A multimodal quantification and measurement system and method for overall atherosclerotic burden

Abstract

The present invention provides a multimodal quantification measurement system and method for the overall atherosclerotic burden. In this system, a parameter information extraction module extracts parameters from the obtained CTA information of the heart and brain in a combined scan, lower extremity artery ultrasound information, and renal artery ultrasound information, so as to obtain atherosclerotic lesion information of six vascular beds including intracranial arteries, extracranial cervical arteries, coronary arteries, thoracic aorta, renal arteries, and lower extremity arteries of the selected patients; an atherosclerotic burden measurement module performs semi-quantitative scoring on the atherosclerotic lesion information of the six vascular beds of the selected patients, respectively obtains the atherosclerotic burden of a single vascular bed of the six vascular beds and stores it in the patient information acquisition module, and then obtains the quantitative score of the overall atherosclerotic burden of the selected patients according to the scores of the atherosclerotic burden of a single vascular bed of all patients stored in the patient information acquisition module.

Description

Technical Field

[0001] The present invention relates to the field of medical technologies, and particularly to a multimodal quantification measurement system and method for the overall atherosclerotic burden. Background Art

[0002] Atherosclerosis is a complex pathological process involving multiple systems and various factors and progressing over a long term. It often does not confine to a single vascular bed but is likely to affect multiple vascular beds simultaneously. Diseases caused by atherosclerosis in different vascular beds mainly include ischemic cerebrovascular diseases, ischemic heart diseases, intermittent claudication, lower limb ulcers and gangrene, refractory hypertension, etc., and patients with atherosclerosis in multiple vascular beds often have poor prognoses. Therefore, early diagnosis and treatment of systemic atherosclerosis and the vascular events caused thereby have significant social and economic benefits.

[0003] Currently, the clinical diagnosis and treatment of patients with atherosclerotic vascular diseases are usually limited to the assessment of a single vascular bed in the lesion responsible area, which has certain limitations. First, the assessment of the responsible blood vessel is often a qualitative or quantitative assessment of a single blood vessel segment, and it is easy to overlook the atherosclerotic lesions in non-responsible blood vessel segments within the same vascular bed. Second, the lack of a comprehensive assessment of the overall atherosclerotic condition of the patient's multiple vascular beds cannot comprehensively understand whether the patient has other potential risks of atherosclerotic diseases. In addition, even if atherosclerotic-related examinations are performed on other vascular beds besides the responsible blood vessel, there is no quantification assessment method for the overall atherosclerotic degree of the patient, which not only is not conducive to the horizontal comparison of the severity of atherosclerosis in different vascular beds, but also makes the examination results between different patients lack comparability, resulting in difficulty in predicting the risk of atherosclerotic vascular events and dynamically evaluating the prevention and control effect of atherosclerosis.

[0004] Therefore, it is necessary to develop a multimodal measurement system for the overall atherosclerotic burden to provide a comprehensive, unified, convenient, and comparable quantification assessment for the overall atherosclerosis of multiple vascular beds and multiple blood vessel segments of patients with atherosclerotic diseases, so as to solve the above technical problems.

[0005] Cardio-cerebral combined computed tomography angiography (CTA) is a new type of computerized angiography technology. By instantaneously switching between the full-width axial scan mode and the spiral scan mode, it can perform head and neck CTA, thoracic aortic CTA, and coronary artery CTA scans in one stop, only requiring one injection of contrast agent, and achieving multi-site vascular imaging in a short time. Compared with the previous examinations that required separate scans of head and neck CTA, thoracic aortic CTA, and coronary artery CTA, the application of cardio-cerebral one-stop CTA examination has a shorter examination time, lower radiation dose, and lower contrast agent usage, and has great advantages in evaluating coronary arteries, thoracic aorta, and carotid and cerebral arteries. In addition to using conventional arterial ultrasound examination to measure the atherosclerotic burden, the new cardio-cerebral combined CTA is expected to play an important role in the multi-modal measurement of the overall atherosclerotic burden. Summary of the Invention

[0006] The technical problem to be solved by the present invention is to provide a multi-modal quantitative measurement system and method for the overall atherosclerotic burden that combines the new cardio-cerebral combined CTA and ultrasound examination technology, aiming at the above-mentioned defects in the prior art, so as to provide a comprehensive, unified, convenient, and comparable quantitative evaluation method for the overall atherosclerosis of multiple vascular beds and multiple vascular segments in patients with atherosclerotic diseases, and to solve the problem that in current clinical practice, the assessment of atherosclerotic risk mainly relies on personal experience, lacks a unified evaluation standard, and is difficult to truly and accurately reflect the actual situation of the patient's atherosclerosis, thus affecting its prevention and control.

[0007] According to the present invention, there is provided a multi-modal quantitative measurement system for the overall atherosclerotic burden, characterized by comprising:

[0008] Patient information acquisition module: used for collecting and / or storing patient information related to atherosclerotic diseases;

[0009] Cardio-cerebral combined CTA information acquisition module: performing imaging examinations of carotid and cerebral arteries, coronary arteries, and thoracic aorta atherosclerosis on the selected patients by using cardio-cerebral combined CTA, and obtaining cardio-cerebral combined CTA information related to the atherosclerotic lesion conditions of the vascular beds;

[0010] Lower limb artery and renal artery ultrasound information acquisition module: for the lower limb arteries and renal arteries, performing imaging examinations of renal artery and lower limb artery atherosclerosis on the selected patients by using ultrasound, and obtaining lower limb artery ultrasound information and renal artery ultrasound information related to the atherosclerotic lesion conditions of the vascular beds;

[0011] Parameter Information Extraction Module: Extract parameters from the obtained CTA information of combined head and brain scans, lower extremity artery ultrasound information, and renal artery ultrasound information to obtain atherosclerotic lesion information of six vascular beds including intracranial arteries, extracranial cervical arteries, coronary arteries, thoracic aorta, renal arteries, and lower extremity arteries of the selected patients;

[0012] Atherosclerosis Load Calculation Module: Perform semi - quantitative scoring on the atherosclerotic lesion information of the six vascular beds of the selected patients, respectively obtain the atherosclerotic load of a single vascular bed of the six vascular beds and store it in the Patient Information Acquisition Module, and then obtain the quantitative score of the overall atherosclerotic load of the selected patients according to the scores of the atherosclerotic load of a single vascular bed of all patients stored in the Patient Information Acquisition Module.

[0013] Preferably, the Parameter Information Extraction Module includes:

[0014] Sub - division Module: Precisely divide the blood vessels contained in six single vascular beds of intracranial arteries, extracranial cervical arteries, coronary arteries, thoracic aorta, renal arteries, and lower extremity arteries into multiple vascular segments according to anatomical structures; among them, extracranial cervical arteries include: bilateral subclavian arteries, common carotid arteries, extracranial carotid arteries, and extracranial vertebral arteries; intracranial arteries include: intracranial carotid arteries, intracranial vertebral arteries, anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, and basilar arteries; thoracic aorta includes: ascending aorta from the aortic root to the brachiocephalic trunk opening, aortic arch between the brachiocephalic trunk and the left subclavian artery opening, proximal descending aorta from the left subclavian aortic opening to the pulmonary artery bifurcation level; coronary arteries include: proximal, middle, and distal parts of the right coronary artery and its posterior descending branch; left coronary artery main trunk; proximal, middle, and apical parts of the left anterior descending branch and its first and second diagonal branches; left circumflex coronary artery and its obtuse margin, posterolateral, and proximal and distal parts of the posterior descending branch; renal arteries include: two segments of the main trunks of the left and right renal arteries; lower extremity arteries include: bilateral common femoral arteries, deep femoral arteries, superficial femoral arteries, peroneal arteries, popliteal arteries, anterior tibial arteries, and posterior tibial arteries;

[0015] Evaluation Module: Used to evaluate the stenosis degree and nature of single vascular segments in different vascular beds according to the sub - division results.

[0016] Preferably, the Evaluation Module includes:

[0017] Artery Measurement Module: Used to perform measurement of the stenosis degree of intracranial arteries, extracranial cervical arteries, and coronary arteries; among them, use the aforementioned CTA examination of combined head and brain scans for image scanning, data reconstruction, and image analysis, and use curved planar reformation, maximum intensity projection, multi - planar reformation, and volume rendering to evaluate the artery stenosis degree; use an automatic vascular analysis tool to quantify the percentage of artery stenosis on orthogonal views; the artery stenosis degree of different vascular beds is calculated by the following formula:

[0018] The arterial stenosis rate (%) of the extracranial cervical artery vascular bed = (1 - the residual inner diameter of the narrowest lumen / the inner diameter of the normal segment of the artery distal to the stenosis) × 100%;

[0019] The arterial stenosis rate (%) of the intracranial artery vascular bed = (1 - the residual inner diameter of the narrowest lumen / the inner diameter of the normal segment of the artery proximal to the stenosis) × 100%;

[0020] The arterial stenosis rate (%) of the coronary artery vascular bed = {1 - [the minimum lumen diameter / (the average of the proximal and distal reference vessel diameters)]} × 100%;

[0021] For extracranial cervical arteries, intracranial arteries, and coronary arteries, if the image shows that the stenosis degree at the most severe stenosis or plaque of a certain artery segment is ≥ 50% or the lumen is occluded, it is defined that there is significant stenosis in this artery segment;

[0022] The property evaluation module: used to perform the evaluation of the properties of thoracic aortic plaques, where aortic complex plaques include non - calcified plaques with a thickness ≥ 4 mm, ulcer plaques, and mural thrombi; the aortic plaque thickness is the distance from the highest point of the plaque perpendicular to the aortic adventitial wall; ulcer plaques refer to the presence of filling defects on the plaque surface, and the basal width and maximum depth of the filling defect are ≥ 2 mm; mural thrombi refer to the presence of low - density imaging areas in the aortic lumen;

[0023] The lower limb measurement module: used to perform the measurement of the degree of lower limb artery stenosis. The following formula is used to calculate the stenosis degree: stenosis degree = (vessel inner diameter - effective vessel diameter) / vessel inner diameter × 100%. If the stenosis degree at the most severe stenosis or plaque of a certain lower limb artery segment is ≥ 50% or the lumen is occluded, it is defined that there is significant stenosis in this lower limb artery segment;

[0024] The renal artery measurement module: used to perform the measurement of the degree of renal artery stenosis. When the peak systolic velocity at the turbulent area of the renal artery is ≥ 180 cm / s, the corresponding lumen stenosis diameter is ≥ 60%, and it is defined that there is significant stenosis in the renal artery on this side.

[0025] Preferably, the atherosclerotic burden measurement module includes:

[0026] The grade scoring module: used to perform the grade scoring of the atherosclerotic burden of a single vascular bed artery; among them, according to the number of significantly stenosed vascular segments in a single vascular bed, the atherosclerotic burden of a single vascular bed artery is scored;

[0027] The burden measurement module: used to perform the measurement of the overall atherosclerotic burden based on the atherosclerotic burden score of a single vascular bed artery.

[0028] Preferably, the grading score module assigns a grade score of 0-2 to the atherosclerotic burden of a single vascular bed. If there is no significant vascular stenosis in all vascular segments of a single vascular bed, a score of 0 is given; if there is exactly one vascular segment with significant stenosis in a single vascular bed, a score of 1 is given; if there are two or more vascular segments with significant stenosis in a single vascular bed, a score of 2 is given.

[0029] Preferably, the semi-quantitative scoring of the atherosclerotic burden of the intracranial artery, extracranial carotid artery, lower extremity artery, and coronary artery vascular beds is further subdivided into scoring based on the degree of lumen stenosis. First, the atherosclerotic score of a single vascular segment is performed. When there is no obvious atherosclerotic plaque in a single vascular segment, a score of 0 is given; when there are atherosclerotic plaques or calcifications but no obvious lumen stenosis, a score of 1 is given; when the degree of atherosclerotic lumen stenosis is <50%, it is mild stenosis and a score of 2 is given; when the degree of atherosclerotic lumen stenosis is ≥50% but <70%, it is moderate stenosis and a score of 3 is given; when the degree of atherosclerotic lumen stenosis is ≥70% but not completely occluded, it is severe stenosis and a score of 4 is given; when the atherosclerotic lumen is completely occluded, a score of 5 is given; the total score of the atherosclerotic burden of a single vascular bed is the sum of the scores of each vascular segment.

[0030] Preferably, the scoring method for the atherosclerotic burden of the intracranial artery, extracranial carotid artery, and coronary artery vascular beds is based on plaque burden scoring. First, the atherosclerotic score of a single vascular segment is performed, and it is measured based on the plaque at the most severely stenosed part within the vascular segment. Plaque burden = 100% × (plaque volume / vascular volume); the total score of the atherosclerotic burden of a single vascular bed is the sum of the scores of each vascular segment.

[0031] Preferably, the load calculation module includes:

[0032] The first sub-module: arithmetically sum up the atherosclerotic burden of a single vascular bed of six vascular beds obtained by the lower extremity artery and renal artery ultrasound information acquisition module for the selected patients, and then enter the quantitative score of the overall atherosclerotic burden of the subject into the aforementioned atherosclerotic patient database;

[0033] The second sub-module: sort the overall atherosclerotic burden scores of all patients in the aforementioned atherosclerotic patient database.

[0034] Preferably, the second sub-module performs three-classification according to the interquartile range from low to high scores. The overall atherosclerotic burden of the first one-third of the patients is rated as low, the overall atherosclerotic burden of the middle one-third of the patients is rated as medium, and the overall atherosclerotic burden of the last one-third of the patients is rated as high, so as to obtain the grade classification of the overall atherosclerotic burden of the patients.

[0035] According to another aspect of the present invention, there is also provided a multimodal quantification method for the overall atherosclerotic burden, which is implemented by using the multimodal quantification system for the overall atherosclerotic burden described above.

[0036] Thus, the present application combines the new computed tomography angiography technology to establish a systematic quantitative evaluation scheme for atherosclerotic burden. The system of the present application provides a comprehensive, unified, convenient and comparable quantification method for the overall atherosclerotic burden of multiple vascular beds and multiple vascular segments in patients with atherosclerotic diseases, and solves the problem that the risk assessment of atherosclerosis relies more on personal experience and lacks a unified evaluation standard. BRIEF DESCRIPTION OF THE DRAWINGS

[0037] With reference to the accompanying drawings and by referring to the following detailed description, it will be easier to have a more complete understanding of the present invention and easier to understand its accompanying advantages and features, wherein:

[0038] Figure 1 Schematically shows the overall block diagram of the multimodal quantification system for the overall atherosclerotic burden according to a preferred embodiment of the present invention.

[0039] Figure 2 An example of the reconstructed image of the cardiac and cerebral combined scan CTA obtained by the novel cardiac and cerebral combined scan CTA acquisition module of the multimodal measurement system for the overall atherosclerotic burden provided by the present invention.

[0040] Figure 3 An example of the original information and parameter extraction image of the lower limb artery and renal artery ultrasound obtained by the lower limb artery and renal artery ultrasound information acquisition module of the multimodal measurement system for the overall atherosclerotic burden provided by the present invention.

[0041] Figure 4 Schematically shows a specific example of the parameter information extraction module of the multimodal quantification system for the overall atherosclerotic burden according to a preferred embodiment of the present invention.

[0042] Figure 5 and Figure 6 An example of the image obtained by the parameter extraction module of the multimodal measurement system for the overall atherosclerotic burden provided by the present invention to measure the atherosclerotic burden of the thoracic aorta.

[0043] Figure 7 Schematically shows a specific example of the atherosclerotic burden measurement module of the multimodal quantification system for the overall atherosclerotic burden according to a preferred embodiment of the present invention.

[0044] It should be noted that the accompanying drawings are used to illustrate the present invention, rather than to limit it. Note that the drawings showing the structure may not be drawn to scale. Also, in the drawings, the same or similar elements are labeled with the same or similar reference numerals. Detailed implementation manners

[0045] The technical solutions of the present invention will be clearly and completely described below with reference to the accompanying drawings. Apparently, the described embodiments are some, but not all, of the embodiments of the present invention. All other embodiments obtained by those of ordinary skill in the art based on the embodiments of the present invention without creative efforts shall fall within the protection scope of the present invention.

[0046] In the description of the present invention, it should be noted that the orientation or positional relationship indicated by the terms "center", "upper", "lower", "left", "right", "vertical", "horizontal", "inner", "outer", etc. is based on the orientation or positional relationship shown in the accompanying drawings, and is only for the convenience of describing the present invention and simplifying the description, rather than indicating or implying that the device or element referred to must have a specific orientation, be constructed and operated in a specific orientation, and thus should not be construed as a limitation of the present invention. In addition, the terms "first", "second", and "third" are only used for descriptive purposes and cannot be construed as indicating or implying relative importance.

[0047] In the description of the present invention, it should be noted that unless otherwise clearly defined and limited, the terms "installed", "connected", and "connected" should be understood in a broad sense. For example, it can be a fixed connection, a detachable connection, or an integral connection; it can be a mechanical connection or an electrical connection; it can be directly connected or indirectly connected through an intermediate medium, and it can be the communication inside two elements. For those of ordinary skill in the art, the specific meanings of the above terms in the present invention can be understood according to specific situations.

[0048] In addition, the technical features involved in different embodiments of the present invention described below can be combined with each other as long as they do not conflict with each other.

[0049] <Overall system>

[0050] Figure 1 The overall block diagram of the overall atherosclerotic burden multimodal quantification measurement system according to a preferred embodiment of the present invention is schematically shown.

[0051] As Figure 1 shown, the overall atherosclerotic burden multimodal quantification measurement system according to a preferred embodiment of the present invention includes:

[0052] Patient information acquisition module M1: used to collect and / or store patient information related to atherosclerotic diseases;

[0053] Cardio-cerebral combined CTA information acquisition module M2: Use cardio-cerebral combined CTA to perform imaging examinations of carotid arteries, coronary arteries and thoracic aorta atherosclerosis on selected patients, and obtain cardio-cerebral combined CTA information related to the atherosclerotic lesions of the vascular bed;

[0054] Lower extremity artery and renal artery ultrasound information acquisition module M3: For the lower extremity arteries and renal arteries, use ultrasound to perform imaging examinations of renal artery and lower extremity artery atherosclerosis on selected patients, and obtain lower extremity artery ultrasound information and renal artery ultrasound information related to the atherosclerotic lesions of the vascular bed;

[0055] Parameter information extraction module M4: Extract parameters from the obtained cardio-cerebral combined CTA information, lower extremity artery ultrasound information and renal artery ultrasound information to obtain atherosclerotic lesion information of six vascular beds including intracranial arteries, extracranial carotid arteries, coronary arteries, thoracic aorta, renal arteries and lower extremity arteries of the selected patients;

[0056] Atherosclerosis burden calculation module M5: Perform semi-quantitative scoring on the atherosclerotic lesion information of six vascular beds of the selected patients, respectively obtain the single-vascular-bed atherosclerosis burden of six vascular beds and store them in the patient information acquisition module, and then obtain the quantitative score of the overall atherosclerosis burden of the selected patients according to the single-vascular-bed atherosclerosis burden scores of all patients stored in the patient information acquisition module.

[0057] <Specific example of patient information acquisition module M1>

[0058] For example, the functions of the patient information acquisition module M1 include but are not limited to:

[0059] Directly collect patient data, including: name, hospital number, age, gender, weight, height, history of hypertension, history of diabetes, history of dyslipidemia, history of hyperhomocysteinemia, history of coronary heart disease, history of hyperuricemia, history of heart disease, history of peripheral atherosclerosis, history of kidney disease, medication history, smoking and drinking history, exercise history and family history, etc.;

[0060] Indirectly collect patient data, including symptoms determined by doctors and examination results of doctors and medical testing equipment, covering clinical diagnosis, vital signs, blood routine, blood biochemistry, coagulation, immune markers, three items of myocardial infarction, anti-nuclear antibody spectrum, head magnetic resonance, head CT, etc.

[0061] Take the identity ID of each patient and the data collected directly or indirectly and supplementary data as a complete data unit, establish a data object, and enter all data objects into the atherosclerosis database.

[0062] Specifically, for example, the patient information acquisition module M1 records the clinical data and imaging data of patients with atherosclerotic diseases in the form of an electronic database, including but not limited to the physiological data, medical history, medication history, personal history, physical examination results, laboratory test results, and conventional imaging examination results of the patients.

[0063] In addition, particularly, the patient information acquisition module M1 stores the single-vessel bed atherosclerotic burden of the six vessel beds of all patients obtained by the atherosclerotic burden measurement module M5. Moreover, preferably, the patient information acquisition module M1 can also store all the data obtained by the cardiac and cerebral combined CTA information acquisition module M2, the lower extremity artery and renal artery ultrasound information acquisition module M3, and the parameter information extraction module M4.

[0064] <Specific example of the cardiac and cerebral combined CTA information acquisition module M2>

[0065] The cardiac and cerebral combined CTA information acquisition module M2 performs the cardiac and cerebral combined CTA information acquisition function. For example, Figure 2 FIG. is an example of a cardiac and cerebral combined CTA reconstructed image obtained by the novel cardiac and cerebral combined CTA acquisition module of the overall atherosclerotic burden multimodal measurement system provided by the present invention.

[0066] For example, the acquisition function can be carried out in the following way: The new one-stop cardiac and cerebral CTA scan is performed using a 192-slice dual-source CT scanner (Somatom Force, Siemens Healthcare, Forchheim, Germany). Data is acquired in the cephalocaudal direction from the diaphragm to the top of the head. Image acquisition is prospectively triggered by the patient's electrocardiogram and initiated at 30% or 60% of the R-R interval according to the patient's heart rate, using the Turbo Flash Spiral mode. The CT parameters are a slice collimation of 192 × 0.6 mm; a gantry rotation time of 250 ms, and a pitch of 3.2. Automatic tube current modulation (CARE Dose4D, Siemens) is used, with a reference tube current-time of 330 - 450 mAs, and a tube voltage range of 70 to 90 kV, using tube voltage selection based on automatic attenuation (CAREkV, Siemens). The amount of contrast agent is adjusted according to the patient's body mass index, ranging from 40 to 50 ml. The contrast agent (Ultravist 370 Iodine / ml; Bayer Schering Pharma, Germany) is injected by a power injector through the antecubital vein with a 20 - 22 gauge needle at a flow rate of 5 mL / s, followed by an injection of 50 ml of saline. The bolus tracking technique in the ascending aorta is used to control the application of the contrast agent (signal attenuation threshold of 100 HU). Data acquisition starts after reaching the threshold in the ascending aorta, with an average delay of 8 seconds. Each raw data point is reconstructed using advanced model-based iterative reconstruction with a slice thickness of 0.6 mm and an increment of 0.4 mm, using a medium smoothing reconstruction kernel (Bv36), and transferred to an external workstation (MMWP, Syngo.via, Siemens) for evaluation of all CTA datasets.

[0067] When the patient is not eligible for the new cardiac and cerebral CTA scan or has already undergone one of the carotid CTA and coronary CTA scans, the outstanding carotid CTA and / or coronary CTA scans can be performed separately. When the patient has undergone both the carotid CTA and coronary CTA scans, it can be regarded as the completion of the cardiac and cerebral CTA scan, and the examination results are also applicable to the measurement of atherosclerotic conditions in the thoracic aorta, intracranial arteries, extracranial carotid arteries, and coronary arteries using the imaging-based single-vessel bed atherosclerotic burden measurement method with the M5 module.

[0068] <Specific example of the lower limb artery and renal artery ultrasound information acquisition module M3>

[0069] The lower limb artery and renal artery ultrasound information acquisition module M3 performs the function of acquiring lower limb artery and renal artery ultrasound information, for example,Figure 3 The figure shows an image example of the original ultrasound information of the lower limb arteries and renal arteries and the parameter extraction obtained by the ultrasound information acquisition module for the lower limb arteries and renal arteries.

[0070] For example, the acquisition function can be carried out in the following way: For the lower limb arteries, a Philips IU22 color Doppler ultrasound diagnostic instrument is used, with an ultra-wideband linear array probe of 3 - 9 MHz, and the angle between the sound velocity and the blood flow ≤ 60°. The subject lies supine, exposing both lower limbs and the waist. Along the anatomical position, the bilateral arterial intima-media thickness and vessel diameter are displayed and measured by two-dimensional ultrasound to observe whether there is the formation of atherosclerotic plaques. Then, the blood flow filling condition in the vessel lumen is observed by color Doppler flow imaging, and hemodynamic parameters are obtained by sampling in the vessel with pulsed Doppler. For the renal arteries, Philips IU22 and HDI5000 ultrasound diagnostic instruments are used, with a probe frequency of 2.0 - 5.0 MHz. The subject fasts for 8 - 12 hours, and is scanned in the right abdomen, with a transverse section under the costal margin or a coronal section on the lateral waist. Using the liver, gallbladder, and both kidneys as the acoustic beds, strive to obtain the smallest possible half-divergence angle, and measure the peak systolic velocity of the renal arteries at the proximal, middle, and distal segments of the renal arteries.

[0071] <Specific example of the parameter information extraction module M4>

[0072] The parameter information extraction module M4 is used to extract the parameters in the CTA and ultrasound information collected by the heart-brain combined scan CTA information acquisition module M2 and the parameter information extraction module M4.

[0073] Preferably, as Figure 4 shown, the parameter information extraction module M4 includes the following modules:

[0074] Subdivision module M41: Precisely subdivide the blood vessels contained in six single vascular beds of the intracranial arteries, extracranial cervical arteries, coronary arteries, thoracic aorta, renal arteries, and lower limb arteries into multiple vascular segments according to the anatomical structure; among them, the extracranial cervical arteries include: 8 segments of bilateral subclavian arteries, common carotid arteries, extracranial carotid arteries, and extracranial vertebral arteries; the intracranial arteries include: 11 segments of intracranial carotid arteries, intracranial vertebral arteries, anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, and basilar arteries; the thoracic aorta includes 3 segments: the ascending aorta from the aortic root to the brachiocephalic trunk opening, the aortic arch between the brachiocephalic trunk and the left subclavian artery opening, and the proximal descending aorta from the left subclavian aortic opening to the pulmonary artery bifurcation level; the coronary arteries include 15 segments: the proximal, middle, and distal parts of the right coronary artery and its posterior descending branch; the left coronary artery main trunk; the proximal, middle, and apical parts of the left anterior descending branch and its first and second diagonal branches; the left circumflex coronary artery and its obtuse margin, posterolateral, and proximal and distal posterior descending branches; the renal arteries include: 2 segments of the left and right renal artery main trunks; the lower limb arteries include: 14 segments of bilateral common femoral arteries, deep femoral arteries, superficial femoral arteries, peroneal arteries, popliteal arteries, anterior tibial arteries, and posterior tibial arteries.

[0075] Evaluation module M42: used to evaluate the stenosis degree and nature of single blood vessel segments in different vascular beds according to the segmentation results.

[0076] For example, the evaluation module M42 may include the following modules:

[0077] Artery measurement module M421: used to perform the measurement of the stenosis degree of intracranial arteries, extracranial cervical arteries, and coronary arteries; specifically, use the aforementioned new type of cardiac and cerebral combined CTA examination for image scanning, data reconstruction, and image analysis, and use curved planar reformation, maximum intensity projection, multi-planar reformation, and volume rendering to evaluate the artery stenosis degree; use an automatic vessel analysis tool to quantify the percentage of artery stenosis on orthogonal views; the artery stenosis degree of different vascular beds is calculated using the following formula:

[0078] Artery stenosis rate of the extracranial cervical artery vascular bed (%) = (1 - residual inner diameter of the narrowest lumen / inner diameter of the normal segment of the vessel distal to the stenosis) × 100%;

[0079] Artery stenosis rate of the intracranial artery vascular bed (%) = (1 - residual inner diameter of the narrowest lumen / inner diameter of the normal segment of the vessel proximal to the stenosis) × 100%;

[0080] Artery stenosis rate of the coronary artery vascular bed (%) = {1 - [minimum lumen diameter / (average of the proximal and distal reference vessel diameters)]} × 100%;

[0081] For extracranial cervical arteries, intracranial arteries, and coronary arteries, if the image shows that the stenosis degree at the most severe stenosis or plaque of a certain artery segment is ≥ 50% or the lumen is occluded, it is defined that there is significant stenosis in this artery segment;

[0082] Nature evaluation module M422: used to perform the evaluation of the nature of thoracic aortic plaques: for example, refer to Figure 5 and Figure 6 As shown, aortic complex plaques include non-calcified plaques with a thickness ≥ 4 mm, ulcer plaques, and mural thrombi; the aortic plaque thickness is the distance from the highest point of the plaque perpendicular to the aortic adventitial wall, and the average value can be calculated after multiple measurements; ulcer plaques refer to the presence of filling defects on the plaque surface, and the base width and maximum depth should be at least ≥ 2 mm; mural thrombi refer to the presence of low-density image areas in the aortic lumen.

[0083] Lower limb measurement module M423: used to perform the measurement of the stenosis degree of lower limb arteries: as Figure 3 shown, the following formula is used to calculate the artery stenosis degree: stenosis degree = (vessel inner diameter - effective vessel diameter) / vessel inner diameter × 100%, if the stenosis degree at the most severe stenosis or plaque of a certain lower limb artery segment is ≥ 50% or the lumen is occluded, it is defined that there is significant stenosis in this lower limb artery segment;

[0084] Renal artery measurement module M424: used to perform the measurement of the degree of renal artery stenosis: as Figure 3 shown, if the peak systolic velocity at the turbulent part of the renal artery ≥ 180 cm / s, then the corresponding stenosis diameter of the lumen ≥ 60%; it is defined that there is significant stenosis in the renal artery on that side.

[0085] When the above modules perform functions, according to the anatomical structure, six different single vascular beds are subdivided into multiple different vascular segments; if there are multiple atherosclerotic plaques or vascular stenosis sites in one vascular segment, the degree of vascular stenosis is calculated according to the most severe stenosis.

[0086] <Specific example of atherosclerotic burden measurement module M5>

[0087] For example, as Figure 7 shown, the atherosclerotic burden measurement module M5 includes:

[0088] Grade scoring module M51: used to perform the grade scoring of the atherosclerotic burden of a single vascular bed; among them, according to the number of significant stenoses in the vascular segments within a single vascular bed, the atherosclerotic burden of the single vascular bed is scored; for example, a grade scoring of 0 - 2 points, if there are no significant vascular stenoses in all vascular segments of the single vascular bed, it is scored 0 points; if there is exactly one vascular segment with significant stenosis in the single vascular bed, it is scored 1 point; if there are two or more significant stenoses in the single vascular bed, it is scored 2 points.

[0089] Optionally, the semi - quantitative scoring of the atherosclerotic burden of the intracranial artery, extracranial carotid artery, lower limb artery, and coronary artery vascular beds can be further subdivided into scoring based on the degree of lumen stenosis. Specifically, first, the atherosclerotic score of a single vascular segment is performed. When there are no obvious atherosclerotic plaques in a single vascular segment, it is scored 0 points; when there are atherosclerotic plaques or calcifications but no obvious stenosis in the lumen, it is recorded as 1 point; when there is atherosclerotic lumen stenosis < 50%, it is mild stenosis and recorded as 2 points; when there is atherosclerotic lumen stenosis ≥ 50% but < 70%, it is moderate stenosis and recorded as 3 points; when there is atherosclerotic lumen stenosis ≥ 70% but not completely occluded, it is severe stenosis and recorded as 4 points; when there is atherosclerotic lumen complete occlusion, it is recorded as 5 points. At this time, the total score of the atherosclerotic burden of a single vascular bed is the sum of the scores of each vascular segment.

[0090] Optionally, the scoring method for the atherosclerotic burden of the intracranial artery, extracranial carotid artery, and coronary artery vascular beds can be extended to scoring based on plaque burden. Specifically, first, the atherosclerotic score of a single vascular segment is performed, and the measurement is based on the plaque at the most severe stenosis within the vascular segment. Plaque burden = 100% × (plaque volume / vascular volume). At this time, the total score of the atherosclerotic burden of a single vascular bed is the sum of the scores of each vascular segment.

[0091] Load calculation module M52: used to perform the overall atherosclerotic burden calculation based on the single-vessel bed atherosclerotic burden score.

[0092] Furthermore, the load calculation module M52 is further used to enter the quantitative score of the overall atherosclerotic burden into the patient information acquisition module M1 (database) and perform sorting and grading.

[0093] For example, the load calculation module M52 may include the following modules:

[0094] The first sub-module M521: arithmetically sum up the single-vessel bed atherosclerotic burdens of the six vessel beds obtained by the subject through the lower limb artery and renal artery ultrasound information acquisition module M3. For example, in the case of the above-mentioned grade scoring of 0-2 points, a score of 0-12 points will be obtained, which is the quantitative score of the overall atherosclerotic burden of the patient. Then, enter the quantitative score of the overall atherosclerotic burden of the subject into the aforementioned atherosclerotic patient database;

[0095] The second sub-module M522: sort the overall atherosclerotic burden scores of all patients in the aforementioned atherosclerotic patient database. For example, perform three classifications according to the interquartile range from low to high scores. The first one-third of the patients are rated as having a low overall atherosclerotic burden, the middle one-third of the patients are rated as having a medium overall atherosclerotic burden, and the last one-third of the patients are rated as having a high overall atherosclerotic burden, so as to obtain the grade classification of the overall atherosclerotic burden of the patient.

[0096] <Calculation method>

[0097] According to another aspect of the present invention, there is also provided a multi-modal quantitative calculation method for the overall atherosclerotic burden, which can advantageously be implemented by using the above-mentioned multi-modal quantitative calculation system for the overall atherosclerotic burden.

[0098] <Beneficial effects>

[0099] The advantages of the present invention mainly lie in:

[0100] Measuring the atherosclerotic burden of the head and neck arteries, coronary arteries, and thoracic aorta in patients using one-stop cardiac and cerebral combined CTA: Conventional coronary CTA and head and neck CTA examinations need to be performed separately, which requires repeated injection of contrast agents and scanning. The operation is complex, the dosage of contrast agent is large, the radiation dose is high, and the examination cost is expensive. One-stop cardiac and cerebral combined CTA effectively solves the drawback of repeated injection of contrast agents when the head and neck arteries and coronary arteries need to be examined separately. In addition, the advantages of one-stop cardiac and cerebral combined CTA examination also lie in its non-invasiveness, high resolution, and comprehensiveness. Since CTA examination does not require surgery or intubation, the risks and pain endured by patients are much lower than those of traditional DSA technology. CTA examination can provide three-dimensional images, more comprehensively and intuitively observe the vascular conditions, and can simultaneously obtain atherosclerotic information of the thoracic aorta, intracranial arteries, extracranial cervical arteries, and coronary arteries, which has important value for the early detection, early diagnosis, and early treatment of atherosclerotic diseases.

[0101] Measuring the atherosclerotic lesions of the renal arteries and lower limb arteries in patients using renal artery ultrasound examination and lower limb artery ultrasound examination: Renal artery ultrasound examination has a high diagnostic value for atherosclerotic renal artery stenosis, with a sensitivity of 86% and a specificity of 96%. It is the preferred method for screening atherosclerotic renal arteries recommended by current guidelines. Ultrasonography staff can exclude rare non-atherosclerotic renal artery stenosis etiologies such as fibromuscular dysplasia and Takayasu arteritis based on the characteristics of the lesion sites and sonogram features shown by ultrasound, combined with clinical manifestations and laboratory examinations. The screening methods for lower limb atherosclerosis mainly include lower limb artery ultrasound examination and measurement of the ankle-brachial index (ABI). Among them, ABI is the ratio between the systolic blood pressure at the ankle and the arm when the patient is in the supine position. Currently, most studies use ABI to diagnose lower limb atherosclerosis. Compared with lower limb artery ultrasound examination, ABI cannot accurately locate the location and scope of lower limb artery lesions, cannot quantitatively reflect the severity and extent of lower limb atherosclerosis, and its sensitivity is only 75% and the specificity is 86%. In contrast, the sensitivity of ultrasound examination for lower limb artery stenosis is 85-90%, and the specificity >95%, which is significantly higher than ABI. At the same time, it can directly judge the location of atherosclerotic lesions and the degree of stenosis of the affected lumen blood vessels.

[0102] The predictive value of the invented overall atherosclerotic burden measurement system for the prognosis of patients is better than that of traditional prognostic risk assessment methods: In the previous research of our team, it was found that the prognosis prediction model established based on the multi-vessel bed atherosclerotic burden measurement of the thoracic aorta, coronary artery, and carotid arteries in the head and neck by using cardiac and cerebral combined CTA examination with this system combined with other risk factors has a better predictive effect on the one-year vascular event risk of ischemic stroke patients than the currently widely used clinical risk assessment scale (ESSEN score). The area under the receiver operating characteristic curve of the model established based on the atherosclerotic burden of a single vessel bed is 58.3-68.0, the area under the receiver operating characteristic curve of the model established based on the traditional clinical risk assessment scale is 64.0, while the area under the receiver operating characteristic curve of the model established based on the quantitative measurement of the overall atherosclerotic burden of the thoracic aorta, coronary artery, and carotid arteries in the head and neck combined with other risk factors is 72.8, and the difference from the former two is statistically significant, indicating that the prediction effect of the model constructed for the atherosclerotic burden measurement of the cardiac and cerebral multi-vessel beds is better than that of the traditional model. However, in the previous research, only cardiac and cerebral combined CTA examination was performed on the patients, and the atherosclerotic burden information of the lower limb arteries and renal arteries was not included, and the overall atherosclerotic situation of the patients in multiple systems has not been measured. Recently, our team added the atherosclerotic burden information of the lower limb arteries and renal arteries based on individual risk factors and intracranial and extracranial atherosclerotic burden scores for research and found that it can further improve the predictive performance of the model for prognosis. The area under the receiver operating characteristic curve of the model established based on individual risk factors and intracranial and extracranial atherosclerotic burden scores is 71.8, and the C statistic is 0.65, while the area under the receiver operating characteristic curve of the model established based on individual risk factors and intracranial arteries, extracranial arteries, lower limb arteries, and renal artery atherosclerotic burden scores is 72.1, and the C statistic is 0.68, and the difference between the two is statistically significant. Therefore, the overall atherosclerotic burden multimodal measurement system and method that incorporates atherosclerotic information from each vessel bed can further improve the ability to predict the prognosis and risk stratify atherosclerotic patients.

[0103] Combined with the new type of cardiac and cerebral angiography CTA and lower extremity artery and renal artery ultrasound examinations, the multi-modal measurement system for the overall atherosclerotic burden provided by the present invention comprehensively evaluates the atherosclerotic lesions of six vascular beds, namely the intracranial arteries, extracranial cervical arteries, coronary arteries, thoracic aorta, renal arteries, and lower extremity arteries, by combining the new type of cardiac and cerebral angiography CTA (or head and carotid artery, coronary artery CTA) and lower extremity artery and renal artery ultrasound. And by adopting the same scoring method for the atherosclerotic burden of a single vascular bed, the overall atherosclerotic burden is quantitatively calculated. Compared with the traditional qualitative diagnosis that only focuses on the presence or absence of atherosclerosis in a single vascular bed, the present invention provides a more specific method for quantitatively measuring the degree of multi-system atherosclerosis in patients. This method evaluates the degree of multi-system atherosclerosis in patients, comprehensively covers the main arterial vascular beds of the human body, and the examination methods are non-invasive and simple. It not only improves the compliance of patients, but also ensures the comparability between different vascular beds and different patients, and enhances the operational consistency between different medical institutions. It is especially suitable for patients who need repeated monitoring or long-term diagnosis and treatment management, and can dynamically monitor the disease development and treatment response. The present invention not only helps to promote the relevant basic research on atherosclerosis, but also provides an accurate quantitative measurement tool for the clinical research of related drugs and intervention measures, helps to promote the prognosis risk stratification and treatment effect monitoring of atherosclerosis-related diseases, and provides an important means for guiding the clinical adoption of more optimized and active prevention and treatment measures.

[0104] It can be understood that, except for the inspection equipment part, each module in the present application can be composed of hardware based on operating systems such as windows, various linux-based operating systems, MacOS, etc. These hardware include but are not limited to processors (including but not limited to Intel, AMD, Qualcomm, MediaTek, Apple, Loongson, Feiteng, Zhaoxin, etc.), memories, display devices, connection devices, etc.

[0105] Those skilled in the art can use suitable languages, including but not limited to C++, JAVA, etc. to write software to execute the functions of each module, and various software interfaces may be adopted.

[0106] It should be noted that unless otherwise specified, the terms "first", "second", "third", etc. in the specification are only used to distinguish each component, element, step, etc. in the specification, rather than to represent the logical relationship or sequential relationship between each component, element, step, etc.

[0107] It will be understood that although the present invention has been disclosed above in preferred embodiments, the above embodiments are not intended to limit the present invention. For any person skilled in the art, without departing from the scope of the technical solution of the present invention, many possible variations and modifications can be made to the technical solution of the present invention by using the technical content disclosed above, or it can be modified into equivalent embodiments with equivalent changes. Therefore, any simple modification, equivalent change and modification made to the above embodiments based on the technical essence of the present invention without departing from the content of the technical solution of the present invention still fall within the scope of protection of the technical solution of the present invention.

Claims

1. A multi-modal quantitative measurement system for overall atherosclerosis burden, characterized in that: The measuring system comprises: Patient information acquisition module; Heart-brain CTA information acquisition module: Use heart-brain CTA to perform imaging examinations of atherosclerosis of the head and neck arteries, coronary arteries, and thoracic aorta on the selected patients, and obtain heart-brain CTA information related to atherosclerotic lesions in the vascular bed; Lower limb artery and renal artery ultrasound information acquisition module: obtain lower limb artery ultrasound information and renal artery ultrasound information related to vascular bed atherosclerotic lesions; Parameter information extraction module: extract parameters from the acquired heart-brain CTA information, lower limb artery ultrasound information and renal artery ultrasound information to obtain atherosclerotic lesion information of six vascular beds including intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries and lower limb arteries of the selected patient; Atherosclerosis load calculation module: semi-quantitatively scoring the atherosclerotic lesion information of the six vascular beds of the selected patient, respectively obtaining the single vascular bed atherosclerosis load of the six vascular beds and storing them in the patient information acquisition module, and then obtaining the quantitative score of the overall atherosclerosis load of the selected patient based on the single vascular bed atherosclerosis load scores of all patients stored in the patient information acquisition module; The parameter information extraction module includes a segmentation module and an evaluation module; the evaluation module is used to evaluate the stenosis degree and properties of a single vascular segment in different vascular beds according to the segmentation results; the evaluation module includes an artery measurement module, a property evaluation module, a lower limb measurement module and a renal artery measurement module: Artery measurement module: used to measure the degree of stenosis of intracranial arteries, extracranial neck arteries, and coronary arteries; it uses cardio-cerebral CTA examination for image scanning, data reconstruction, and image analysis, and uses surface reconstruction, maximum intensity projection, multi-planar reconstruction, and volume rendering images to evaluate the degree of arterial stenosis; and uses automatic vascular analysis tools to quantify the percentage of arterial stenosis on orthogonal views; Property assessment module: used to perform the assessment of the properties of thoracic aortic plaques, where complex aortic plaques include non-calcified plaques with a thickness of ≥4mm, ulcerated plaques and mural thrombi; the thickness of aortic plaques is the distance from the highest point of the plaque perpendicular to the aortic adventitia wall; ulcerated plaques refer to the presence of filling defects on the surface of the plaque, and the filling defects are judged by base width and maximum depth ≥2mm; mural thrombi refer to the presence of low-density imaging areas in the aortic lumen.

2. The measuring system according to claim 1, characterized in that: The atherosclerosis burden calculation module includes: A grade assignment module: used to perform grade assignment of the atherosclerotic burden of a single vascular bed; wherein the atherosclerotic burden of a single vascular bed is graded according to the number of significant stenosis of the vascular segments in the single vascular bed; Burden calculation module: used to perform overall atherosclerosis burden calculation based on single vessel bed atherosclerosis burden score.

3. The measuring system according to claim 2, characterized in that: The grade scoring module assigns a grade of 0-2 points to the atherosclerotic burden of a single vascular bed, where if there is no significant vascular stenosis in all vascular segments of a single vascular bed, the score is 0; if there is significant stenosis in only one vascular segment in a single vascular bed, the score is 1; if there are two or more significant stenosis in a single vascular bed, the score is 2.

4. The measuring system according to claim 2, characterized in that: The grade-assignment module semi-quantitatively scores the atherosclerotic burden of intracranial arteries, extracranial neck arteries, lower limb arteries, and coronary artery beds based on the degree of lumen stenosis. The atherosclerosis of a single vascular segment is scored first. When there is no obvious atherosclerotic plaque in a single vascular segment, the score is 0; when there is atherosclerotic plaque or calcification but no obvious lumen stenosis, 1 point is scored; when there is atherosclerotic lumen stenosis of less than 50%, it is mild stenosis, 2 points; when there is atherosclerotic lumen stenosis of ≥50% but <70%, it is moderate stenosis, 3 points; when there is atherosclerotic lumen stenosis of ≥70% but not completely occluded, it is severe stenosis, 4 points; when there is complete atherosclerotic lumen occlusion, 5 points are scored; the total score of atherosclerosis in a single vascular bed is the sum of the scores of each vascular segment.

5. The measuring system according to claim 2, characterized in that: The scoring method of the grade assignment module for the atherosclerotic burden of the intracranial arteries, extracranial neck arteries, and coronary artery vascular beds is based on the plaque burden score; wherein, the atherosclerosis score of a single vascular segment is first performed, and the plaque at the most severe stenosis in the vascular segment is measured, and the plaque burden = 100% × (plaque volume / vascular volume); the total score of atherosclerosis in a single vascular bed is the sum of the scores of each vascular segment.

6. The measuring system according to claim 1, characterized in that: The atherosclerosis burden calculation module includes: The first submodule: summing up the single vascular bed atherosclerosis burden of the six vascular beds obtained by the lower limb artery and renal artery ultrasound information acquisition module for the selected patient, and then entering the subject's overall atherosclerosis burden quantitative score into the atherosclerosis patient database; The second submodule: sorting the overall atherosclerosis burden scores of all patients in the atherosclerosis patient database.

7. The measuring system according to claim 6, characterized in that: The second submodule classifies the scores into three categories according to the tertile interval from low to high. The overall atherosclerotic burden of the first third of patients is rated as low, the overall atherosclerotic burden of the middle third of patients is rated as medium, and the overall atherosclerotic burden of the last third of patients is rated as high, thus obtaining a grade classification of the overall atherosclerotic burden of patients.

8. The measuring system according to claim 1, characterized in that: The subdivision module is used to accurately subdivide the blood vessels contained in six single vascular beds, namely, intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries, and lower limb arteries, into multiple vascular segments according to the anatomical structure; The extracranial cervical arteries include: bilateral subclavian arteries, common carotid arteries, extracranial carotid arteries and extracranial vertebral arteries; the intracranial arteries include: intracranial carotid arteries, intracranial vertebral arteries, anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries and basilar arteries; the thoracic aorta includes: the ascending aorta from the aortic root to the opening of the brachiocephalic trunk, the aortic arch between the brachiocephalic trunk and the opening of the left subclavian artery, and the proximal descending aorta from the opening of the left subclavian aorta to the level of the pulmonary artery bifurcation; the coronary arteries include: the proximal, middle and distal ends of the right coronary artery and its posterior descending branch; the left main coronary artery; the proximal, middle and apical ends of the left anterior descending branch and its first and second oblique branches; the left circumflex coronary artery and its obtuse, posterolateral and proximal and distal ends of the posterior descending branches; the renal arteries include: two segments of the left and right renal artery trunks; the lower limb arteries include: the common femoral arteries, deep femoral arteries, superficial femoral arteries, peroneal arteries, popliteal arteries, anterior tibial arteries and posterior tibial arteries on both sides.

9. The measuring system according to claim 1, characterized in that: The degree of arterial stenosis of different vascular beds in the artery measurement module is calculated using the following formula: Stenosis rate of extracranial cervical artery vascular bed (%) = (1-residual inner diameter of the lumen at the narrowest part / inner diameter of the normal segment distal to the stenosis) × 100%; Stenosis rate of intracranial arterial vascular bed (%) = (1-residual inner diameter of the lumen at the narrowest part / inner diameter of the normal segment proximal to the stenosis) × 100%; Coronary artery vascular bed artery stenosis rate (%) = {1-[minimum lumen diameter / (average of proximal and distal reference vessel diameters)]} × 100%; Among them, for the extracranial neck arteries, intracranial arteries and coronary arteries, if the image shows that a certain segment of artery is narrowed or the stenosis at the most severe part of the plaque is ≥50% or the lumen is occluded, it is defined as the presence of significant stenosis in this segment of artery.

10. The measuring system according to claim 1, characterized in that: The lower limb measurement module is used to perform the measurement of the degree of lower limb artery stenosis, wherein the following formula is used to calculate the artery stenosis: stenosis = (vascular inner diameter - vascular effective diameter) / vascular inner diameter × 100%. If the degree of stenosis at the most severe part of a certain section of lower limb artery stenosis or plaque is ≥ 50% or the lumen is occluded, it is defined as the presence of significant stenosis in the lower limb artery; The renal artery measurement module is used to perform the measurement of the degree of renal artery stenosis, wherein the peak systolic velocity at the renal artery turbulence is ≥180cm / s, and the corresponding lumen stenosis diameter is ≥60%, which is defined as the presence of significant stenosis in the renal artery on that side.

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