Total atherosclerosis load multi-modal quantitative measurement and calculation system and method

Abstract

The invention provides a multi-modal quantitative measurement and calculation system and method for total atherosclerosis load. In the system, a parameter information extraction module carries out parameter extraction on acquired cardio-cerebral continuous scanning CTA information, lower limb artery ultrasonic information and renal artery ultrasonic information so as to acquire atherosclerosis lesion information of six blood vessel beds including an intracranial artery, an extracranial neck artery, a coronary artery, a thoracic aorta, a renal artery and a lower limb artery of a selected patient; the atherosclerosis load measuring and calculating module is used for performing semi-quantitative score assignment on atherosclerosis lesion information of six blood vessel beds of a selected patient, respectively obtaining single-blood-vessel-bed atherosclerosis loads of the six blood vessel beds and storing the single-blood-vessel-bed atherosclerosis loads into the patient information obtaining module; and then the quantitative score of the total atherosclerosis load of the selected patient is obtained according to the single-vessel bed atherosclerosis load score conditions of all patients stored in the patient information acquisition module.

Description

Technical Field

[0001] The present invention relates to the field of medical technology, and in particular to a system and method for multi-modal quantitative measurement of overall atherosclerosis load. Background Art

[0002] Atherosclerosis is a complex pathological process involving multiple systems and multiple factors, which progresses over a long period of time. It is often not limited to a single vascular bed, but is prone to affect multiple vascular beds at the same time. Diseases caused by atherosclerosis in different vascular beds mainly include ischemic cerebrovascular disease, ischemic heart disease, intermittent claudication, lower limb ulcers and gangrene, and refractory hypertension, and patients with atherosclerosis in multiple vascular beds often have a poor prognosis. Therefore, early diagnosis and treatment of systemic atherosclerosis and the vascular events it causes have significant socioeconomic benefits.

[0003] At present, the diagnosis and treatment of patients with atherosclerotic vascular disease in clinical practice is usually limited to the assessment of a single vascular bed in the responsible area of ​​the lesion, which has certain limitations. First, the assessment of the responsible vessel is often a qualitative or quantitative assessment of a single vascular segment, which easily ignores the atherosclerotic lesions of the non-responsible vascular segment in the same vascular bed; second, the lack of a comprehensive assessment of the overall condition of atherosclerosis in multiple vascular beds of patients cannot fully understand whether the patient has other potential risks of atherosclerotic diseases. In addition, even if relevant examinations of atherosclerosis in vascular beds other than the responsible vessel are performed, there is no quantitative assessment method for the overall degree of atherosclerosis in patients, which is not only 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, making it difficult to predict the risk of atherosclerotic vascular events and dynamically evaluate the effect of atherosclerosis prevention and control.

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

[0005] Computed tomography angiography (CTA) is a new type of computer angiography technology. Through the instantaneous switching between full-width axial scanning mode and spiral scanning mode, it can perform head and neck CTA, thoracic aorta CTA and coronary artery CTA scans in one stop. Only one injection of contrast agent is required, and multi-site vascular imaging can be achieved in a short time. Compared with the previous examinations that required separate scanning of head and neck CTA, thoracic aorta CTA and coronary artery CTA, the one-stop cardiovascular and cerebrovascular CTA examination has a shorter examination time, lower radiation dose and contrast agent usage, and has great advantages in evaluating the coronary artery, thoracic aorta and head and neck arteries. In addition to using conventional arterial ultrasound examination to measure the burden of atherosclerosis, the new type of heart and brain CTA with continuous scanning is expected to play an important role in the multimodal measurement of the overall burden of atherosclerosis. Summary of the invention

[0006] The technical problem to be solved by the present invention is to provide a system and method for multimodal quantitative measurement of overall atherosclerosis burden combining novel cardio-cerebral CTA and ultrasound examination technology in view of the above-mentioned defects in the prior art, so as to provide a comprehensive, unified, convenient and comparable quantitative evaluation method for overall atherosclerosis in multiple vascular beds and multiple vascular segments of patients with atherosclerotic diseases, so as to solve the situation in which the risk assessment of atherosclerosis in existing clinical practice mostly relies on personal experience and lacks unified evaluation standards, making it difficult to truly and accurately reflect the actual condition of patients' atherosclerosis and affecting its prevention and control.

[0007] According to the present invention, a system for multimodal quantitative measurement of overall atherosclerosis load is provided, which is characterized by comprising:

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

[0009] 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;

[0010] Lower limb artery and renal artery ultrasound information acquisition module: for lower limb arteries and renal arteries, ultrasound is used to perform renal artery and lower limb artery atherosclerosis imaging examinations on selected patients, and obtain lower limb artery ultrasound information and renal artery ultrasound information related to vascular bed atherosclerosis lesions;

[0011] 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;

[0012] Atherosclerosis burden calculation module: semi-quantitatively score the atherosclerotic lesion information of the six vascular beds of the selected patient, obtain the single vascular bed atherosclerosis burden of the 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 patient based on the single vascular bed atherosclerosis burden scores of all patients stored in the patient information acquisition module.

[0013] Preferably, the parameter information extraction module includes:

[0014] Subdivision module: According to the anatomical structure, the blood vessels contained in the six single vascular beds, namely, intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries and lower limb arteries, are precisely subdivided into multiple vascular segments; the extracranial neck 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 brachiocephalic trunk opening, the brachiocephalic trunk and the left subclavian artery opening The aortic arch between the left and right subclavian aortas 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 main trunk of the left 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 arteries of the lower limbs include: the common femoral arteries on both sides, the deep femoral arteries, the superficial femoral arteries, the peroneal arteries, the popliteal arteries, the anterior tibial arteries and the posterior tibial arteries;

[0015] Evaluation module: used to evaluate the degree and nature of stenosis of single vascular segments in different vascular beds based on the segmentation results.

[0016] Preferably, the evaluation module includes:

[0017] Artery measurement module: used to measure the degree of stenosis of intracranial arteries, extracranial neck arteries, and coronary arteries; the aforementioned heart-brain CTA examination is used for image scanning, data reconstruction, and image analysis; curved reconstruction, maximum intensity projection, multi-planar reconstruction, and volume rendering images are used to evaluate the degree of arterial stenosis; the automatic vascular analysis tool is used to quantify the percentage of arterial stenosis on orthogonal views; the degree of arterial stenosis in different vascular beds is calculated using the following formula:

[0018] 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%;

[0019] 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%;

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

[0021] For the extracranial neck arteries, intracranial arteries, and coronary arteries, if the image shows that a certain segment of artery is stenotic 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 that segment of artery;

[0022] Property assessment module: used to evaluate 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 between the highest point of the plaque and the aortic adventitia wall; ulcerated plaques refer to plaques with filling defects on the surface, with the base width and maximum depth of the filling defects ≥2mm; mural thrombi refer to low-density imaging areas in the aortic lumen;

[0023] Lower limb measurement module: used to measure the degree of lower limb artery stenosis, in which the following formula is used to calculate the artery stenosis: stenosis = (vascular inner diameter - vascular effective diameter) / vascular inner diameter × 100%. If the stenosis of a certain section of lower limb artery or the stenosis of the most serious plaque is ≥ 50% or the lumen is occluded, it is defined as the presence of significant stenosis in the lower limb artery;

[0024] Renal artery measurement module: used to calculate the degree of renal artery stenosis. If the peak systolic velocity at the renal artery turbulence is ≥180cm / s, the corresponding lumen stenosis diameter is ≥60%, which is defined as significant stenosis of the renal artery on that side.

[0025] Preferably, the atherosclerosis load calculation module includes:

[0026] 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;

[0027] Burden calculation module: used to perform overall atherosclerosis burden calculation based on single vessel bed atherosclerosis burden score.

[0028] Preferably, the grade scoring module assigns a grade of 0-2 points to the atherosclerotic burden of a single vascular bed, wherein 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 significant stenosis in only one vascular segment in a single vascular bed, a score of 1 is given; if there are two or more significant stenosis in a single vascular bed, a score of 2 is given.

[0029] Preferably, the semi-quantitative score of atherosclerosis burden of intracranial arteries, extracranial neck arteries, lower limb arteries, and coronary artery vascular beds is further subdivided into scores based on the degree of lumen stenosis; wherein the atherosclerosis score of a single vascular segment is first performed, and when there is no obvious atherosclerotic plaque in a single vascular segment, the score is 0; when there is atherosclerotic plaque or calcification but there is no obvious stenosis of the lumen, 1 point is recorded; when there is atherosclerotic lumen stenosis degree <50%, it is mild stenosis, 2 points are recorded; when there is atherosclerotic lumen stenosis degree ≥50% but <70%, it is moderate stenosis, 3 points are recorded; when there is atherosclerotic lumen stenosis degree ≥70% but not completely occluded, it is severe stenosis, 4 points are recorded; when there is complete atherosclerotic lumen occlusion, 5 points are recorded; the total score of atherosclerosis in a single vascular bed is the sum of the scores of each vascular segment.

[0030] Preferably, the scoring method for the atherosclerosis 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.

[0031] Preferably, the load calculation module includes:

[0032] The first submodule: arithmetic sum of 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 enter the subject's overall atherosclerosis burden quantitative score into the aforementioned atherosclerosis patient database;

[0033] The second submodule: sorting the overall atherosclerosis burden scores of all patients in the aforementioned atherosclerosis patient database.

[0034] Preferably, the second submodule is classified into three categories according to the scores from low to high based on the tertile interval, the overall atherosclerosis burden of the first one-third of patients is rated as low, the overall atherosclerosis burden of the middle one-third of patients is rated as medium, and the overall atherosclerosis burden of the last one-third of patients is rated as high, thereby obtaining a grade classification of the overall atherosclerosis burden of patients.

[0035] According to another aspect of the present invention, a method for multimodal quantitative calculation of overall atherosclerosis burden is provided, which is implemented by using the multimodal quantitative calculation system of overall atherosclerosis burden.

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

[0037] A more complete understanding of the present invention and its attendant advantages and features will be more readily appreciated by reference to the following detailed description taken in conjunction with the accompanying drawings, in which:

[0038] Figure 1 The overall block diagram of the multi-modal quantitative measurement system for overall atherosclerosis burden according to a preferred embodiment of the present invention is schematically shown.

[0039] Figure 2 This is an example of a heart-brain continuous scanning CTA reconstructed image obtained by the novel heart-brain continuous scanning CTA acquisition module of the overall atherosclerosis load multimodal measurement system provided by the present invention.

[0040] Figure 3 This is an image example of original ultrasound information and parameter extraction of lower limb arteries and renal arteries obtained by the lower limb artery and renal artery ultrasound information acquisition module of the overall atherosclerosis load multimodal measurement system provided by the present invention.

[0041] Figure 4 A specific example of a parameter information extraction module of a multimodal quantitative measurement system for overall atherosclerosis load according to a preferred embodiment of the present invention is schematically shown.

[0042] Figure 5 and Figure 6 This is an image example of measuring the thoracic aorta atherosclerosis load by the parameter extraction module of the overall atherosclerosis load multimodal measurement system provided by the present invention.

[0043] Figure 7 A specific example of an atherosclerosis load calculation module of a system for multi-modal quantitative calculation of overall atherosclerosis load according to a preferred embodiment of the present invention is schematically shown.

[0044] It should be noted that the drawings are used to illustrate the present invention, rather than to limit the present invention. Note that the drawings showing the structures may not be drawn to scale. In addition, in the drawings, the same or similar elements are marked with the same or similar reference numerals. DETAILED DESCRIPTION

[0045] The technical solution of the present invention will be described clearly and completely below in conjunction with the accompanying drawings. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0046] In the description of the present invention, it should be noted that the terms "center", "upper", "lower", "left", "right", "vertical", "horizontal", "inner", "outer", etc., indicating the orientation or positional relationship, are based on the orientation or positional relationship shown in the drawings, and are 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 therefore cannot be understood as limiting the present invention. In addition, the terms "first", "second", and "third" are used for descriptive purposes only, and cannot be understood as indicating or implying relative importance.

[0047] In the description of the present invention, it should be noted that, unless otherwise clearly specified 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 a direct connection, or it can be indirectly connected through an intermediate medium, or it can be the internal communication of two components. For ordinary technicians in this field, the specific meanings of the above terms in the present invention can be understood according to specific circumstances.

[0048] In addition, the technical features involved in the 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 multi-modal quantitative measurement system for overall atherosclerosis burden according to a preferred embodiment of the present invention is schematically shown.

[0051] like Figure 1 As shown, the multi-modal quantitative measurement system for overall atherosclerosis load according to a preferred embodiment of the present invention includes:

[0052] Patient information acquisition module M1: used for collecting and / or storing patient information related to atherosclerotic diseases;

[0053] Heart-brain CTA information acquisition module M2: 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;

[0054] Lower limb artery and renal artery ultrasound information acquisition module M3: for lower limb arteries and renal arteries, ultrasound is used to perform renal artery and lower limb artery atherosclerosis imaging examinations on selected patients, and lower limb artery ultrasound information and renal artery ultrasound information related to vascular bed atherosclerosis lesions are obtained;

[0055] Parameter information extraction module M4: extracting 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;

[0056] Atherosclerosis burden calculation module M5: semi-quantitatively scoring the atherosclerotic lesion information of the six vascular beds of the selected patient, respectively obtaining the single vascular bed atherosclerosis burden of the six vascular beds and storing them in the patient information acquisition module, and then obtaining the quantitative score of the overall atherosclerosis burden of the selected patient based on 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, hospitalization number, age, gender, weight, height, history of hypertension, diabetes, dyslipidemia, homocysteineemia, coronary heart disease, hyperuricemia, heart disease, peripheral arteriosclerosis, kidney disease, medication history, smoking and drinking history, exercise history, and family history;

[0060] Patient data is collected indirectly, including symptoms determined by doctors and examination results from doctors and medical testing equipment, covering clinical diagnosis, vital signs, blood routine, blood biochemistry, coagulation, immune markers, three myocardial infarction items, antinuclear antibody spectrum, head MRI, head CT, etc.

[0061] Each patient's ID and the data collected directly or indirectly as well as the supplementary data are taken as a complete data unit to establish a data object, and all data objects are entered into the atherosclerosis database.

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

[0063] In addition, in particular, the patient information acquisition module M1 stores the single vascular bed atherosclerosis load of the six vascular beds of all patients obtained by the atherosclerosis load measurement module M5, and preferably, the patient information acquisition module M1 can also store all data obtained by the heart and brain CTA information acquisition module M2, the lower limb artery and renal artery ultrasound information acquisition module M3 and the parameter information extraction module M4.

[0064] <Specific example of the heart and brain scanning CTA information acquisition module M2>

[0065] The heart-brain continuous scanning CTA information acquisition module M2 performs the heart-brain continuous scanning CTA information acquisition function, for example, Figure 2 This is an example of a heart-brain continuous scanning CTA reconstructed image obtained by the novel heart-brain continuous scanning CTA acquisition module of the overall atherosclerosis load multimodal measurement system provided by the present invention.

[0066] For example, the acquisition function can be performed in the following manner: The new one-stop heart and brain CTA is performed using a 192-slice dual-source CT scanner (Somatom Force, Siemens Healthcare, Forchheim, Germany). Data are acquired in a craniocaudal direction from the diaphragm to the top of the head. Image acquisition is triggered prospectively by the patient's electrocardiogram, starting at 30% or 60% of the R peak to R peak interval according to the patient's heart rate, using Turbo Flash Spiral mode. CT parameters are 192×0.6mm slice film; gantry rotation time 250ms, pitch 3.2. Automatic tube current adjustment (CARE Dose4D, Siemens) is used, the reference tube current time is 330-450mAs, the tube voltage range is 70 to 90kV, and the tube voltage selection based on automatic attenuation is used (CAREkV, Siemens). The amount of contrast agent is adjusted according to the patient's body mass index, ranging from 40 to 50ml. Contrast agent (Ultravist 370 Iodine / ml; Bayer Schering Pharma, Germany) was 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 50 ml of normal saline. The application of contrast agent was controlled using bolus tracking in the ascending aorta (signal attenuation threshold was 100 HU). Data acquisition began after reaching the threshold in the ascending aorta with an average delay of 8 seconds. Each raw data point was 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 data sets.

[0067] When patients are not eligible for the new type of combined heart and brain CTA examination or have already undergone either the head and neck CTA or the coronary CTA examination, they can undergo the pending head and neck CTA and (or) coronary CTA examinations. When patients have undergone both the head and neck CTA and the coronary CTA examinations, the combined heart and brain CTA examination can be considered completed, and the examination results can also be used to calculate the atherosclerosis of the thoracic aorta, intracranial artery, extracranial neck artery, and coronary artery using the imaging-based single vascular bed atherosclerosis burden calculation method of the M5 module.

[0068] <Specific example of 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 lower limb artery and renal artery ultrasound information acquisition function, for example Figure 3 An image example of the original ultrasound information and parameter extraction of the lower limb arteries and renal arteries obtained by the lower limb artery and renal artery ultrasound information acquisition module is shown.

[0070] For example, the acquisition function can be performed in the following ways: the lower limb arteries are examined using a Philips IU22 color Doppler ultrasound diagnostic instrument, using a 3-9MHz ultra-wideband linear array probe, and the angle between the sound velocity and the blood flow is ≤60°. The subject lies on his back, exposing both lower limbs and waist, and two-dimensional ultrasound is used to display and measure the thickness of the bilateral arterial intima-media and the inner diameter of the blood vessels along the anatomical position to observe whether there is atherosclerotic plaque formation. Then, color Doppler blood flow imaging is used to observe the blood flow filling in the vascular cavity, and pulsed Doppler is used to sample the blood vessels to obtain hemodynamic parameters. The renal artery uses a Philips IU22 and HDI5000 ultrasound diagnostic instrument with a probe frequency of 2.0-5.0MHz. The subject fasts for 8-12 hours, and the right abdomen, the transverse section below the rib margin or the coronal section of the lateral waist are scanned, with the liver, gallbladder, and kidneys as the sound bed, striving to obtain the smallest possible half-diffusion angle, and measuring the renal artery systolic peak velocity in the proximal, middle, and distal segments of the renal artery.

[0071] <Specific Example of Parameter Information Extraction Module M4>

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

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

[0074] Subdivision module M41: The blood vessels contained in the six single vascular beds of intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries, and lower limb arteries are precisely subdivided into multiple vascular segments according to the anatomical structure; the extracranial neck arteries include 8 segments: bilateral subclavian arteries, common carotid arteries, extracranial carotid arteries, and extracranial vertebral arteries; the intracranial arteries include 11 segments: 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 opening of the brachiocephalic trunk, the brachiocephalic trunk, and the left subclavian artery The aortic arch between the openings of the left subclavian aorta 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 15 segments: 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: the left and right renal artery trunks; the lower limb arteries include 14 segments: the common femoral arteries on both sides, the deep femoral arteries, the superficial femoral arteries, the peroneal arteries, the popliteal arteries, the anterior tibial arteries, and the posterior tibial arteries.

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

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

[0077] Artery measurement module M421: used to measure the degree of stenosis of intracranial arteries, extracranial neck arteries, and coronary arteries; specifically, the aforementioned novel heart-brain CTA examination is used for image scanning, data reconstruction, and image analysis, and surface reconstruction, maximum intensity projection, multi-planar reconstruction, and volume rendering images are used to evaluate the degree of arterial stenosis; the automatic vascular analysis tool is used to quantify the percentage of arterial stenosis on orthogonal views; the degree of arterial stenosis in different vascular beds is calculated using the following formula:

[0078] 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%;

[0079] 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%;

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

[0081] For the extracranial neck arteries, intracranial arteries, and coronary arteries, if the image shows that a certain segment of artery is stenotic 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 that segment of artery;

[0082] Property assessment module M422: used to perform the assessment of the properties of thoracic aortic plaques: for example, reference Figure 5 and Figure 6 As shown in the figure, 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 to the aortic adventitia wall perpendicularly, and the average value can be calculated after multiple measurements; ulcerated plaques refer to the presence of filling defects on the surface of the plaque, and its base width and maximum depth must be at least ≥2mm; mural thrombi refer to the presence of low-density imaging areas in the aortic lumen.

[0083] Lower limbs calculation module M423: used to calculate the degree of lower limb arterial stenosis: Figure 3 The following formula was used to calculate the degree of arterial stenosis: stenosis = (vascular inner diameter - effective vascular diameter) / vascular inner diameter × 100%. If the degree of stenosis of a certain segment of lower limb artery or the most severe plaque stenosis is ≥ 50% or the lumen is occluded, it is defined as the presence of significant stenosis in the segment of lower limb artery.

[0084] Renal artery calculation module M424: used to calculate the degree of renal artery stenosis: Figure 3 As shown in the figure, the peak systolic velocity at the turbulent part of the renal artery is ≥180cm / s, which corresponds to a stenosis diameter of the lumen of ≥60%, which is defined as significant stenosis of the renal artery on that side.

[0085] When the above modules perform their functions, they subdivide six different single vascular beds into multiple different vascular segments according to the anatomical structure; if one of the vascular segments has multiple atherosclerotic plaques or vascular stenosis sites, the degree of vascular stenosis is calculated based on the most severe stenosis.

[0086] <Specific Example of Atherosclerosis Burden Calculation Module M5>

[0087] For example, Figure 7 As shown, the atherosclerosis load calculation module M5 includes:

[0088] Grade scoring module M51: used to perform grade scoring 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 in the vascular segments within the single vascular bed; for example, a grade scoring of 0-2 points, if there is no significant stenosis in all vascular segments of a single vascular bed, a score of 0 is given; if there is significant stenosis in only one vascular segment in a single vascular bed, a score of 1 is given; if there are two or more significant stenosis in a single vascular bed, a score of 2 is given.

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

[0090] Optionally, the scoring method for the atherosclerosis burden of intracranial arteries, extracranial neck arteries, and coronary artery vascular beds can be expanded to be based on plaque burden scoring. Specifically, 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). At this time, the total score of atherosclerosis in a single vascular bed is the sum of the scores of each vascular segment.

[0091] The load calculation module M52 is used to perform overall atherosclerosis load calculation based on the single vascular bed atherosclerosis load score.

[0092] Furthermore, the load calculation module M52 is further used to input the overall atherosclerosis load quantitative score into the patient information acquisition module M1 (database) and sort and grade it.

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

[0094] The first submodule M521: arithmetically summing the single vascular bed atherosclerosis loads of the six vascular beds obtained by the lower limb artery and renal artery ultrasound information acquisition module M3, for example, in the case of the aforementioned 0-2 point grade assignment, a score of 0-12 points will be obtained, which is the overall atherosclerosis load quantitative score of the patient, and then entering the overall atherosclerosis load quantitative score of the subject into the aforementioned atherosclerosis patient database;

[0095] The second submodule M522: sorting the overall atherosclerosis load scores of all patients in the aforementioned atherosclerosis patient database, for example, classifying them into three categories according to the scores from low to high based on the tertile interval, with the overall atherosclerosis load of the first one-third of patients being rated as low, the overall atherosclerosis load of the middle one-third of patients being rated as medium, and the overall atherosclerosis load of the last one-third of patients being rated as high, thereby obtaining a grade classification of the overall atherosclerosis load of the patients.

[0096] <Calculation method>

[0097] According to another aspect of the present invention, a method for multimodal quantitative measurement of overall atherosclerosis burden is also provided, which can be advantageously implemented using the multimodal quantitative measurement system for overall atherosclerosis burden described above.

[0098] <Beneficial Effects>

[0099] The advantages of the present invention are mainly:

[0100] One-stop heart-brain CTA is used to simultaneously measure the atherosclerotic burden of the patient's head and neck arteries, coronary arteries, and thoracic aorta: Conventional coronary artery CTA and head and neck artery CTA examinations need to be performed separately, requiring repeated injections of contrast agents and scanning, which are complicated to operate, with large amounts of contrast agents, high radiation doses, and expensive examination costs. One-stop heart-brain CTA effectively solves the drawback of repeated injections of contrast agents when the head and neck arteries and coronary arteries need to be examined separately. In addition, the advantages of one-stop heart-brain CTA examinations also lie in their non-invasiveness, high resolution, and comprehensiveness. Because CTA examinations do not require surgery or intubation, the risks and pain experienced by patients are far lower than traditional DSA technology. CTA examinations can provide three-dimensional images, observe the vascular conditions more comprehensively and intuitively, and simultaneously obtain information on atherosclerosis of the thoracic aorta, intracranial arteries, extracranial neck arteries, and coronary arteries, which is of great value for the early detection, diagnosis, and treatment of atherosclerotic diseases.

[0101] Renal artery ultrasound and lower limb artery ultrasound are used to measure the atherosclerotic lesions of the patient's renal artery and lower limb artery: Renal artery ultrasound 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 renal artery atherosclerosis recommended by the current guidelines. Ultrasound workers can exclude rare non-atherosclerotic causes of renal artery stenosis such as fibromuscular dysplasia and polyarteritis based on the characteristics of the lesion site and sonographic features displayed by ultrasound, combined with clinical manifestations and laboratory tests. The screening methods for lower limb atherosclerosis mainly include lower limb artery ultrasound examination and ankle brachial index (ABI) measurement, where ABI is the ratio between the systolic blood pressure at the ankle and arm when the patient is in the supine position. At present, most studies use ABI to diagnose lower limb atherosclerosis. Compared with lower limb artery ultrasound examination, ABI cannot accurately locate the location and range of lower limb artery lesions, cannot quantitatively reflect the severity and range of lower limb atherosclerosis, and has a sensitivity of only 75% and a specificity of 86%. In comparison, the sensitivity of ultrasound examination for lower limb artery stenosis is 85-90%, and the specificity is >95%, which is significantly higher than ABI. It can also directly determine the location of atherosclerosis and the degree of stenosis of the affected lumen vessels.

[0102] The invented overall atherosclerosis burden measurement system has better predictive value for patient prognosis than traditional prognostic risk assessment methods: Previous studies by our team found that the prognostic prediction model established based on this system, which uses heart-brain CTA examinations to measure the atherosclerosis burden of multiple vascular beds of the thoracic aorta, coronary arteries, and head and neck arteries and combines 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 curve of the receiver operating characteristic curve of the model established based on the atherosclerosis burden of a single vascular bed was 58.3-68.0, the area under the curve of the receiver operating characteristic curve of the model established based on the traditional clinical risk assessment scale was 64.0, and the area under the curve of the receiver operating characteristic curve of the model established by quantitatively measuring the overall atherosclerosis burden of the thoracic aorta, coronary artery and head and neck arteries combined with other risk factors was 72.8, which was statistically significantly different from the former two, indicating that the prediction effect of the model constructed for the measurement of atherosclerosis burden in multiple vascular beds of the heart and brain is better than that of the traditional model. However, previous studies only performed CTA examinations on patients with combined heart and brain scans, and did not include information on atherosclerosis burden of lower limb arteries and renal arteries, and had not yet conducted an overall measurement of multi-system atherosclerosis in patients. Our team recently added information on atherosclerosis burden of lower limb arteries and renal arteries based on individual risk factors and intracranial and extracranial atherosclerosis burden scores, and found that it can further improve the model's predictive performance for prognosis. The area under the curve of the receiver operating characteristic curve of the model established based on individual risk factors and intracranial and extracranial atherosclerosis burden scores was 71.8, and the C statistic was 0.65, while the area under the curve of the model established based on individual risk factors and intracranial, extracranial, lower limb and renal artery atherosclerosis burden scores was 72.1, and the C statistic was 0.68, and the difference between the two was statistically significant. Therefore, the overall atherosclerosis burden multimodal measurement system and method that incorporates the atherosclerosis information of each vascular bed can further improve the ability to predict the prognosis and risk stratification of patients with atherosclerosis.

[0103] Combined with the new type of heart-brain combined scanning CTA and ultrasound examination of lower limb arteries and renal arteries, the overall atherosclerosis load multimodal measurement system provided by the present invention comprehensively evaluates the atherosclerotic lesions of six vascular beds, namely, intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries, and lower limb arteries, by combining the new type of heart-brain combined scanning CTA (or head and neck arteries, coronary artery CTA) and ultrasound examination of lower limb arteries and renal arteries, and adopts the same single vascular bed atherosclerosis load scoring evaluation method, and quantitatively obtains the overall atherosclerosis load by calculation. 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 method is non-invasive and simple, which not only improves the compliance of patients, but also ensures the comparability between different vascular beds and different patients, and enhances the consistency of operations 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 progression of the disease 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 prognostic risk stratification and treatment effect monitoring of atherosclerosis-related diseases, and provides an important means for guiding the clinic to take 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 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.), memory, display device, connection device, etc.

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

[0106] It should be noted that, unless otherwise specified, the terms "first", "second", "third", etc. in the specification are only used to distinguish the various components, elements, steps, etc. in the specification, and are not used to indicate the logical relationship or sequential relationship between the various components, elements, steps, etc.

[0107] It is to be understood that, although the present invention has been disclosed as a preferred embodiment, the above embodiment is 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, the technical content disclosed above can be used to make many possible changes and modifications to the technical solution of the present invention, or modified into equivalent embodiments of equivalent changes. Therefore, any simple modification, equivalent change and modification made to the above embodiments according to the technical essence of the present invention without departing from the content of the technical solution of the present invention still falls 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 include: Patient information acquisition module: used for collecting and / or storing patient information related to atherosclerotic diseases; 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: for lower limb artery and renal artery, ultrasound is used to perform renal artery and lower limb artery atherosclerosis imaging examination on selected patients, and obtain lower limb artery ultrasound information and renal artery ultrasound information related to vascular bed atherosclerotic lesions; parameter information extraction module: parameters are extracted from the acquired heart and 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 patients; Atherosclerosis burden calculation module: semi-quantitatively score the atherosclerotic lesion information of the six vascular beds of the selected patient, obtain the single vascular bed atherosclerosis burden of the 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 patient based on the single vascular bed atherosclerosis burden scores of all patients stored in the patient information acquisition module.

2. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 1, characterized in that: The parameter information extraction module includes: Subdivision module: According to the anatomical structure, the blood vessels contained in the six single vascular beds, namely, intracranial arteries, extracranial neck arteries, coronary arteries, thoracic aorta, renal arteries and lower limb arteries, are precisely subdivided into multiple vascular segments; the extracranial neck 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 brachiocephalic trunk opening, the brachiocephalic trunk and the left subclavian artery opening The aortic arch between the left and right subclavian aortas 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 main trunk of the left 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 arteries of the lower limbs include: the common femoral arteries on both sides, the deep femoral arteries, the superficial femoral arteries, the peroneal arteries, the popliteal arteries, the anterior tibial arteries and the posterior tibial arteries; Evaluation module: used to evaluate the degree and nature of stenosis of single vascular segments in different vascular beds based on the segmentation results.

3. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 2, characterized in that: Preferably, the evaluation module includes: Artery measurement module: used to measure the degree of stenosis of intracranial arteries, extracranial neck arteries, and coronary arteries; the aforementioned heart-brain CTA examination is used for image scanning, data reconstruction, and image analysis; curved reconstruction, maximum intensity projection, multi-planar reconstruction, and volume rendering images are used to evaluate the degree of arterial stenosis; the automatic vascular analysis tool is used to quantify the percentage of arterial stenosis on orthogonal views; the degree of arterial stenosis in different vascular beds 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 plaque is ≥50% or the lumen is occluded, it is defined as the presence of significant stenosis in this segment of artery; Property assessment module: used to evaluate 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 between the highest point of the plaque and the aortic adventitia wall; ulcerated plaques refer to plaques with filling defects on the surface, and the filling defects are marked by base width and maximum depth ≥2mm; mural thrombi refer to low-density imaging areas in the aortic lumen; Lower limb measurement module: used to measure the degree of lower limb artery stenosis, in which the following formula is used to calculate the artery stenosis: stenosis = (vascular inner diameter - vascular effective diameter) / vascular inner diameter × 100%. If the stenosis of a certain section of lower limb artery or the stenosis of the most serious plaque is ≥ 50% or the lumen is occluded, it is defined as the presence of significant stenosis in the lower limb artery; Renal artery measurement module: used to calculate the degree of renal artery stenosis. If the peak systolic velocity at the renal artery turbulence is ≥180cm / s, the corresponding lumen stenosis diameter is ≥60%, which is defined as significant stenosis of the renal artery on that side.

4. The multimodal quantitative measurement system for overall atherosclerosis burden according to claim 1 or 2, 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.

5. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 4, 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.

6. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 4, characterized in that: The semi-quantitative scoring of atherosclerotic burden in intracranial arteries, extracranial neck arteries, lower limb arteries, and coronary artery beds was further subdivided into scores based on the degree of lumen stenosis. First, the atherosclerosis score of a single vascular segment was performed. When there was no obvious atherosclerotic plaque in a single vascular segment, the score was 0; when there was atherosclerotic plaque or calcification but no obvious lumen stenosis, the score was 1; when there was atherosclerotic lumen stenosis of less than 50%, it was mild stenosis, scored 2 points; when there was atherosclerotic lumen stenosis of ≥50% but <70%, it was moderate stenosis, scored 3 points; when there was atherosclerotic lumen stenosis of ≥70% but not completely occluded, it was severe stenosis, scored 4 points; when there was complete atherosclerotic lumen occlusion, the score was 5 points; the total score of atherosclerosis in a single vascular bed was the sum of the scores of each vascular segment.

7. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 4, characterized in that: The scoring method 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.

8. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 1 or 2, characterized in that: The load calculation module includes: The first submodule: arithmetic sum of 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 enter the subject's overall atherosclerosis burden quantitative score into the aforementioned atherosclerosis patient database; The second submodule: sorting the overall atherosclerosis burden scores of all patients in the aforementioned atherosclerosis patient database.

9. The multi-modal quantitative measurement system for overall atherosclerosis burden according to claim 1 or 2, 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.

10. A method for multimodal quantitative measurement of overall atherosclerosis burden, characterized in that The method is implemented by using the multimodal quantitative measurement system for overall atherosclerosis burden according to any one of claims 1 to 9.

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