U.S. patent application number 10/570235 was filed with the patent office on 2007-02-15 for device and method for displaying ultrasound images of a vessel.
This patent application is currently assigned to Koninklijke Philips Electronics N.V.. Invention is credited to Jorg Bredno, Kai Eck, Barbara Martin-Leung, Jurgen Weese.
Application Number | 20070038081 10/570235 |
Document ID | / |
Family ID | 34259202 |
Filed Date | 2007-02-15 |
United States Patent
Application |
20070038081 |
Kind Code |
A1 |
Eck; Kai ; et al. |
February 15, 2007 |
Device and method for displaying ultrasound images of a vessel
Abstract
The invention relates to a device and a method for displaying a
vessel (2) with the aid of intravascular ultrasound images (1). A
sequence of intravascular ultrasound images (I(E,x)) is generated
by means of a probe (5) and stored in a memory (10) in a manner
indexed by the associated location (x) where they were generated
and also the associated heartbeat phase (E) and/or breathing phase.
During a subsequent medical intervention, those ultrasound images
(I.sub.1,1.sub.2,1.sub.3) which best correspond to the heartbeat
phase of a current fluoroscopic image (A.sub.t) or belong to the
current stopping location of a catheter (13) can be selected from
the memory (10) and displayed on a monitor (12).
Inventors: |
Eck; Kai; (Aachen, DE)
; Martin-Leung; Barbara; (Aachen, DE) ; Bredno;
Jorg; (Aachen, DE) ; Weese; Jurgen; (Aachen,
DE) |
Correspondence
Address: |
PHILIPS INTELLECTUAL PROPERTY & STANDARDS
P.O. BOX 3001
BRIARCLIFF MANOR
NY
10510
US
|
Assignee: |
Koninklijke Philips Electronics
N.V.
Eindhoven
NL
5621
|
Family ID: |
34259202 |
Appl. No.: |
10/570235 |
Filed: |
August 23, 2004 |
PCT Filed: |
August 23, 2004 |
PCT NO: |
PCT/IB04/51525 |
371 Date: |
February 28, 2006 |
Current U.S.
Class: |
600/437 |
Current CPC
Class: |
A61B 8/12 20130101; A61B
8/4416 20130101; A61B 6/12 20130101; A61B 6/5247 20130101 |
Class at
Publication: |
600/437 |
International
Class: |
A61B 8/00 20060101
A61B008/00 |
Foreign Application Data
Date |
Code |
Application Number |
Sep 4, 2003 |
EP |
03102691.7 |
Claims
1. A device for displaying a vessel (2), comprising a) a memory
(10) in which a sequence of intravascular ultrasound images (I) is
stored, the ultrasound images being indexed by the respective
locations (x) of their recording in the vessel (2), b) a data input
for information (A) which describes a current location in the
vessel (2), c) a display unit (12) for displaying images (I.sub.1,
I.sub.2, I.sub.3, A.sub.t) of the vessel (2), wherein the device is
designed to select from the memory (10) at least one ultrasound
image (I.sub.2) corresponding to the current location in the vessel
(2) and to display it on the display unit (12).
2. A device for displaying a vessel (2) which is subject to a
cyclic intrinsic movement that can be characterized by a parameter
(E), in particular a device as claimed in claim 1, comprising a) a
memory (10) in which a sequence of intravascular ultrasound images
(I) is stored, the ultrasound images being indexed by the
respective values of the parameter (E) of the intrinsic movement at
the time of recording, b) a data input for the parameter (E) of the
intrinsic movement, c) a display unit (12) for displaying images
(I.sub.1, I.sub.2, I.sub.3, A.sub.t) of the vessel (2), wherein the
device is designed to select from the memory (10) at least one
ultrasound image (I.sub.1, I.sub.2, I.sub.3) corresponding to the
current value of the parameter (E) of the intrinsic movement and to
display it on the display unit (12).
3. A device as claimed in claim 1, characterized in that it
comprises an electrocardiograph (4) for recording a parameter (E)
that characterizes the heart phase and/or a breathing sensor for
recording a parameter that characterizes the breathing phase.
4. A device as claimed in claim 1, characterized in that it
comprises an intravascular ultrasound probe (5) for generating the
ultrasound images (I) stored in the memory (10).
5. A device as claimed in claim 1, characterized in that it
comprises an X-ray device (3, 7) for generating projection images
of the vessel (2).
6. A device as claimed in claim 1, characterized in that it
comprises a device for injecting contrast agent into the vessel
(2).
7. A device as claimed in claim 1, characterized in that it
comprises a further memory (11) in which angiograms (A*) of the
vessel (2) are stored in a manner indexed with a parameter (E) of
an intrinsic movement of the vessel (2), and in that the device is
designed to select from the further memory (11) at least one
angiogram (A*) corresponding to the current value of the parameter
(E) of the intrinsic movement and to display it on the display unit
(12).
8. A device as claimed in claim 1, characterized in that it
comprises a data input for a current image (A.sub.t) of the vessel
(2) and is designed to determine from the current image (A.sub.t),
as the current location, the position of an object of interest
(13).
9. A device as claimed in claim 1, characterized in that the
intravascular ultrasound images in the memory (10) are indexed by
the respective locations (x) of their recording in the vessel (2),
and in that the device is designed to display an image (A.sub.t) of
the vessel (2) on the display unit (12) and to show within this
image the geometric position of an ultrasound image (I.sub.1,
I.sub.2, I.sub.3) that is likewise displayed on the display unit
(12).
10. A method of displaying a vessel (2), comprising the steps: a)
generating and storing a sequence of intravascular ultrasound
images (I) while at the same time recording the associated
locations (x) in the vessel, b) detecting a current location in the
vessel, c) selecting at least one ultrasound image (I.sub.2)
corresponding to the current location, d) displaying the selected
ultrasound image (I.sub.2).
11. A method of displaying a vessel (2) which is subject to a
cyclic intrinsic movement that can be characterized by a parameter
(E), in particular a method as claimed in claim 10, comprising the
steps: a) generating and storing a sequence of intravascular
ultrasound images (I) while at the same time recording the
associated parameters (E) of the intrinsic movement, b) detecting
the current value of the parameter (E) of the intrinsic movement,
c) selecting at least one ultrasound image (I.sub.1, I.sub.2,
I.sub.3) corresponding to the current value of the parameter (E) of
the intrinsic movement, d) displaying the selected ultrasound image
(I.sub.1, I.sub.2, I.sub.3).
Description
[0001] The invention relates to a device and a method for
displaying a vessel with the aid of ultrasound images, the vessel
being subject to a cyclic intrinsic movement.
[0002] In catheter examinations of the heart, a number of
angiographic X-ray images of the heart are usually generated from
various directions, a contrast agent typically being injected
during the recording. The angiograms of the vascular system that
are thus obtained may than be of assistance, for example, in
locating the site of a lesion that is to be treated, or else they
may be used as (static) road maps for navigating a catheter during
a subsequent medical intervention.
[0003] Moreover, so-called intravascular ultrasound probes (IVUS
probes) are used, which can be guided for example by means of a
catheter through a vessel and generate ultrasound section images
transversely to the vessel axis. Ultrasound images are often
generated in a so-called pullback sequence using an IVUS probe. In
this case, the IVUS probe is pulled back through the vessel at a
defined speed while at the same time recording a series of
ultrasound images. The IVUS images provide useful additional
information about the vessel or a vessel lesion, for example the
length of a vessel section affected by a disease, the
minimum/maximum thickness of a vessel, the type of a deposit and
the like.
[0004] U.S. Pat. No. 6,148,095 discloses a method of reconstructing
three-dimensionally winding vessels such as, for example, the
coronary vessels, in which firstly the three-dimensional course of
the vessel is reconstructed from biplanar angiographs, and this is
then combined with the two-dimensional section images of an IVUS
pullback sequence. Although good reconstruction of the
three-dimensional course of the vessel is possible by means of the
method, the result is a static representation of the vascular tree,
in which intrinsic movements and deformations on account of the
heartbeat and/or breathing cannot be seen. When navigating a
catheter with an intervention device such as, for example, a stent
or a balloon toward a lesion during a medical intervention, the
treating physician therefore has to correlate the current
fluoroscopic images of the catheter with the static
three-dimensional vessel model in order to be able to use the
information contained in the IVUS images.
[0005] Against this background, it is an object of the present
invention to provide means of displaying a vessel which allow more
convenient use of information from intravascular ultrasound images,
this being continually adapted to an ongoing medical
intervention.
[0006] This object is achieved according to a first aspect of the
invention by a device having the features of claim 1, according to
a second aspect of the invention by a device having the features of
claim 2, and also by methods having the features of claims 10 and
11. Advantageous refinements are given in the dependent claims.
[0007] According to a first aspect of the invention, the device,
which is used to display a vessel or a section of a vascular
system, comprises the following components:
[0008] a) a (data) memory in which a sequence of intravascular
ultrasound images is stored, the ultrasound images being indexed by
the respective locations (x) of their recording in the vessel. Said
ultrasound images may have been generated, for example, with the
aid of an intravascular ultrasound probe. In particular, the images
may come from an IVUS pullback sequence, wherein as the IVUS probe
is being pulled back, the respective stopping location of the IVUS
probe in the vessel is determined in parallel by means of further
imaging. The latter may moreover be estimated from existing images
of the vascular system (angiographs).
[0009] b) a data input for information which describes (at least) a
current location in the vessel. By way of example, a pointer
(mouse, etc.) could be connected to this input, by means of which
pointer a user indicates, on a road map, a current location of
interest to him in the vessel, or else a locating device could be
connected to said input, which locating device detects, for example
by means of magnetic fields, the current stopping location of an
intervention device on a catheter. Other examples will be described
within the context of the developments of the invention.
[0010] c) a display unit such as, for example, a monitor for
displaying images of the vessel.
[0011] The device comprising the described components is
furthermore designed to select from said memory at least one
ultrasound image and to display it on the display unit, wherein the
ultrasound image corresponds to the current location in the vessel
indicated at the data input. By way of example, an ultrasound image
whose associated recording location is identical to the current
location or is no more than a predefined distance from the latter
may be selected from the memory. The selection function may be
implemented in the device for example by means of a suitably
programmed microprocessor.
[0012] According to a second aspect, the invention comprises a
device for displaying a vessel or a section of a vascular system
which is subject to a cyclic intrinsic movement. The most important
typical causes of such an intrinsic movement are the heartbeat and
breathing. The most important typical causes of a change in the
vessel cross section is pathological constriction. The cyclic
intrinsic movement is to be characterized by a (single-component or
multicomponent) parameter. For the heartbeat, this parameter is for
example the electrical heartbeat phase that can be quantitatively
described by the electrocardiogram (ECG). The device comprises the
following components:
[0013] a) a (data) memory in which a sequence of intravascular
ultrasound images is stored, the ultrasound images being indexed by
the respective values of the parameter of the intrinsic movement
belonging to the recording time. Said ultrasound images may have
been generated, for example, with the aid of an intravascular
ultrasound probe. In particular, the images may come from an IVUS
pullback sequence, wherein as the IVUS probe is being pulled back,
the parameter of the intrinsic movement (for example the ECG) is
recorded in parallel, as is preferably also the respective stopping
location of the IVUS probe in the vessel, using methods of the type
mentioned above. The latter may moreover be estimated from existing
images of the vascular system (angiographs).
[0014] b) a data input for the current value of the parameter of
the intrinsic movement.
[0015] c) a display unit such as, for example, a monitor for
displaying images of the vessel.
[0016] The device comprising the described components is
furthermore designed to select from said memory at least one
ultrasound image and to display it on the display unit, wherein the
selected ultrasound image corresponds to the current value of the
parameter of the intrinsic movement at the data input. By way of
example, an ultrasound image whose associated ECG phase is
identical to the current ECG phase or deviates from the latter by
no more than a predefined amount may be selected from the memory.
The selection function may be implemented in the device for example
by means of a suitably programmed microprocessor. The device may
moreover also have the features of a device according to the first
aspect of the invention, that is to say an additional indexing of
the ultrasound images by their recording location, a data input for
a current location and also a selection function that is
additionally based on the location. On account of the analog
structure of the devices and their ability to be combined, special
refinements of the invention are hereinbelow described in parallel
for the "device according to the first and/or second aspect of the
invention".
[0017] The described devices according to the first and/or second
aspect of the invention allow, in real time during a medical
intervention, optimal use of information contained in IVUS images
of a vessel or vessel lesion. This is made possible in that the
device determines and displays on the display unit the IVUS
image(s) corresponding to a current location in the vessel and/or
to the current phase of the cyclic intrinsic movement. The
physician therefore need not be satisfied with a possibly
misleading static display of IVUS images, but rather sees at all
times the images corresponding to the actual state. This makes it
much easier for him to navigate a catheter to the desired target
position such as, for example, a stenosis.
[0018] As has already been mentioned, the causes of the cyclic
intrinsic movement of vessels are primarily the heartbeat and
breathing. The device according to the first and/or second aspect
of the invention therefore preferably comprises an
electrocardiograph for recording a (electrical) parameter that
characterizes the heart phase and/or a breathing sensor for
recording a parameter that characterizes the breathing phase.
[0019] The device according to the first and/or second aspect of
the invention furthermore preferably comprises an intravascular
ultrasound probe (IVUS probe), by means of which the ultrasound
images stored in said memory can be generated. As mentioned in the
introduction, such IVUS images contain useful additional
information for assessing the condition of a vessel.
[0020] The device according to the first and/or second aspect of
the invention may furthermore comprise an X-ray device for
generating X-ray projection images of the vessel. The X-ray device
may in particular be coupled to a data input of the device in order
to provide a current image of the vessel in the form of an X-ray
projection image. Moreover, the X-ray projections may also be used
during generation of a (pullback) sequence of IVUS images, in order
to determine the respective stopping location of the IVUS
probe.
[0021] In another development, the device according to the first
and/or second aspect of the invention comprises a device for
injecting contrast agent into the vessel. By means of contrast
agent injections it is possible to considerably improve the
representation of the vessel on (X-ray) images. In particular,
angiograms can be produced using a contrast agent and an X-ray
device.
[0022] Furthermore, the device according to the first and/or second
aspect of the invention may comprise a further memory in which
angiograms of the vessel are stored, these being indexed with the
respective values of the parameter of the cyclic intrinsic movement
belonging to their recording time according to the second aspect of
the invention. For each of the stored angiograms it is thus known
from which phase of the cyclic intrinsic movement it comes. The
device is in this case furthermore designed to select from said
further memory and display on the display unit at least one
angiogram corresponding to the current value of the parameter of
the intrinsic movement. The angiograms, which clearly show the
course of the vessel, are thus displayed on the display unit in
real time in a manner corresponding to the actual state of the
intrinsic movement (for example heartbeat phase or breathing
phase). The ultrasound images and the angiograms are preferably
stored in the same physical memory at different storage
locations.
[0023] In another development of the device according to the first
aspect of the invention, said device has a data input for data of a
current image of the vessel. This current image may be, for
example, an X-ray image or an NMR image of the vessel. Furthermore,
the device is designed to determine from a current image of the
vessel the position of an object of interest (e.g. a specific
anatomical structure or a catheter in the vessel) and use it as
"current location" to select a corresponding ultrasound image from
the memory. In other words, of the stored ultrasound images, only
those which show the vessel in the region of the object are
displayed on the display unit. The physician thus obtains a display
of ultrasound images that is updated in real time and corresponds
to the position of an object of interest, so that he can make
optimal use of the information contained therein. Furthermore, the
current image present in each case at the data input is preferably
also displayed on the display unit together with the intravascular
ultrasound images, and this allows the physician to observe a
medical intervention in an optimal manner.
[0024] When, in the abovementioned case, the intravascular
ultrasound images are indexed by the location of their recording,
the device according to the first and/or second aspect of the
invention may furthermore be designed to display an (any) image of
the vessel on the display unit and to show with reference to this
image the geometric position of an ultrasound image that is
likewise displayed on the display unit. The image of the vessel may
for example be a current image or a stored angiogram of the vessel.
Since, in respect of each ultrasound image, it is known at which
position of the vessel it was generated, this position of the
ultrasound image can be marked, for example by means of an arrow or
a cross, on the image of the vessel that is displayed. The user can
then see at a glance to which location a displayed ultrasound image
belongs.
[0025] The invention furthermore relates to a method of displaying
a vessel, said method comprising the following steps:
[0026] a) generating a sequence of intravascular ultrasound images
while at the same time recording the associated locations in the
vessel,
[0027] b) detecting a current location in the vessel and optionally
generating a current image of the vessel,
[0028] c) selecting at least one ultrasound image corresponding to
the current location,
[0029] d) displaying the selected ultrasound image, optionally
together with a current image or a stored image corresponding
thereto.
[0030] The invention moreover also relates to a method of
displaying a vessel which is subject to a cyclic intrinsic movement
that can be characterized by a parameter. The method may in
particular be combined with a method of the type mentioned above
and comprises the following steps:
[0031] a) generating a sequence of intravascular ultrasound images
while at the same time recording the associated parameters of the
intrinsic movement,
[0032] b) determining the current value of the parameter of the
intrinsic movement and optionally generating a current image of the
vessel,
[0033] c) selecting at least one ultrasound image corresponding to
the current value of the parameter of the intrinsic movement,
[0034] d) displaying the selected ultrasound image, optionally
together with the current image or a stored image corresponding
thereto.
[0035] Said methods in general implement the steps that can be
carried out using a device according to the first and/or second
aspect of the invention. With regard to a description of the
details, advantages and developments of the method, reference is
therefore made to the explanations given above.
[0036] The invention will be further described with reference to an
example of embodiment shown in the drawing to which, however, the
invention is not restricted.
[0037] The single figure schematically shows the components of a
device according to the invention for displaying a vessel.
[0038] The left-hand part of the figure shows a vessel (segment) 2
within the body of a patient 1, wherein said vessel may be, for
example, a coronary vessel. X-ray projection images A of the vessel
2 may be generated by means of an X-ray radiation source 3 and an
X-ray detector 7, and forwarded to a data processing device 8
(workstation, etc.).
[0039] Furthermore, an IVUS probe 5 for generating intravascular
ultrasound images I is arranged at the tip of a catheter 6. By
means of the IVUS probe 5, in particular a so-called pullback
sequence (see dashed lines) can be generated when the probe 5 is
pulled back through the vessel at a defined speed and in the
process generates ultrasound section images I at regular time
intervals, said ultrasound section images being transmitted to the
data processing device 8. The position of the IVUS probe 5 during
an image I generated by the latter, which position can be described
by a coordinate x, may be determined in various ways. For instance,
by way of example it is possible during the ultrasound recordings
for X-ray projections to be produced at the same time, from which
the associated position of the IVUS probe 5 can be determined. In
order to reduce the X-ray exposure for the patient 1, however, it
is also possible for X-ray projections to be generated only at the
start and at the end of the IVUS pullback sequence, it being
possible for the positions of the intermediate IVUS images to be
estimated on account of the defined pullback speed of the probe
5.
[0040] Furthermore, an electrocardiograph 4 is also shown in the
left-hand part of the figure, by means of which the electrical
heart activity E (electrocardiogram) can be recorded and fed to the
data processing device 8. The ECG represents a parameter E for
characterizing the heartbeat phase, which has a dominating effect
on the location and the shape of the vessel 2.
[0041] The data processing device 8 comprises a central processor 9
(CPU) which receives the abovementioned information (ECG E, IVUS
images I, X-ray projections A) and further processes it. The
processor 9 is connected to two memories or memory areas 10 and 11
(RAM, hard disk, etc.) and also to a display unit 12 (monitor).
[0042] Stored in the first memory area 10 are the IVUS images I
which have been generated in a pullback sequence of the IVUS probe
5. During the pullback sequence, the ECG E was recorded in
parallel. Each of the IVUS images stored in the memory area 10 can
thus be indexed by the heartbeat phase E at the time they were
generated and the location x where they were generated: I=I(E, x).
Since an IVUS pullback sequence typically lasts about 30 seconds
(and comprises about 10 to 30 ultrasound images per second), about
30 heart cycles and two to four breathing cycles fall within the
time of the sequence. The sensory detection of the breathing cycle
and the indexing of the ultrasound images I with a corresponding
parameter is not shown in the figure for reasons of clarity.
However, it is preferably likewise carried out and dealt with in a
manner similar to the characterizing by the ECG E.
[0043] The second memory area 11 comprises a sequence of angiograms
A*. These are X-ray projections of the vessel 2 which have been
recorded with administration of contrast agent. By virtue of a
parallel recording of the ECG E, the angiograms A* can once again
be indexed by the associated heartbeat phase (and in accordance
with what has been stated above also by a breathing cycle).
[0044] The generation of the ultrasound images I(E,x) of the memory
area 10 and where appropriate of the angiograms A*(E) of the memory
area 11 takes place in the run-up to a medical intervention. During
the actual intervention, e.g. the placing of a stent with the aid
of a catheter 13, the catheter must be pushed as precisely as
possible up to the actual stenosis with continual
X-ray-fluoroscopic observation (but without contrast agent in order
to minimize the exposure of the patient). The precise placing of
the stent in this case has a decisive effect on the success of the
intervention or the risk of subsequent restenosis. In order in this
connection to allow the physician to make optimal use of the
available information in real time during the intervention, the
data processing device 8 is designed, by means of corresponding
programs for the processor 9, etc., to carry out the steps
explained below.
[0045] Firstly, as already mentioned above, the catheter 13 is
pushed up to the lesion under continual fluoroscopic observation.
On each current fluoroscopic X-ray image A.sub.t provided by the
X-ray device 3, 7, the instantaneous stopping location of the
catheter 13 is located by the data processing device 8, and the
X-ray image A.sub.t is displayed on the display unit 12. By virtue
of the electrocardiogram E recorded at the same time, the
angiographic image A*(E) that best corresponds to the current
fluoroscopic image A.sub.t in terms of the ECG phase can be
selected from the memory area 11, and displayed for example on the
display unit 12 next to the image A.sub.t or superposed on the
latter. Details of such a combination of current fluoroscopic
images and static "road maps" are known and therefore do not have
to be discussed in any more detail in the present text.
[0046] Furthermore, one or more IVUS images I(E,x) are selected
from the memory area 10 by the data processing device 8 in a manner
corresponding to the ECG phase E of the current image A.sub.t. In
the example shown, three IVUS images I.sub.1, I.sub.2, I.sub.3 have
been determined in this way and displayed on the display unit 12
next to the picture of the current image A.sub.t. The choice of
IVUS images I.sub.1, I.sub.2, I.sub.3 corresponding to the
heartbeat phase of the current image A.sub.t ensures that the
physician is shown on the monitor 12 at all times X-ray information
and intravascular ultrasound information from the same current
heartbeat phase. In this way he can make optimal use of the
important information contained in the IVUS images.
[0047] The IVUS images I.sub.1, I.sub.2, I.sub.3 displayed on the
monitor 12 belong to various known positions x along the vessel 2.
As shown in the figure, in this respect the physician is shown the
respective location of the IVUS images I.sub.1, I.sub.2, I.sub.3
for example by connecting lines on the current image A.sub.t.
[0048] According to one modification or further development of the
method, the processor 9 selects, among the IVUS images I(E,x) from
the memory area 10, only one (or a few) which have been generated
at least approximately at the current stopping location of the
catheter 13. In a modification of the figure, therefore, only the
IVUS image I.sub.2 which corresponds to the current stopping
location of the catheter tip 13 would be displayed on the monitor
12. The physician then sees, next to the current fluoroscopic image
A.sub.t, at all times the associated vessel cross section at the
location of the catheter tip. In this connection, it may be useful
or necessary to carry out a weighting of the selection criteria
"corresponding to the stopping location of the object" and
"corresponding to the ECG phase". That is to say, depending on the
settings of the user, that IVUS image which best corresponds to the
current position of the catheter 13 is selected and displayed, or
that IVUS image which best corresponds to the current heart phase
is selected and displayed, or an IVUS image in which a weighted
compromise between the abovementioned criteria is met is
displayed.
[0049] Finally, it should be pointed out that the method and system
described preferably also take account of the breathing phase,
which is dealt with in a manner analogous to the heart phase.
* * * * *