CN103479381A - Method and equipment for accurately diagnosing coronary atherosclerosis - Google Patents
Method and equipment for accurately diagnosing coronary atherosclerosis Download PDFInfo
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- CN103479381A CN103479381A CN201310498065.9A CN201310498065A CN103479381A CN 103479381 A CN103479381 A CN 103479381A CN 201310498065 A CN201310498065 A CN 201310498065A CN 103479381 A CN103479381 A CN 103479381A
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Abstract
The acute coronary syndrome can lead to myocardial infarction and even cardiac sudden death (more than one million people suffering from acute myocardial infarction are devitalized year after year in China and potential patients are far more than ten millions). The acute coronary syndrome is caused due to the pathological basis that unstable atheromatous plaques are generated by the coronary atherosclerosis so as to lead the generation of spasm, rupture, hemorrhage and thrombosis. The invention relates to a method and relevant equipment for accurately diagnosing coronary atherosclerosis. Particularly, the method comprises the steps that firstly, the patients without diffuse coronary atherosclerosis are excluded according to the 'proportionality law CT (Computerized Tomography) diagnosis method'; then, the vessel wall thickening and the plaque load of pathological coronary vessels of the patients unable to be excluded are advised to be measured in a precise intervention manner by utilizing 'plaque load diagnostic instrument'. The method and the equipment have the characteristics of high diagnosis accuracy, high safety, low hospitalization cost and the like, and is simple to operate, thereby greatly perfecting and improving the health index of the people.
Description
Technical field
The present invention relates to a kind of method and relevant device of Precise Diagnosis coronary atherosclerosis.Particularly, at first the present invention gets rid of the patient without the diffusivity coronary atherosclerosis by " proportionality law CT method of diagnosis ", then the patient to getting rid of, advise that the patient accurately gets involved with " speckle load diagnostic apparatus " vessel wall thickening and the speckle of measuring pathological changes arteria coronaria blood vessel and loads.
Background technology
One of major fields of Chinese science and technology development are: " major disease early warning and the key technologies such as diagnosis, disease risk factor early intervention such as exploitation cardiovascular and cerebrovascular disease, tumor, research standardization, personalization and Comprehensive Treatment key technology and scheme." acute coronary syndrome can cause myocardial infarction, cardiac sudden death (in China, have every year 1000000 people of surpassing to be devitalized by acute myocardial infarction, potential patient is considerably beyond 1,000 ten thousand people) even.The pathologic basis of acute coronary syndrome is the existence of unstable atheromatous plaque in coronary artery, spasm has occurred then, breaks, hemorrhage and thrombosis.It is diffuse that unstable atheromatous plaque mostly is, the zone of breaking and mostly occurring at stricture of artery<50%, and then cause myocardial ischemia and infarction.Present stage, angiography was " golden standard " of diagnosis coronary stricture, and still, aspect the diagnosis of diffusivity coronary artery pathological changes, owing to lacking normal reference vessel, angiography can cause the mistaken diagnosis of vast scale.In clinical practice, intravascular ultrasound (IVUS) is " golden standard " of diagnosis diffusivity coronary artery pathological changes, but it is a kind of intervention measurement means, need intervene operation, and diagnosis expensive (a disposable ultrasound catheter about 1.5 ten thousand yuans, additional high surgery cost).In addition, present stage the intravascular ultrasound technology by offshore company, monopolized, Chinese impotentia is produced product of the same type.The development of Chinese medical cause in the urgent need to a kind of measuring method and with it supporting equipment diagnose the diffusivity coronary artery pathological changes, and the method and equipment need to meet the characteristics such as the diagnostic result degree of accuracy is high, simple to operate, degree of safety is high, medical expense is cheap, thereby improve the people's health index.
Summary of the invention
Main purpose of the present invention is in the coronary atherosclerosis diagnostic procedure, at first use " proportionality law CT method of diagnosis " to be screened, then use " speckle load diagnostic apparatus " Precise Diagnosis and location atheromatous plaque, guarantee that the expense of common diagnosis is similar to cardioangiographic expense, the farther expense of measuring that gets involved lower than existing intravascular ultrasound.
" proportionality law CT diagnostic method " can be used for screening and gets rid of the diffusivity coronary artery disease, and its formation comprises: the diagnostic criteria of CT reconfiguration program, proportionality law program, diffusivity coronary atherosclerosis.For example, by annual health check-up, the patient will accept coronary artery CT angiography.Patient's coronary artery CT angiographic results will be stored as the DICOM file.As shown in Figure 1, the CT reconfiguration program in " proportionality law CT method of diagnosis " will import the DICOM file, then use serial Region Segmentation technology to the CT Image Segmentation Using, thereby generate blood vessel.The characteristics of serial Region Segmentation technology be whole processing procedure can be decomposed into the order a plurality of steps carry out successively, generally can be divided into: region growing is (from certain pixel, according to certain criterion, progressively add neighborhood pixels, when meeting some requirements, region growing stops) and division merges, and (from whole image, constantly division obtains each sub regions, and then foreground area is merged to the extraction of realize target).Differentiate in the serial zone, determine the contour line of blood vessel.The contour line of contrast blood vessel both sides, determine its normal direction, then calculates vessel centerline.Finally, extract the Morphologic Parameters (cross-sectional area-CSA of every blood vessel, length-L, volume-V, and the connected mode between blood vessel and blood vessel) of three-dimensional arterial tree, and to store these parameters be data file.
As shown in Figure 2, at first proportionality law need to determine the dry hat unit (stem-crown unit) of a tree.In one tree, any one branch chosen except the tree tip is defined as dry dry (stem) who is preced with unit, and the summation of all branches in downstream that this is dry and dry is defined as the hat (crown) of a dry hat unit.Obviously one tree comprises a lot of dry hat unit (any one branch except the tree tip and all branches in its downstream all can form a dry hat unit).As shown in Figure 3, proportionality law program in " proportionality law CT method of diagnosis " will import Morphologic Parameters (cross-sectional area-CSA of every blood vessel, length-L, the volume-V of the three-dimensional coronary tree generated by the CT reconfiguration program, and the connected mode between blood vessel and blood vessel), then create heart table coronary arterial tree, determine all dry hat unit of this arterial tree, the method by integration calculate each dry hat unit in heart table coronary arterial tree crown length (
) and the hat body (
), wherein: crown length is defined as the length summation of all blood vessels in a dry hat unit, and the hat body is defined as the volume summation of all blood vessels in a dry hat unit.Several proportionality laws will be followed in all dry hat unit of one tree.Wherein: length-volume ratio law is defined as
, wherein:
coefficient for length-volume ratio law.Finally, the coefficient of length-volume ratio law will be determined and export to the proportionality law program,
.If
, can determine that the patient is without the diffusivity coronary atherosclerosis.If
, the suggestion patient further uses " speckle load diagnostic apparatus " accurately to get involved and measures vessel wall thickening coronarius and speckle load condition.
" speckle load diagnostic apparatus " can be used for the atheromatous plaque in Precise Diagnosis and position patient heart table coronary arterial tree, and its formation comprises: operation bench and impedance conduit.As shown in Fig. 4-1, the formation of operation bench is: programmable DC current source, A-D converter, computer, data processor.The exportable 0.1-10 milliampere of programmable DC current source DC current (I) and 0.1-10 volt output voltage.A-D converter is accepted the analogue signal of continuous variable, then is converted into discrete digital signal.A-D converter has the digital filtering function to carry out anti-interference process to primary signal, can on amplifier, select gain, and sample rate can free setting.
As shown in Fig. 4-2, data processor can be controlled by computer constant output current and the output voltage of DC current source, can accept and record the voltage difference (△ V) by A-D converter conversion by computer, wherein: data processor bales catch except the collecting electrode in the impedance conduit and metal wire cause the loss of voltage.This program also can read in the three-dimensional arterial tree produced by the CT reconfiguration program Morphologic Parameters (vessel cross-sections is long-pending-CSA, length-L, volume-V, and the connected mode between blood vessel and blood vessel), then determine the blood vessel path.The blood vessel path definition is the propagation path of blood flow heart table coronary arterial tree from the coronary arterial tree porch, determines the long-pending Changing Pattern along the blood vessel path of vessel cross-sections.Data processor can calculate
numerical value, then determine
numerical value along the Changing Pattern in blood vessel path, wherein:
for the blood of measurement gained and the effective conductance sum of blood vessel wall (blood and blood vessel wall are in parallel);
effective conductance for blood.
mean the effective conductance of blood vessel wall, it has reflected vessel wall thickening and speckle load condition.Amass (CSA) along the Changing Pattern in blood vessel path and the effective conductance of blood vessel wall by the contrast vessel cross-sections
along the Changing Pattern in blood vessel path, data processor is the Changing Pattern along the blood vessel path by the atheromatous plaque in Precise Diagnosis patient coronary artery.
Based on syllogic design smoothly, the impedance conduit is for forming soft glue head tip, middle transition section, on-deformable conduit handle (standard REDEL Speediness link line interface), and its length and outer circumference diameter can be selected between 1200-1500 millimeter and 0.5-0.9 millimeter.As shown in Figure 5, four the exposing metal electrodes that distributing at the tip of impedance conduit.Four electrodes become the cylindric tip around the impedance conduit.Four electrodes are by metallics (as: platinum) formation of good conductivity, can be detected (X ray visuality) by x light.In testing process coronarius, two detecting electrodes are positioned in the middle of two emission electrodes.Two detecting electrodes to each other apart from (
) be 1 millimeter, two emission electrodes to each other apart from (
) be 4 millimeters.In peripheral blood vessel or other organs, electrode to each other apart from (
with
) can suitably increase or shorten and improve diagnostic accuracy.As shown in Fig. 4-1 and Fig. 5, four mutually insulated metal wires are screwed in the peripheral catheters of passing together different model, connect four exposing metal electrodes.Two mutually insulated metal wires that are connected with emission electrode are connected with the programmable DC current source by the conduit handle (standard REDEL Speediness link line interface) of peripheral catheters, two mutually insulated metal wires that are connected with detecting electrode are connected with A-D converter by the conduit handle (standard REDEL Speediness link line interface) of peripheral catheters, four wires are made by the material of good conductivity, its outer circumference diameter can be selected between the 0.0254-0.0762 millimeter, and epoxy resin is for forming insulation function.
The patient that can't get rid of " proportionality law CT method of diagnosis " advises implementing Percutaneous Coronary Intervention.In intervene operation, the impedance conduit arrives the tailing edge blood vessel path, bottom of heart table coronary arterial tree and at the uniform velocity extracts out.The constant output current of DC current source is 5 milliamperes (5 KHz RMS AC noises), and DC current source is connected with emission electrode by metal wire, and constant current, after blood transmits, gathers current signal by detecting electrode and metal wire by A-D converter.Blood and blood vessel wall are in parallel, with collecting electrode in the impedance conduit and the metal wire that is attached thereto for connect, the voltage difference that they all will affect A-D converter acceptance and change.Data processor in operation bench is the impact except blood and metal wire by bales catch, only stays the effective conductance of blood vessel wall.By contrasting the long-pending Changing Pattern along the blood vessel path of vessel cross-sections and the blood vessel wall effective conductance Changing Pattern along the blood vessel path, " speckle load diagnostic apparatus " is by the atheromatous plaque in Precise Diagnosis and position patient coronary artery.
The method and apparatus related in the present invention also can be used for the atherosclerosis in Precise Diagnosis cerebrovascular atherosclerosis, peripheral blood vessel atherosclerosis, other organs, also can be used for improving angiocarpy bracket operation degree of accuracy and success rate, and assist the posttransplantation coronary artery pathological changes of Diagnosing Cardiac.The specific embodiment is similar in appearance to the diagnosis of coronary atherosclerosis.
The accompanying drawing explanation
Introduce in detail below with reference to the accompanying drawings preferred embodiment of the present invention, in accompanying drawing:
Fig. 1 has meaned the flow process of CT reconfiguration program;
Fig. 2 has meaned the dry hat cell schematics of a tree;
Fig. 3 has meaned the flow process of proportionality law program;
Fig. 4-1 has meaned the formation of " speckle load diagnostic apparatus " operation bench;
Fig. 4-2 have meaned the data processor module of " speckle load diagnostic apparatus " operation bench; And
Fig. 5 has meaned the formation of " speckle load diagnostic apparatus " impedance conduit.
With reference to figure 1, " proportionality law CT diagnostic method " relates to CT reconfiguration program 40, it will carry out the importing 41 of DICOM file, by serial Region Segmentation technology, thereby the CT Image Segmentation Using is generated to blood vessel 42, in the serial zone, the contour line 43 of blood vessel is determined in differentiate, calculate vessel centerline 44, extract Morphologic Parameters (cross-sectional area-CSA of every blood vessel, length-L, the volume-V of three-dimensional arterial tree, and the connected mode between blood vessel and blood vessel) 45, finally these Morphologic Parameters are saved as to data file 46.
With reference to figure 2, " proportionality law CT diagnostic method " need to introduce the concept of dry hat unit in a tree.
With reference to figure 3, " proportionality law CT method of diagnosis " needs to analyze by proportionality law program 50 Morphologic Parameters of arterial tree, it will carry out the importing and establishment heart table coronary arterial tree 51 of Morphologic Parameters, determine all dry hat unit 52 of this arterial tree, determine that in heart table coronary arterial tree, each does crown length and hat body 53 of hat unit, determine and export the coefficient 54 of length-volume ratio law.
With reference to figure 4-1 and Fig. 4-2, the formation of " speckle load diagnostic apparatus " operation bench is programmable DC current source 101, A-D converter 102, computer 103, data processor 104.Programmable DC current source 101 exportable 0.1-10 milliampere DC current and 0.1-10 volt output voltage.A-D converter 102 is accepted the analogue signal of continuous variable, then is converted into discrete digital signal.Control DC current source program 105 and can control by computer 103 constant output current of DC current source 101.Accept and record by the change in voltage program 107 of A-D converter conversion and can accept and record the voltage difference by the A-D converter conversion by computer.The read-in programme 106 of the Morphologic Parameters of three-dimensional arterial tree can read in the three-dimensional arterial tree produced by CT reconfiguration program 40 Morphologic Parameters (vessel cross-sections is long-pending-CSA, length-L, volume-V, and the connected mode between blood vessel).Morphologic Parameters based on constant output current, voltage difference, arterial tree, vessel wall thickening and speckle load diagnotor 108 be the Changing Pattern along the blood vessel path by the atheromatous plaque in Precise Diagnosis patient coronary artery.
With reference to figure 4-1 and Fig. 5, the impedance conduit is for forming soft tip 36, middle transition section 30, on-deformable conduit handle 37.Soft tip (glue head) is connected by 31 with the middle transition section.Four exposure cylinder platinum electrode 32-35 are distributing at the tip of impedance conduit.In testing process coronarius, two detecting electrodes 33,34 are positioned at the centre of two emission electrodes 32,35.With emission electrode 32,35 two mutually insulated metal wires that are connected are connected with programmable DC current source 101 by the conduit handle of peripheral catheters, two mutually insulated metal wires that are connected with detecting electrode 33,34 are connected with A-D converter 102 by the conduit handle of peripheral catheters.
Claims (25)
1. the method and apparatus for the Precise Diagnosis coronary atherosclerosis, described method and apparatus comprises:
At first use " proportionality law CT method of diagnosis " to get rid of the patient without the diffusivity coronary atherosclerosis, then the patient to getting rid of, accurately get involved vessel wall thickening and the speckle load of measuring pathological changes arteria coronaria blood vessel with " speckle load diagnostic apparatus ".
2. according to claims 1 described " proportionality law CT method of diagnosis ", wherein: this CT method of diagnosis is for forming reconfiguration program, the diagnostic criteria of proportionality law program and diffusivity coronary atherosclerosis.
3. according to claims 1 and 2 described methods, wherein: store patient CT angiography is the DICOM file, then with the CT reconfiguration program, processes this document.
4. according to the described CT reconfiguration program of claims 3, comprise: image imports, image is cut apart, determining of blood vessel contour line, determining of vessel centerline, extract the three-dimensional arterial tree Morphologic Parameters (vessel cross-sections is long-pending-CSA, length-L, volume-V, and the connected mode between blood vessel and blood vessel), storing these parameters is data file.
5. according to the described method of claims 1-4, wherein: with the Morphologic Parameters of proportionality law routine processes three-dimensional arterial tree.
6. according to the described proportionality law program of claims 5, comprising: determine all dry hat unit (stem-crown unit) of arterial tree, determine each dry hat unit crown length (
) and the hat body (
), then determine and output length-volume ratio law (
) coefficient (
).
7. according to the described method of claims 1-6, wherein: based on patient CT angiography, generate the Morphologic Parameters of heart table coronary arterial tree with the CT reconfiguration program, by these parameters of proportionality law routine processes, determine in heart table coronary arterial tree each dry hat unit (stem-crown unit) crown length (
) and the hat body (
), then determine length-volume ratio law (
) coefficient (
), if
, can determine that the patient is without the diffusivity coronary atherosclerosis, if
, the suggestion patient further uses " speckle load diagnostic apparatus " accurately to get involved and measures vessel wall thickening coronarius and speckle load condition.
8. according to claims 1 described " speckle load diagnostic apparatus ", wherein: this diagnostic apparatus is for forming operation bench and impedance conduit.
9. according to the described operation bench of claims 8, wherein: this operation bench is for forming programmable DC current source, A-D converter, computer and data processor.
10. according to the described programmable DC current source of claims 9, wherein: this current source lies prostrate output voltage for exporting 0.1-10 milliampere DC current and 0.1-10, and can programme fully.
11. according to the described A-D converter of claims 9, wherein: this changer is used for accepting the analogue signal of continuous variable, and is converted into discrete digital signal.
12. according to the described impedance conduit of claims 8, wherein: four mutually insulated metal wires are screwed in the peripheral catheters of passing together different model, connect four exposed electrode.
13. according to the described peripheral catheters of claims 12, wherein: syllogic design smoothly makes this impedance conduit for forming soft glue head tip, middle transition section, on-deformable conduit handle (standard REDEL Speediness link line interface), and its length and outer circumference diameter can be selected between 1200-1500 millimeter and 0.5-0.9 millimeter.
14. according to claims 12 and 13 described methods, wherein: four exposed electrode for the metallics that forms good conductivity (for example: the cylindrical electrode of platinum) making, be surrounded on the tip of impedance conduit, can be detected by x light, two detecting electrodes are positioned in the middle of two emission electrodes, in testing process coronarius, two detecting electrodes to each other apart from (
) be 1 millimeter, two emission electrodes to each other apart from (
) be 4 millimeters, in peripheral blood vessel or other organs, electrode to each other apart from (
with
) can suitably increase or shorten and improve diagnostic accuracy.
15. according to the described method of claims 10-14, wherein: two mutually insulated metal wires that are connected with emission electrode are connected with the programmable DC current source by the conduit handle (standard REDEL Speediness link line interface) of peripheral catheters, two mutually insulated metal wires that are connected with detecting electrode are connected with A-D converter by the conduit handle (standard REDEL Speediness link line interface) of peripheral catheters, four wires are made by the material of good conductivity, its outer circumference diameter can be selected between the 0.0254-0.0762 millimeter, and epoxy resin is for forming insulation function.
16. according to claims 4 and the described method of 8-15, wherein: data processor can regulate and control the DC current (I) of DC current source output, processing is by the voltage difference (△ V) of A-D converter conversion, read in the three-dimensional arterial tree produced by the CT reconfiguration program Morphologic Parameters (vessel cross-sections is long-pending-CSA, length-L, volume-V, and the connected mode between blood vessel and blood vessel).
17., according to claims 4 and the described method of 9-16, wherein: data processor can be determined
and the relation between the blood vessel path.
18. according to the described method of claims 17, wherein: the blood vessel path definition is the propagation path of blood flow heart table coronary arterial tree from the coronary arterial tree porch.
19., according to claims 4 and the described method of 9-18, wherein: data processor can pass through
variation follow the trail of along the vessel wall thickening in different blood vessel path and speckle load.
20. according to the described method of claims 8-19, wherein: the patient that can't get rid of " proportionality law CT method of diagnosis " implements arteria coronaria and gets involved measurement, the impedance conduit arrives the tailing edge blood vessel path, bottom of heart table coronary arterial tree and at the uniform velocity extracts out, and the data processor of " speckle load diagnostic apparatus " can record and analyze vessel wall thickening and speckle load on the way.
21. according to the described method and apparatus of claims 1-20, wherein: the method and equipment also can be used for Precise Diagnosis cerebrovascular atherosclerosis.
22. according to the described method and apparatus of claims 1-20, wherein: the method and equipment also can be used for Precise Diagnosis peripheral blood vessel atherosclerosis.
23. according to the described method and apparatus of claims 1-20, wherein: the method and equipment also can be used for the atherosclerosis in other organs of Precise Diagnosis.
24. according to the described method and apparatus of claims 1-20, wherein: the method and equipment also can be used for improving angiocarpy bracket operation degree of accuracy and success rate.
25. according to the described method and apparatus of claims 1-20, wherein: the method and equipment also can be used for assisting the posttransplantation coronary artery pathological changes of Diagnosing Cardiac.
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