This invention relates to medical diagnostic ultrasound systems and, in particular, to ultrasound systems which produce quantified measurements of the volume flow of blood through the heart or a blood vessel.
Ultrasound has long been used to assess various parameters of blood flow in the heart and vascular system using the Doppler principle. The basic Doppler response is flow velocity, which can further be used to determine additional characteristics of blood flow. One characteristic of interest to cardiologists is the volume flow of blood through a vessel. Early efforts to estimate volume flow consisted of multiplying the mean velocity of blood flow by the nominal cross-sectional area of a blood vessel. However, these early efforts had shortcomings due to the need to make certain estimates. One is that the vessel lumen is circular. Another is the estimation of the mean velocity from a single Doppler measurement or from a qualitative assessment of spectral Doppler data. Velocity measurement must also be corrected for the angle between the ultrasound beam direction and the direction of flow. Yet another consideration is the laminar flow profile in the presence of stenosis.
A further complication arises due to the pulsatility of arterial flow. While venous flow is substantially constant, arterial flow is constantly changing over the heart cycle. Thus, the standard techniques often lack for user independency and repeatability. Some of these demands have been eased by the advent of 3D ultrasound to assess flow conditions and particularly its ability to acquire volume blood flow information. With 3D imaging, the full vessel lumen can be imaged and a sequence of 3D image data sets acquired for later replay and diagnosis. When data of the full volumetric flow in the vessel is acquired in the data sets, the image data can be examined during post-acquisition diagnosis to assess the flow profile. Different 2D image planes can be extracted from the 3D data in multi-planar reconstruction (MPR), so that an image plane of a desired orientation through a vessel can be examined. Three dimensional imaging thus addresses many of the static imaging challenges which are problematic with 2D flow estimation.
In recent years the problem of analyzing the temporal dynamics of blood flow have been addressed by a technique called “spatial-temporal image correlation,” or STIC. With STIC, a sweep is made through a blood vessel with ultrasound and many image frames are acquired over a sequence of heart cycles.
When done by manually scanning with a 2D ultrasound probe, this image acquisition can take ten seconds or longer. The same acquisition can be performed with a mechanical 3D probe which mechanically sweeps the image plane through the vessel, but 3D mechanical probes often have poorer elevation focus which leads to inaccuracies when constructing MPR images in the elevation dimension. After the acquisition is complete and the image frames are stored, image frames of the desired anatomy, created by MPR reconstruction if necessary, are reassembled into a loop of images according to their phase sequence in the cardiac cycle. This task is made difficult by the fact that the heart cycle may not be uniform over the time required to acquire the data sets. Consequently, synthetic methods of estimating the heart rate from analysis of the movement of cardiac tissue or blood have been developed, which nonetheless is often difficult to assess and prone to inaccuracy. Accordingly, it is desirable to develop more robust techniques for accurately assessing volume flow in the presence of flow pulsatility and erratic heartbeats. It is further desirable to automate such techniques so as to prioritize and shorten the time interval needed to acquire the volume flow data and reduce the impact of motional effects by both the probe and the anatomy.
In accordance with the principles of the present invention, a diagnostic ultrasound system is described which produces a blood flow profile using volume flow acquisition. A 3D imaging probe is used to acquire one or more image volumes of flow data from a vessel and a B- or C- cross-sectional plane of the vessel is extracted which is processed to determine the blood volume flow rate. When arterial flow is being assessed, it is preferable to acquire multiple subvolumes of the volume flow, with each spatially different volume flow dataset being acquired over all phases of a cardiac cycle to maintain temporal sampling precision. The subvolumes are then spatially assembled in cardiac phase order so as to produce a full volume flow sequence with adequate temporal sampling. The B- or C-plane is then extracted and a volume flow profile estimated through the plane using Gauss's theorem.
In a preferred implementation, volume or subvolume acquisition starts around the center of the vessel where flow signals are stronger and thus cardiac phases are easier to identify. This also results in acquisition of subvolumes with the greatest contribution to total volume flow earlier in the acquisition process to minimize adverse motional effects. The acquisition process will in this case begin by identifying the vessel center prior to subvolume acquisition, as by user designation or an automated technique such as a rapid Doppler sequence through the vessel. Subvolume acquisition then begins from the vessel center and proceeds outward therefrom.
Acquisition in synchronism with the phase of the heart cycle can be achieved by a non-synthetic method of measuring the heart cycle (e.g., an ECG monitor attached to the patient), or by a synthetic method such as user estimation or automatic M-mode or speckle tracking of cardiac or vascular anatomy or blood flow. Preferably the flow profile is calculated on the fly during acquisition, and heart rate estimations based on the cardiac cycles of previously acquired subvolumes are updated each heart cycle to account for irregularities in the heart cycle. Preferably the acquisition of each subvolume is temporally centered about the systolic phase, so that systolic flow, when volume flow is greatest in arterial vessels, is fully sampled.
According to aspects of the invention, an ultrasonic diagnostic imaging system for analyzing volume flow of blood includes a 3D imaging probe adapted to acquire volume image flow data sets of a blood vessel, an image data processor responsive to the volume image flow data sets, and a vessel center locator. The vessel center locator is responsive to spatially organized blood vessel data, which is adapted to identify a center of the blood vessel. The system further includes a beamformer controller, responsive to the vessel center locator, which is adapted to control the 3D imaging probe to acquire volume image flow data sets of the blood vessel commencing around the center of the vessel. In certain embodiments, there is also a volume flow calculator, which is responsive to acquired volume image flow data sets of the blood vessel, which is adapted to calculate volume flow profile data.
In some embodiments, the ultrasonic diagnostic imaging system further includes a heart rate calculator adapted to produce data representing a heart rate and the volume image flow data sets are acquired in timed relation to the heart rate data.
In some embodiments, the heart rate calculator includes one of an ECG monitor or an ultrasound data processor which is adapted to produce estimated heart rate data using ultrasound data.
In some embodiments, the ultrasonic diagnostic imaging system includes a subvolume selector responsive to the vessel center locator. The subvolume selector controls the beamformer controller to acquire volume image flow data sets of subvolumes of a blood vessel commencing around the center of the vessel.
In some embodiments, the beamformer controller acquires volume image flow data sets of a subvolume of a blood vessel over the duration of a heart cycle.
In some embodiments, the beamformer controller acquires volume image flow data sets of a subvolume of a blood vessel over an acquisition interval commencing in the middle of a diastolic portion of a heart cycle and ending in the middle of the next diastolic portion of a heart cycle.
In some embodiments, the beamformer controller acquires volume image flow data sets of a subvolume of a blood vessel during systolic heart phases occurring in the middle of the acquisition interval.
In some embodiments, the heart rate calculator is further coupled to the volume flow calculator and adapted to calculate a subvolume acquisition time in relation to systolic peaks of a flow profile.
In some embodiments, the ultrasonic diagnostic imaging system further includes a 3D image data memory adapted to store volume image data sets. In some embodiments, the ultrasonic diagnostic imaging system further includes a multi-planar reformatter, which is coupled to the 3D image data memory and selects an image plane intersecting the blood vessel.
In some embodiments, the volume flow calculator is further adapted to calculate volume flow profile data in relation to the image plane intersecting the blood vessel.
In some embodiments, the system further includes a volume renderer coupled to the 3D image data memory and adapted to produce a 3D image of the blood vessel.
In some embodiments, the system further includes a display configured to display one or more of an image plane selected by the multi-planar reformatter, a 3D image of the blood vessel, and a flow profile curve. The display may be coupled to one or more other elements of the system.
The present invention also provides a method of analyzing volume flow of blood by ultrasound data acquisition comprising: identifying a center of a blood vessel; acquiring volume image flow data sets of the blood vessel commencing around the center of the vessel with a 3D ultrasound imaging probe; processing image data sets acquired with the imaging probe for the display of an ultrasound image of the blood vessel; and calculating volume flow profile data using the acquired volume image flow data sets.
In some embodiments, the method also includes estimating heart cycle timing. In some embodiments, volume image flow data sets of the blood vessel are acquired from subvolumes of the vessel in synchronism with the heart cycle timing.
In some embodiments, the method includes detecting a systolic phase of the heart cycle. In some embodiments, the volume image flow data sets of the blood vessel are acquired from a subvolume of the vessel during an acquisition interval starting in mid-diastole of a heart cycle and ending in mid-diastole of a subsequent heart cycle, wherein acquisition during the systolic phase occurs during the middle of the acquisition interval.
In some embodiments, acquiring the volume image flow data sets of the blood vessel from subvolumes of the vessel further comprises updating the estimated heart cycle timing during a plurality of the subvolume acquisition intervals.
In the drawings:
It is preferable to acquire subvolume data of a vessel lumen beginning in the center of the lumen where flow signals are strongest and it is easier to reliably identify cardiac phases. More flow signals are contained in a central subvolume and preserved after wall filtering for analysis such as heart rate estimation as discussed below. Central subvolumes also comprise the greatest contributions to total volume flow of the vessel. Such an acquisition sequence is illustrated in
It is also seen in
It is thus seen that accurate heart rate information is important for accurate volume flow assessment. In accordance with a further aspect of the present invention, when the heart rate is determined from ultrasonic signal information, the heart rate estimation is continuously updated during each subvolume acquisition to properly adjust for the occurrence of a longer or shorter interval between heartbeats. A heartrate estimation can be estimated from M-mode data as described in U.S. Pat. No. 9,357,978 (Dow et al.) This can be done in the background, with the heartrate estimated even before volume flow acquisition begins, thereby enabling the acquisition of the first subvolume in proper synchrony with the heartrate. Another way to determine the heartrate is to continuously calculate the flow profile signal during each subvolume acquisition, and use this updated information to properly synchronize the following acquisition with the phase of the heart. One example of this technique is illustrated in
The equation T2 +rΔT is calculated which yields a starting time for acquiring the second subvolume as shown at 86. While the first subvolume is not sampled with the systolic phase temporally located in the middle of the subvolume acquisition interval, properly phased acquisition will occur for the second and all subsequent subvolumes.
In
The echoes received by a contiguous group of transducer elements are beamformed by appropriately delaying them and then combining them. The partially beamformed signals produced by the microbeamformer 14 from each patch are coupled to the main beamformer 18 where partially beamformed signals from individual patches of transducer elements are combined into a fully beamformed coherent echo signal. For example, the main beamformer 18 may have 128 channels, each of which receives a partially beamformed signal from a patch of 12 transducer elements. In this way the signals received by over 1500 transducer elements of a two-dimensional matrix array transducer can contribute efficiently to a single beamformed signal.
The coherent echo signals undergo signal processing by a signal processor 20, which includes filtering by a digital filter and noise reduction as by spatial or frequency compounding. The signal processor may also perform speckle reduction as by spatial or frequency compounding. The digital filter of the signal processor 20 can be a filter of the type disclosed in U.S. Pat. No. 5,833,613 (Averkiou et al.), for example. The echo signals are then coupled to a quadrature bandpass filter (QBP) 22. The QBP performs three functions: band limiting the r.f. echo signal data, producing in-phase and quadrature pairs (I and Q) of echo signal data, and decimating the digital sample rate. The QBP comprises two separate filters, one producing in-phase samples and the other producing quadrature samples, with each filter being formed by a plurality of multiplier-accumulators (MACs) implementing an FIR filter.
The beamformed and processed coherent echo signals are coupled to a pair of image data processors. A B mode processor 26 produces signal data for a B mode image of structure in the body such as tissue. The B mode processor performs amplitude (envelope) detection of quadrature demodulated I and Q signal components by calculating the echo signal amplitude in the form of (I2+Q2)1/2. The quadrature echo signal components are also coupled to a Doppler processor 24. The Doppler processor 24 stores ensembles of echo signals from discrete points in an image field which are then used to estimate the Doppler shift at points in the image with a fast Fourier transform (FFT) processor. The rate at which the ensembles are acquired determines the velocity range of motion that the system can accurately measure and depict in an image. The Doppler shift is proportional to motion at points in the image field, e.g., blood flow and tissue motion. For color Doppler image data, the estimated Doppler flow values at each point in a blood vessel are wall filtered and converted to color values using a look-up table. The wall filter has an adjustable cutoff frequency above or below which motion will be rejected such as the low frequency motion of the wall of a blood vessel when imaging flowing blood. The B mode image data and the Doppler flow values are coupled to a scan converter 28 which converts the B mode and Doppler samples from their acquired R-θ coordinates to Cartesian (x,y) coordinates for display in a desired display format, e.g., a rectilinear display format or a sector display format. Either the B mode image or the Doppler image may be displayed alone, or the two shown together in anatomical registration in which the color Doppler overlay shows the blood flow in B mode processed tissue and vessels in the image.
Another display possibility is to display side-by-side images of the same anatomy which have been processed differently. This display format is useful when comparing images. The scan-converted image data, both B mode and Doppler data, is coupled to and stored in a 3D image data memory 30 where it is stored in memory locations addressable in accordance with the spatial locations from which the image data values were acquired. Image data from 3D scanning can be accessed by a volume renderer 32, which converts the data values of a 3D data set into a projected 3D image as viewed from a given reference point as described in U.S. Pat. No. 6,530,885 (Entrekin et al.) The 3D images produced by the volume renderer 32 and 2D images from data produced by the scan converter 28 are coupled to a display processor 34 for further enhancement, buffering and temporary storage for display on an image display 36. The 3D image data is also coupled to a multi-planar reformatter 48 which, in response to user input from the user controls 38, is able to extract image data for a user-designated image plane from the 3D dataset. This image data is coupled to the display processor 34 for display of a selected MPR image, and the plane of the MPR image is used in the estimation of volume flow as described below.
In accordance with the present invention, B mode and Doppler data produced by processors 24 and 26 are coupled to a vessel center locator 44. This enables the vessels center locator to do several things. One is to enable a user to click on a point in a B mode image of a blood vessel which the user believes is the center of the vessel. A signal indicating this user action is coupled to the vessel center locator from the user interface 38, and the identified vessel center point is stored in the locator and coupled to subvolume selector 46. Another operation of the vessel center locator 44 is to receive velocity data from the Doppler processor after a rapid Doppler scan of a blood vessel. The locator 44 analyzes this data to determine the spatial location in the vessel with the highest flow velocity. In that case, this spatial location is coupled to the subvolume selector 46 and used as the vessel center. It will be appreciated that the B mode and Doppler data coupled to the vessel center locator can be that which is processed by scan conversion, so that the spatial location coordinates will correspond with that used by the display 36. The vessel center locator 44 is thus capable of using either user input or automated methods to determine a vessel center and couple that information to the subvolume selector 46.
The multi-planar reformatter 48 is also coupled to a volume flow calculator 40. The volume flow calculator also receives Doppler velocity data from the Doppler processor 24 and is thus able to compute the volume blood flow through a B- or C-plane of a blood vessel using Gauss's theorem. For volume flow data, Gauss's theorem is calculated as:
Q=∫
S
v·dA
where Q is the volume flow in, e.g., milliliters per second, v is flow velocity, and the surface S is a selected plane through a vessel lumen. A surface integral of velocity v over the enclosing boundary S yields the volume flow Q. Volume flow through a plane intersecting a blood vessel can thus be updated with new data for each new phase of the heart cycle to produce a flow profile curve of Q as a function of time, and the flow volume over the phases of an entire heart cycle can be summed to calculate the volume flow per heart cycle.
The flow data of volume flow produced by the volume flow calculator 40 is coupled to a graphics generator 49, which produces a flow profile curve such as that shown in
The flow profile curve data is also coupled to a heart rate calculator 42, where it is used to estimate the heartrate in the absence of ECG monitor signals or user input of a heartrate value. The heartrate calculator uses the flow profile curve data to detect systolic peaks of the flow profile, to detect the interval ΔT between systolic peaks, and to calculate the start times for successive subvolume acquisitions as described above. The heartrate timing data is coupled to the subvolume selector 46, which determines when to acquire each subvolume needed to scan the entire volumetric region of a vessel. The data from the vessel center locator 44 informs the subvolume selector of where the first subvolume is to be acquired (i.e., around the vessel center,) and the data from the heart rate calculator 42 informs the subvolume selector of the timing of each subvolume acquisition so that the systolic phase will be acquired in the middle of each subvolume acquisition for at least the second and subsequent subvolume acquisitions. Acting on this information, the subvolume selector informs the beamformer controller of when and where each subvolume acquisition is to be performed. The ultrasound system of
Filing Document | Filing Date | Country | Kind |
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PCT/EP2020/057584 | 3/19/2020 | WO | 00 |
Number | Date | Country | |
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62820549 | Mar 2019 | US |