrast analysis for scanning comprises four steps including (a) dividing pelvic veins, (b) obtaining time curve of the rate of blood flow of the veins, (c) accumulating and calibrating, and (d) calculating quantification parameters of the rate of blood flow of the veins. Following interesting vein sections are scanned and measured: lower cavity veins, left ovarian veins, right exoskeleton veins and left exoskeleton veins. The following quantification parameters of each analyzed vein section can be obtained: stroke quantity, forward flow, rearward flow, reverse flow fraction, absolute stroke quantity, average flux, stroke distance and average rate.
Referring to
Referring to
It is possible to obtain blood vessels data by triggering sample signals in time using gated imaging acquisition technology. It is also possible to establish a three-dimensional blood vessel structure using imaging technology, i.e., three-dimensional imaging. As shown in (b) of
Referring to
Referring to
The invention uses quantification phase-contrast analysis to analyze 36 patients having pelvic congestion syndrome as experiment group and 10 healthy individuals as control group and analysis results are arranged in Table 1 below. As shown, there are differences among vein measurement parameters between the experiment group and the control group. Also, many measurement targets have shown significant differences in terms of statistics. Specifically, blood from left ovary veins flows back to the heart is significant for the patients having pelvic congestion syndrome. It is noted that p value less than 0.05 is marked by * in order to show there is a great difference.
The invention uses NC-MRA and ultrasound scan to analyze 46 patients having pelvic congestion syndrome and analysis results are arranged in Table 2 below.
In Table 2, true positive (TP) means both ultrasound scan and NC-MRA are positive; false positive (FP) means ultrasound scan is negative and NC-MRA is positive; false negative (FN) means ultrasound scan is positive and NC-MRA is negative; and true negative (TN) means both ultrasound scan and NC-MRA are negative.
Further, TP, FP, TN and FN are substituted into expressions of Table 3 and results are arranged in Table 3 below.
90%
In Table 3, sensitivity, specificity and accuracy of pelvic congestion syndrome are 80.6%, 90% and 82.6% respectively. Inter-rater agreement shows Cohen's Kappa is 0.58 so that it is a moderate agreement.
In view of Tables 1, 2 and 3, it is concluded that the method of the invention can effectively evaluate pelvic veins and correctly diagnose pelvic congestion syndrome.
It is envisaged by the invention that balanced turbo field echo wave sequence is utilized to generate the two-dimensional images, fast spin-echo short tau inversion recovery wave sequence is utilized to generate the three-dimensional images, and quantification phase-contrast analysis is utilized to measure blood flowing through transverse sections of the veins. Different signals can be obtained from the three-dimensional images by processing different rates of blood flow between the heart contraction and the heart relaxation. Then images obtained at the heart relaxation are subtracted from image obtained at the heart contraction to eliminate signals of the arteries, the bones and the body tissues by means of silhouette technique. As a result, clear three-dimensional images are generated.
While the invention has been described in terms of preferred embodiments, those skilled in the art will recognize that the invention can be practiced with modifications within the spirit and scope of the appended claims.
