Ultrasonic diagnostic apparatus, medical image analyzer and medical image analysis program

Abstract

To acquire relation between the left / right of the heart and relation between atriums in a simple operation and an inexpensive device.SOLUTION: An ultrasonic diagnostic apparatus according to the present embodiment includes an index acquisition section and a display section. The index acquisition section uses boundary positions of a plurality of cardiac chambers in an apical four-chamber moving image of a subject including one or more heartbeats to simultaneously acquire a plurality of cardiac function indices relating to at least two cardiac chambers including the left ventricle and the right ventricle out of the plurality of cardiac chambers in the apical four-chamber moving image. The display section displays at least one or more of the plurality of cardiac function indices.SELECTED DRAWING: Figure 2

Description

[Technical field]

[0001] The embodiments disclosed in this specification and the drawings relate to an ultrasound diagnostic apparatus, a medical image analysis apparatus, and a medical image analysis program. [Background technology]

[0002] Conventionally, cardiac function evaluation is performed based on a technique called speckle-tracking (ST) using moving images of the heart obtained by an ultrasound diagnostic device or cardiac MRI. ST methods include 3DST, which uses three-dimensional (3D) data, and 2DST, which uses two-dimensional (2D) cross-sectional data, and both generally analyze one cavity of the heart. In recent years, as the ST method has become more widespread, it has become possible to understand the relationship between the left and right sides of the heart and the relationship between the atrioventricular chambers using functional information about multiple cavities of the heart. As a known technique for such multiple cavities, the concept of simultaneous analysis of volume data for the four chambers of the heart has been shown. A version of this known technique is the simultaneous display of volume change curves of the left ventricle and the left atrium. In addition, Quad chamber Tracking (QCT) inputs analysis results by 2DST or 3DST of individual cavities for multiple cavities, and automatically switches and provides available analysis functions.

[0003] However, in the conventional technology, simultaneous analysis of volume data related to the four chambers of the heart requires a 2D array configuration to obtain 3D data, and analysis cannot be performed from 2D data (tomograms) that can be provided even with low-cost devices. In addition, in QCT, individual results must be created and then input, which is time-consuming and makes it impossible to create results related to multiple chambers at the same time. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] JP 2018-15558 A Summary of the Invention [Problem to be solved by the invention]

[0005] One of the problems to be solved by the embodiments disclosed in this specification and the drawings is to grasp the relationship between the left and right sides of the heart and the relationship between the atrioventricular chambers with a simple operation and an inexpensive device. However, the problems to be solved by the embodiments disclosed in this specification and the drawings are not limited to the above problems. Problems corresponding to the effects of each configuration shown in the embodiments described later can also be positioned as other problems. [Means for solving the problem]

[0006] The ultrasound diagnostic device according to the present embodiment includes an index acquisition unit and a display unit. The index acquisition unit simultaneously acquires a plurality of cardiac function indexes for at least two or more of the cardiac chambers in an apical four-chamber moving image of a subject, the at least two chambers including the left ventricle and the right ventricle, by using boundary positions of the cardiac chambers in the apical four-chamber moving image of the subject including one or more heartbeats. The display unit displays at least one or more of the cardiac function indexes. [Brief description of the drawings]

[0007] [Figure 1] FIG. 1 is a diagram showing an example of the arrangement of an ultrasonic diagnostic apparatus according to a first embodiment. [Diagram 2] FIG. 2 is a flowchart showing an example of a procedure of an index acquisition process according to the first embodiment. [Diagram 3] FIG. 3 is an example of the first embodiment in which time-varying curves of cardiac function indices including size information and GLS are displayed together with an A4C image having a display of a region of interest indicating a group of intracardiac cavity positions in each cardiac chamber. [Figure 4] FIG. 4 is a diagram showing an example in which only a GLS curve is displayed as a time-varying curve according to a second modified example of the first embodiment. [Diagram 5] FIG. 5 is a diagram showing an example of a display according to a third modified example of the first embodiment. [Figure 6] FIG. 6 is a diagram showing an example of the configuration of a medical image analysis apparatus according to the second embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] Hereinafter, an ultrasonic diagnostic device, a medical image analysis device, and a medical image analysis program according to the present embodiment will be described with reference to the drawings. In order to make the description more specific, the first embodiment will be described using an ultrasonic diagnostic device as an example. In the following embodiments, parts with the same reference numerals perform the same operations, and duplicated descriptions will be omitted as appropriate.

[0009] (First embodiment) Fig. 1 is a diagram showing an example of the configuration of an ultrasonic diagnostic device 1 according to this embodiment. As shown in Fig. 1, the ultrasonic diagnostic device 1 has an ultrasonic probe 11, an input interface (input unit) 13, a display (display unit) 15, an electrocardiograph 17, and a device main body 19.

[0010] The ultrasonic probe 11 includes a plurality of piezoelectric transducers, a matching layer provided on the ultrasonic wave emitting surface side of the piezoelectric transducers, and a backing material provided on the rear side of the piezoelectric transducers to prevent the propagation of ultrasonic waves backward from the piezoelectric transducers. Each of the plurality of piezoelectric transducers generates ultrasonic waves in response to a drive signal supplied from a transmission / reception circuit 23 described later. The ultrasonic probe 11 is a one-dimensional array probe detachably connected to the device body 7. The plurality of piezoelectric transducers generate ultrasonic waves based on a drive signal supplied from an ultrasonic transmission circuit 71 in the device body 7. The ultrasonic probe 11 may be provided with a button to be pressed during a freeze operation or the like.

[0011] When ultrasonic waves are transmitted from the ultrasonic probe 11 to the subject P, the transmitted ultrasonic waves are reflected one after another by discontinuous surfaces of acoustic impedance in the internal tissues of the subject P. The reflected ultrasonic waves are received as reflected wave signals (hereinafter referred to as echo signals) by a plurality of piezoelectric transducers of the ultrasonic probe 11. The amplitude of the received echo signal depends on the difference in acoustic impedance at the discontinuous surface where the ultrasonic waves are reflected. When the transmitted ultrasonic pulse is reflected by the surface of a moving blood flow or a heart wall, the echo signal undergoes a frequency shift due to the Doppler effect depending on the velocity component of the moving object in the ultrasonic transmission direction. The ultrasonic probe 11 receives the echo signal from the subject P and converts it into an electrical signal.

[0012] The input interface 13 inputs various instructions, commands, information, selections, and settings from the operator into the ultrasonic diagnostic device 1. The input interface 13 is realized by a trackball, a switch button, a mouse, a keyboard, a touch pad that performs input operations by touching the operation surface, and a touch panel display in which a display screen and a touch pad are integrated, etc. The input interface 13 converts the input operation received from the operator into an electric signal. Note that in this specification, the input interface 13 is not limited to an interface having physical operation parts such as a mouse and a keyboard. For example, an electric signal processing circuit that receives an electric signal corresponding to an input operation from an external input device provided separately from the ultrasonic diagnostic device 1 and outputs the received electric signal to the device main body 19 is also included as an example of the input interface 13.

[0013] The display 15 may be, for example, a liquid crystal display (LCD), a cathode ray tube (CRT) display, an organic electroluminescence display (OELD), a plasma display, or any other arbitrary display. The display 15 may be incorporated in the device body 7. The display 15 may be a desktop type, or may be configured as a tablet terminal or the like capable of wireless communication with the device body 7.

[0014] The display 15 displays various images generated by an image generating circuit 29 (described later) and the like. The display 15 has a display circuit that realizes the display of various images. The display 15 also displays a Graphical User Interface (GUI) that allows the operator to input various setting requests. Note that multiple displays may be connected to the device body 19 of the ultrasonic diagnostic device 1.

[0015] The electrocardiograph 17 is connected to the device main body 19 via the communication interface 31. The electrocardiograph 17 acquires an electrocardiogram (ECG) of the subject P as a biological signal of the subject P subjected to ultrasonic scanning. The electrocardiograph 17 outputs the acquired ECG to the device main body 19.

[0016] The device main body 19 has a transmission / reception circuit (transmission / reception section) 23, a B-mode data generation circuit (B-mode data generation section) 25, a Doppler data generation circuit (Doppler data generation section) 27, an image generation circuit (image generation section) 29, a communication interface 31, a memory (storage section) 33, a control circuit (control section) 35, and a processing circuit (processing section) 37.

[0017] The transmission / reception circuit 23 has a pulse generator, a transmission delay circuit, and a pulser circuit, and supplies a drive signal to each of the piezoelectric transducers in the ultrasonic probe 11. The pulse generator repeatedly generates a rate pulse for forming a transmission ultrasonic wave at a predetermined rate frequency fr (Hz) (period: 1 / fr second). The transmission delay circuit provides each rate pulse with a delay time required to converge the transmission ultrasonic wave into a beam and determine the transmission directivity. The pulser circuit applies a voltage pulse as a drive signal to each piezoelectric transducer of the ultrasonic probe 11 at a timing based on the rate pulse. As a result, an ultrasonic beam is transmitted to the subject P.

[0018] The transmission / reception circuit 23 further includes a preamplifier, an analog-to-digital (hereinafter referred to as A / D) converter, a reception delay circuit, and an adder. The transmission / reception circuit 23 generates a reception signal based on the reception echo signal generated by each piezoelectric transducer. The preamplifier amplifies the echo signal from the subject P captured via the ultrasonic probe 11 for each channel. The A / D converter converts the amplified reception echo signal into a digital signal. The reception delay circuit provides the reception echo signal converted into a digital signal with a delay time required to determine reception directivity. The adder adds multiple echo signals to which a delay time has been applied. By this addition, the transmission / reception circuit 23 generates a reception signal in which the reflection component from the direction corresponding to the reception directivity is emphasized. By this transmission directivity and reception directivity, The overall directivity of the ultrasonic transmission and reception is determined. This overall directivity determines the ultrasonic beam (so-called "ultrasonic scan line").

[0019] The B-mode data generation circuit 25 has an envelope detector and a logarithmic converter, and generates B-mode data based on the received signal. The envelope detector performs envelope detection on the received signal. The logarithmic converter performs logarithmic conversion on the envelope-detected signal, and relatively emphasizes weak signals in the envelope-detected signal. The B-mode data generation circuit 25 generates signal values ​​(referred to as B-mode data) for each depth in each scanning line based on the signals emphasized by the logarithmic converter.

[0020] Specifically, the B-mode data generating circuit 25 generates two-dimensional B-mode data by two-dimensional scanning. The B-mode data is generated, for example, by two-dimensional ultrasonic scanning (hereinafter referred to as apical four-chamber scan) of a cross section (apical four-chamber cross section) from the apex of the subject P toward multiple cardiac chambers. The multiple cardiac chambers are at least two of the four chambers. For the sake of concrete explanation, the B-mode data is data generated by the apical four-chamber scan (hereinafter referred to as apical four-chamber data), and is associated with the time phase of the electrocardiogram when the apical four-chamber scan is performed. The four chambers are the left atrium (LA), left ventricle (LV), right atrium (RA), and right ventricle (RV).

[0021] The Doppler data generation circuit 27 has a mixer, a low pass filter (hereinafter referred to as LPF), etc., and generates Doppler data based on the received signal. The mixer multiplies the received signal by a reference signal having the frequency f0 of the transmitted ultrasound, and generates a signal having a Doppler shift frequency fd component and a signal having a frequency component of (2f0+fd). The LPF removes the high frequency component (2f0+fd) from the signal output from the mixer. In this way, the Doppler data generation circuit 27 generates Doppler data having a Doppler shift frequency fd component from the received signal.

[0022] The image generating circuit 29 has a digital scan converter (hereinafter referred to as DSC), an image memory, and the like, neither of which are shown. The DSC converts the scan line signal sequence of an ultrasound scan, which is made up of B-mode data and Doppler data, into a scan line signal sequence in a video format (scan conversion). The image generating circuit 29 synthesizes text information of various parameters, scales, and the like, with the scan-converted B-mode data and Doppler data to generate ultrasound image data. The ultrasound image data is data for display. The ultrasound image is an example of a medical image. The ultrasound image data is also an example of medical data. Meanwhile, the B-mode data, volume data, and Doppler data are also called raw data. The image memory stores a plurality of ultrasound images (hereinafter referred to as ultrasound video images) corresponding to a series of frames immediately before the input of a freeze operation. The plurality of ultrasound images stored in the image memory are used for cine display.

[0023] For example, the image generating circuitry 29 generates an ultrasound moving image (hereinafter referred to as an apical four-chamber moving image) over at least one heartbeat based on apical four-chamber data generated by an apical four-chamber scan performed over at least one heartbeat of the subject P. The generated apical four-chamber moving image is stored in an image memory together with a cardiac phase in an electrocardiogram, and is used for cine display as appropriate. The image generating circuitry 29 also stores the apical four-chamber moving image in a memory 33.

[0024] The communication interface 31 is connected to an external device such as a medical image storage device via a network. The communication interface 31 receives ultrasound image data related to the four cavities of the subject P from the medical image storage device and outputs the data to the memory 33. The communication interface 31 transfers various data output from the image generating circuit 29, the processing circuit 37, etc. to the external device.

[0025] The memory 33 is composed of an HDD (hard disk drive), an SSD (solid state drive), a magnetic disk (floppy disk, hard disk, etc.), an optical disk (CD-ROM, DVD, etc.), a semiconductor memory, etc. The memory 33 stores programs related to ultrasonic transmission and reception, programs corresponding to various processes executed by the control circuit 35 and the processing circuit 37, etc. The memory 33 stores raw data, ultrasonic image data, various data generated and processed by the processing circuit 37, etc.

[0026] The control circuit 35 includes, for example, a processor and a memory as hardware resources. The control circuit 35 functions as the core of the ultrasonic diagnostic apparatus 1. Specifically, the control circuit 35 reads out a control program stored in the memory 33, loads it on the memory, and controls various units of the ultrasonic diagnostic apparatus 1 according to the loaded control program.

[0027] The processing circuitry 37 includes, for example, a processor and a memory as hardware resources. Specifically, the processing circuitry 37 reads out a program stored in the memory 33, expands the program on the memory, and realizes various functions according to the expanded program. The processing circuitry 37 has a boundary detection function 371, a tracking function 373, a boundary position acquisition function 375, and an index acquisition function 377. The processing circuitry 37 that realizes the boundary detection function 371, the tracking function 373, the boundary position acquisition function 375, and the index acquisition function 377 corresponds to a boundary detection unit, a tracking unit, a boundary position acquisition unit, and an index acquisition unit, respectively. When an instruction to acquire indexes related to cardiac function of at least two or more chambers in the apical four-chamber moving image (hereinafter referred to as cardiac function indexes) is input via the input interface 13, the processing circuitry 37 executes index acquisition processing by the boundary detection function 371, the tracking function 373, the boundary position acquisition function 375, and the index acquisition function 377. The index acquisition process is a process for acquiring and displaying cardiac function indexes of the subject P using the apical four-chamber motion image. An instruction to acquire cardiac function indexes is input by, for example, pressing a button that executes the index acquisition process.

[0028] The cardiac function index includes the lumen volume and the volume change rate for the left ventricle, the left atrium, and the right atrium, and the lumen area and the area change rate for the right ventricle. The cardiac function index also includes the GLS (Global Longitudinal Strain) of the entire wall for the left ventricle, the left atrium, and the right atrium among the multiple cardiac chambers, and the GLS of the free wall for the right ventricle among the multiple cardiac chambers. Here, the free wall corresponds to the entire wall excluding the septum. The cardiac function index also includes the left atrial volume index for the left atrium, and the systolic tricuspid annulus movement distance for the right ventricle.

[0029] The processing circuitry 37 automatically detects a group of boundary positions indicating boundary positions for a plurality of cardiac chambers in at least one cardiac phase or more based on the apical four-chamber motion image by the boundary detection function 371. Specifically, the boundary detection function 371 reads out the apical four-chamber motion image over one cardiac beat or more from the memory 33 in response to pressing a button for executing the index acquisition process. In addition, the boundary detection function 371 reads out a knowledge base database (hereinafter referred to as a knowledge base dictionary) constructed by machine learning for a deep neural network (hereinafter referred to as a DNN) or the like from the memory 33. The boundary detection function 371 may select a knowledge base dictionary to be applied to the apical four-chamber motion image from among multiple types of knowledge base dictionaries, according to a selection instruction from the user inputted via the input interface 13 according to the type of modality related to the apical four-chamber motion image, the name of an expert related to instruction during machine learning, the resolution of the apical four-chamber motion image, and the like.

[0030] The boundary detection function 371 identifies an ultrasound image generated by the apical four-chamber data corresponding to an ED (End Diastole) phase corresponding to an R wave of an electrocardiogram and an ES (End Systole) phase corresponding to an ST elevation portion of an electrocardiogram from the read apical four-chamber motion image. The ES phase is generally defined as a phase a predetermined time after the ED phase as a function of the heart rate. The boundary detection function 371 detects a group of boundary positions for the boundary positions of multiple heart chambers in the initial boundary image by using a knowledge base dictionary for the identified ultrasound image (hereinafter referred to as an initial boundary image). Specifically, the boundary detection function 371 applies a knowledge base dictionary corresponding to the ED phase, which is a result of machine learning, to the four heart chambers in the initial boundary image of the ED phase, to simultaneously detect the boundary positions for each chamber, and treats the boundary positions for the multiple heart chambers as a group of boundary positions.

[0031] Prior to the detection of the boundary position group, if the display depth in the apical four-chamber image, which is the initial boundary image, is sufficiently large for the target heart, the boundary detection function 371 can detect all four cardiac chambers. On the other hand, if the display depth in the apical four-chamber image is insufficient and the left atrium and right atrium are not depicted in the initial boundary image, the boundary detection function 371 will detect only the left ventricle and the right ventricle. Therefore, the boundary detection function 371 defines a state of detected cardiac chamber / undetected cardiac chamber in the initial boundary image. In the index acquisition process, only the detected cardiac chamber is the subject of analysis after the processing by the boundary detection function 371. Regarding this state, in a representative display example of cardiac function indexes on the display 15, a check box corresponding to each chamber (LV (left ventricle), LA (left atrium), RV (right ventricle), RA (right atrium)) is notified to the user as being in a checked state (detected) or grayed-down state (undetected).

[0032] The processing circuitry 37 tracks the boundary positions in the apical four-chamber moving image of the remaining cardiac phase, which is different from the cardiac phase related to the automatic detection of the boundary positions, by the tracking function 373. That is, the tracking function 373 tracks the boundary positions in the apical four-chamber moving image of the remaining cardiac phase along a time series from the ED phase, using a known technique, 2DST (two-dimensional speckle tracking). Specifically, the tracking function 373 estimates the movements of the multiple cardiac chambers by processing including pattern matching, using the boundary positions detected in the ED phase as an initial contour, and tracks the initial contour position of each chamber over a predetermined section (domain). In this embodiment, the domain is the section of one heartbeat by the RR section of the electrocardiogram.

[0033] The processing circuitry 37 acquires the boundary positions of the multiple heart chambers over a period of at least one heartbeat by tracking the boundary position group using the boundary position acquisition function 375. For example, the boundary position acquisition function 375 simultaneously acquires the boundary positions of each of the multiple heart chambers in the entire domain by arranging the tracking results of the boundary position group in time series for each of the multiple heart chambers.

[0034] Processing circuitry 37 uses index acquisition function 377 to simultaneously obtain cardiac function indices for multiple cardiac chambers, the indices being defined using boundary positions of the cardiac chambers. Index acquisition function 377 simultaneously acquires multiple cardiac function indices for at least two or more chambers including the left and right ventricles among the multiple cardiac chambers in the apical four-chamber motion image, using boundary positions of the multiple cardiac chambers in the apical four-chamber motion image of subject P including one or more heartbeats. For example, index acquisition function 377 simultaneously acquires multiple cardiac function indices for the four chambers in the apical four-chamber motion image. Definitions of multiple cardiac function indices for the four chambers will be described below.

[0035] Representative cardiac function indices used in cardiac diagnosis for subject P include information (size information) on the size (volume and area) of the cardiac chambers and GLS, which is an index of wall motion. As shown below, the size information is defined as the volume change rate EF (Ejection Fraction for the ventricle, Emptying Fraction for the atrium) using the volume calculated by the disc summation method or the area-length method in one cross section except for the right ventricle. LVEF=100*(LV maximum volume - LV minimum volume) / LV maximum volume [%] LAEF=100*(LA maximum volume - LA minimum volume) / LA maximum volume [%] RAEF=100*(RA maximum volume - RA minimum volume) / RA maximum volume [%]

[0036] Regarding right ventricular size information, since it is difficult to estimate the volume from one cross section of the apical four-chamber image, the right ventricular fractional area change (RVFAC), which is the ratio of the lumen areas, is used as size information. RVFAC=100*(RV maximum lumen area - RV minimum lumen area) / RV maximum lumen area [%]

[0037] Furthermore, since LAVI (Left Atrium Volume Index) is widely used as information on the size of the left atrium, LAVI may be defined together with LAV (maximum volume of the LA). LAVI=LAV / body surface area [mL / m 2 ] Where LAV = maximum LA volume [mL] The body surface area is the surface area of ​​the subject P. If the height and weight of the subject P are input when the patient information of the subject P is registered, the index acquisition function 377 applies the height and weight of the subject P to an estimation formula for the surface area to obtain the body surface area. If the height and weight of the subject P are not input when the patient information of the subject P is registered, the index acquisition function 377 acquires the LAV.

[0038] Similarly to the left atrium, right atrium volume index (RAVI) may be defined as size information of the right atrium together with the maximum volume of the RA (RA). RAVI=RAV / body surface area [mL / m 2 ] Where RAV = maximum RA volume [mL] The index acquisition function 377 acquires the above-defined LVEF, LAEF, RAEF, RVFAC, LAVI, LAV, RAVI, and RAV as index values ​​indicating cardiac function indexes using the boundary positions of multiple cardiac chambers over a period of at least one heartbeat.

[0039] GLS is defined as LVGLS [%] by either the End-Systolic definition or the Peak definition in reference 1) Voigt JU et al, J Am Soc Echocardiogr 2015;28:183-93. For the right ventricle, the free wall GLS is defined as RVFWSL (Right Ventricle Free Wall Strain longitudinal) [%] in reference 2) Badano LP et al, European Heart Journal - Cardiovascular Imaging (2018) 19, 591-600. For the atrium, the left atrium LASr [%] and the right atrium RASr [%] are defined in reference 2). LVGLS=100*(LV perimeter (t=Peak time phase) - LV perimeter (ED)) / LV perimeter (ED) [%] RVFWSL=100*(RV free wall length (t=Peak time phase) - RV free wall length (ED)) / RV free wall length (ED) [%] LASr=100*(LA perimeter (t=Peak time phase) - LA perimeter (ED)) / LA perimeter (ED) [%] RASr=100*(RA perimeter (t=Peak time phase) - RA perimeter (ED)) / RA perimeter (ED) [%]

[0040] The circumferential lengths in the multiple heart chambers (LV, LA, RV, RA) are functions of time. The peak time phase corresponds to the time phase of the peak value in the time change curve of GLS acquired using the boundary position of the heart chamber. The index acquisition function 377 calculates the circumferential lengths in the multiple heart chambers (LV, LA, RV, RA) using the time phase of the peak value and the time phase of ED, respectively, and acquires LVGLS, RVFWSL, LASr, and RASr as cardiac function indexes.

[0041] Furthermore, TAPSE (Tricuspid Annular Plane Systolic Excursion: systolic tricuspid annular movement distance) is also commonly used as a right ventricular wall motion index. For this reason, the index acquisition function 377 may define TAPSE together with RVFWSL. TAPSE is defined using the distance D(t) between the probe position (Dap(t)) on the apical four-chamber motion image at time t and the tricuspid annular position (Dtv(t)) on the free wall side. As D(t), it is preferable to obtain the maximum value within a heartbeat. That is, the index acquisition function 377 acquires TAPSE using D(t) as the maximum value within a heartbeat. Note that Dtv(t) uses the tricuspid annular portion at the boundary position of the right ventricle. TAPSE=D(ED) - D(t) [mm] where D(t) = |Dap(t) - Dtv(t)| [mm] The index acquiring function 377 calculates the distance D(t) over one heartbeat and the distance D(ED) at the ED time phase, for example. Next, the index acquiring function 377 identifies the maximum distance within the heartbeat among the distances D(t). The index acquiring function 377 subtracts the maximum distance from the distance D(ED) at the ED time phase, and acquires TAPSE as a cardiac function index.

[0042] The index acquisition function 377 also acquires at least one of the time difference (peak time difference) at the peak of index values ​​related to cardiac function of multiple heart chambers or the difference in peak values ​​of index values ​​in the same heartbeat as an associated index indicating an index of cardiac function related to multiple heart chambers. Here, "association" refers to a relationship that is determined by evaluating the degree of delay due to the peak timing of the cardiac function index or evaluating the comparison of the peak values. Therefore, for size information between different heart chambers and time change curves of GLS, the time difference dt [msec] of the peak times, the difference dp [%] of the peak values, and the ratio Rdp [%] of the difference in the peak values ​​are given as secondary wall motion indexes that indicate association. The secondary wall motion index corresponds to the above-mentioned associated index indicating the difference in wall motion index between multiple heart chambers. The peak time is the time of the peak in the time change curve of GLS.

[0043] As the peak time difference dt, for example, it is preferable to define the difference in peak time between the left ventricle and the right ventricle dt_LV-RV or the difference in peak time between the left ventricle and the left atrium dt_LV-LA. Note that, other than dt_LV-RV or dt_LV-LA, the maximum peak time difference max-dt (the difference between the latest peak time and the earliest peak time) in the detected cardiac chamber may be defined.

[0044] As the difference dp in peak values, it is preferable to obtain the difference between the left ventricle and the right ventricle or the difference between the left ventricle and the left atrium, and it is defined as the following related index using GLS as an example. dp_GLS_LV-RV=LVGLS - RVFWSL [%] dp_GLS_LV-LA=LVGLS - LASr [%]

[0045] As the peak value difference ratio Rdp, it is preferable to obtain the difference ratio based on the left ventricle, and it is defined as the following related index using GLS as an example. Rdp_GLS_LV-RV=100*(LVGLS - RVFWSL) / LVGLS [%] Rdp_GLS_LV-LA=100*(LVGLS - LASr) / LVGLS [%]

[0046] The index acquisition function 377 acquires peak time differences dt such as dt_LV-RV, dt_LV-LA, and max-dt using the times of peak values ​​in the time change curves of GLS in multiple heart chambers (LV, LA, RV, RA). The index acquisition function 377 acquires dp_GLS_LV-RV, dp_GLS_LV-LA, Rdp_GLS_LV-RV, and Rdp_GLS_LV-LA using the peak values ​​in the time change curves of GLS in multiple heart chambers (LV, LA, RV, RA).

[0047] As the secondary wall motion index as the related index, a statistical representative value between the cardiac chambers of the primary wall motion index value as the cardiac function index may be used. Suitable statistical representative values ​​include an inter-chamber average value of the peak time and an inter-chamber standard deviation. In this case, the index acquisition function 377 acquires, as the related index, an average value of the peak time differences between up to four cardiac chambers and a standard deviation using the average value and up to four peak time differences.

[0048] The term "processor" used in the description of the control circuit 35 and the processing circuit 37 refers to a circuit such as a CPU (Central Processing Unit), a GPU (graphics processing unit), or an application specific integrated circuit (ASIC), a programmable logic device (e.g., a Simple Programmable Logic Device (SPLD), a Complex Programmable Logic Device (CPLD), and a Field Programmable Gate Array (FPGA)).

[0049] The processor realizes various functions by reading and executing the programs stored in the memory 33. Instead of storing the various programs in the memory 33, the various programs may be directly incorporated into the circuitry of the processor in the control circuit 35 or the processing circuit 37. In this case, the processor realizes various functions by reading and executing the various programs incorporated into the circuitry. The functions executed by the processing circuit 37 may be incorporated in the control circuit 35. The functions executed by the control circuit 35 may be incorporated in the processing circuit 37.

[0050] The index acquisition process will be described below with reference to Fig. 2. Fig. 2 is a flowchart showing an example of the procedure of the index acquisition process.

[0051] (Indicator acquisition process) (Step S201) A command to start index acquisition processing is input through the input interface 13. Specifically, the input interface 13 receives a command from a user to press a button to execute the index acquisition processing.

[0052] (Step S202) In response to an input specifying the start of the index acquisition process, the boundary detection function 371 reads out an apical four-chamber motion image spanning one or more heartbeats from the memory 33. The boundary detection function 371 identifies ultrasound images of the ED phase and the ES phase in the read out apical four-chamber motion image using an electrocardiogram associated with the apical four-chamber motion image.

[0053] (Step S203) The boundary detection function 371 detects the presence or absence of four heart chambers in the identified ultrasound image (initial boundary image) using, for example, a learned model such as segmentation processing or region detection. In this way, the boundary detection function 371 defines the states of detected heart chambers / undetected heart chambers in the initial boundary image. The display 15 displays a check box corresponding to each heart chamber as checked (detected) or grayed out (undetected) in a representative display example of cardiac function indexes (see FIG. 3). The boundary detection function 371 detects a group of boundary positions by applying a knowledge base dictionary to the initial boundary image.

[0054] (Step S204) The tracking function 373 tracks boundary positions of multiple cardiac chambers in time series from the ED phase using 2DST or the like in the apical four-chamber motion image of the remaining cardiac phase different from the cardiac phase of the initial border image.

[0055] (Step S205) The boundary position acquisition function 375 acquires boundary positions of multiple heart chambers over a period of at least one heart beat based on the tracking result of the boundary position group. For example, the boundary position acquisition function 375 acquires boundary positions of multiple heart chambers in a period of one heart beat due to the RR period of an electrocardiogram.

[0056] (Step S206) The index acquisition function 377 acquires cardiac function indexes related to size information of the cardiac chambers based on the boundary positions of the multiple cardiac chambers. Specifically, the index acquisition function 377 simultaneously acquires the time-series lumen volumes (lumen volume change curves) and volume change rates (LVEF, LAEF, RAEF) for the left ventricle, left atrium, and right atrium based on the boundary positions of the left ventricle, left atrium, and right atrium. The index acquisition function 377 acquires the time-series lumen areas (lumen area change curves) and area change rates (RVFAC) based on the boundary position of the right ventricle.

[0057] Furthermore, the index acquiring function 377 acquires the LAVI based on the boundary position of the left atrium, the maximum volume in the left atrium lumen volume change curve, and the body surface area of ​​the subject P. The index acquiring function 377 acquires the RAVI based on the boundary position of the right atrium, the maximum volume in the right atrium lumen volume change curve, and the body surface area of ​​the subject P. If the height and weight of the subject P are not input when the patient information of the subject P is registered, the index acquiring function 377 acquires the LAV and RAV.

[0058] (Step S207) The index acquiring function 377 acquires the GLS (all-wall GLS change curve) of all walls along a time series for the left ventricle, the left atrium, and the right atrium based on the boundary positions of the multiple cardiac chambers, and acquires the GLS (free-wall change curve) of the free wall along a time series for the right ventricle. For example, the index acquiring function 377 acquires the LVGLS based on the LV circumference at the time phase of the peak value of the all-wall GLS change curve of the left ventricle and the LV circumference at the time phase of ED. The index acquiring function 377 also acquires the RVFWSL based on the RV free wall length at the time phase of the peak value of the free wall GLS change curve of the right ventricle and the RV free wall length at the time phase of ED. The index acquiring function 377 also acquires the LASr based on the LA circumference at the time phase of the peak value of the all-wall GLS change curve of the left atrium and the LA circumference at the time phase of ED. Furthermore, the index acquisition function 377 acquires an RASr based on the RA circumference in the time phase of the peak value of the total wall GLS change curve of the right atrium and the RA circumference in the time phase of ED.

[0059] (Step S208) The index acquiring function 377 acquires related indexes using the total wall GLS change curve and the free wall GLS change curve. Specifically, the index acquiring function 377 acquires the time phase (peak time) at the peak value in the total wall GLS change curve and the free wall GLS change curve. Next, the index acquiring function 377 acquires the peak time difference dt_LV-RV using the peak time of the left ventricle and the peak time of the right ventricle. In addition, the index acquiring function 377 acquires the peak time difference dt_LV-LA using the peak time of the left ventricle and the peak time of the left atrium. In addition, the index acquiring function 377 acquires the maximum peak time difference max-dt using the minimum peak time and the maximum peak time of the four heart chambers.

[0060] Moreover, the index acquiring function 377 subtracts RVFWSL from LVGLS to acquire the peak value difference dp_GLS_LV-RV. The index acquiring function 377 subtracts LASr from LVGLS to acquire the peak value difference dp_GLS_LV-LA. The index acquiring function 377 also acquires the peak value difference ratio Rdp_GLS_LV-RV based on LVGLS and RVFWSL. The index acquiring function 377 also acquires the peak value difference ratio Rdp_GLS_LV-LA based on LVGLS and LASr. Note that the index acquiring function 377 may acquire an average value of peak time differences between up to four heart chambers and a standard deviation using the average value and up to four peak time differences based on the peak time differences of a plurality of heart chambers.

[0061] (Step S209) The index acquiring function 377 identifies the tricuspid annulus position on the free wall side along the time series based on the boundary positions of the multiple cardiac chambers acquired by the boundary position acquiring function 375. Next, the index acquiring function 377 identifies the maximum distance D(t) between the probe position (Dap(t)) and the tricuspid annulus position on the free wall side (Dtv(t)) within one cardiac beat, for example. The index acquiring function 377 subtracts D(t) as the maximum value within one cardiac beat from the distance D(ED) at the ED phase to acquire TAPSE (systolic tricuspid annulus movement distance).

[0062] (Step S210) The display 15 displays at least one of the multiple cardiac function indices acquired by the index acquisition function 377. The display 15 simultaneously displays multiple cardiac function indices related to multiple cardiac chambers. Specifically, the display 15 simultaneously displays the cardiac function index values ​​and related indices along with a graph showing the time-varying curve of the cardiac function index. At this time, the display 15 displays the cardiac chambers whose boundary positions have been automatically detected in the apical four-chamber motion image. For example, the display 15 displays a check box corresponding to each cardiac chamber as checked (detected) or grayed out (not detected).

[0063] FIG. 3 shows an example of a display 15 showing a time-varying curve of cardiac function indexes including size information and GLS together with an apical 4-chamber view (A4C) image with a display of a region of interest showing the positions of the cardiac cavities in each cardiac chamber. As shown in FIG. 3, the display 15 further displays the above-mentioned representative cardiac function indexes as a list. In this case, it is preferable to display the heart rate [bpm] and ES time [msec] obtained from the period of one cardiac cycle in the apical 4-chamber moving image. Here, the time phase with the smallest left ventricular cavity volume (the time when the minimum LV volume is obtained) is selected as the ES time. Alternatively, a separately measured AVC (aortic valve closure) time may be input and used.

[0064] As shown in FIG. 3, the time change curve indicates GLS information with a solid line and size information with a dashed line, and up to eight graphs are displayed on the display 15 with the time axis aligned. If there are too many graphs and it is difficult to see them, the display can be turned on / off by unchecking the checkbox indicating the target heart chamber according to a user's instruction via the input interface 13. This allows control to display / hide only any desired graph. It is also preferable to support the user's understanding of the correspondence by displaying the region of interest in the same color as the corresponding graph (e.g., LV: yellow, RV: light blue, LA: pink, RA: green). Also, as shown in FIG. 3, a mark indicating a peak position may be placed on the time change curve of the GLS. Also, related information may be displayed appropriately in FIG. 3.

[0065] As shown in FIG. 3, the square mark (check box) next to TAPSE is a check box indicating whether or not to display the waveform of the distance D(t) calculated to obtain TAPSE. When the check box for TAPSE is checked in response to a command from the user via the input interface 13, the waveform of D(t) is displayed superimposed in a different color (e.g., white) on the graph shown in FIG. 3. At this time, a scale of length (mm) related to the distance D(t) is further displayed on the vertical axis on the right side of the graph shown in FIG. 3. Furthermore, when the check box for TAPSE is checked in response to a command from the user via the input interface 13, the waveform of D(t) may be displayed as a dashed time change curve in place of the dashed time change curve of the RV lumen area (t) on the graph shown in FIG. 3. At this time, the area (cm 2 ) is hidden, and a scale showing the length (mm) for the distance D(t) is displayed.

[0066] According to the ultrasound diagnostic device 1 of the first embodiment described above, multiple cardiac function indices for at least two or more chambers including the left ventricle and the right ventricle among the multiple cardiac chambers in the apical four-chamber moving image of the subject P including one or more heartbeats are simultaneously obtained using the boundary positions of the multiple cardiac chambers in the apical four-chamber moving image, and at least one or more of the multiple cardiac function indices are displayed. For example, according to the ultrasound diagnostic device 1, a boundary position group indicating the boundary positions for the multiple cardiac chambers in at least one cardiac phase or more is automatically detected based on the apical four-chamber moving image which is an ultrasound moving image, and the boundary position group is tracked along a time series in the apical four-chamber moving image of the remaining cardiac phase different from the cardiac phase related to the automatic detection of the boundary position group, and the boundary positions of the multiple cardiac chambers over at least one heartbeat section are obtained by tracking the boundary position group. As a result, according to the ultrasound diagnostic device 1, multiple cardiac function indices for the four chambers in the apical four-chamber moving image are simultaneously obtained. In addition, according to the ultrasound diagnostic device 1, multiple cardiac function indices for the multiple cardiac chambers are simultaneously displayed. At this time, the ultrasonic diagnostic device 1 displays the cardiac cavity whose boundary position is automatically detected from the apical four-chamber moving image.

[0067] Moreover, the cardiac function index according to the first embodiment includes the lumen volume and the volume change rate for the left ventricle, the left atrium, and the right atrium, and includes the lumen area and the area change rate for the right ventricle. Moreover, the cardiac function index according to the first embodiment includes the GLS of the entire wall for the left ventricle, the left atrium, and the right atrium among the multiple cardiac chambers, and includes the GLS of the free wall for the right ventricle among the multiple cardiac chambers. Moreover, the cardiac function index according to the first embodiment includes the left atrial volume index for the left atrium, and includes the systolic tricuspid annular movement distance for the right ventricle. Moreover, according to the ultrasound diagnostic device 1 according to the first embodiment, at least one of the peak time difference or the difference in the peak value of the index value relating to the cardiac function of the multiple cardiac chambers in the same heartbeat is acquired as a related index indicating an index of cardiac function related to the multiple cardiac chambers.

[0068] From the above, according to this embodiment, the relationship between the left and right sides of the heart and the relationship between the atrioventricular chambers can be grasped by a simple one-touch operation that operates a series of processes, and even with a low-cost device that does not include a 2D array or a 3D data acquisition configuration, using cardiac function indices related to multiple chambers obtained at the same time. Here, "relation" refers to a relationship that is determined by evaluating the degree of delay due to the peak timing of the indices and evaluating the comparison of the peak values. Therefore, for the time change curves of size information between different cardiac chambers and the time change curves of GLS, the time difference dt [msec] of the peak times, the difference dp [%] of the peak values, and the ratio Rdp [%] of the difference of the peak values ​​are given as secondary wall motion indices (information on the difference between wall motion indices between multiple cardiac chambers) that mean the relationship. Then, for example, the related information acquired by this embodiment can be used for the relationship evaluation before and after the treatment regarding the degree of asynchrony of myocardial contraction that is the target of biventricular pacing therapy. As a result, according to this embodiment, the degree of the peak timing difference between both ventricles and the degree of the peak timing difference between the left ventricle and the left atrium can be grasped at once.

[0069] For these reasons, the ultrasound diagnostic device 1 according to this embodiment can acquire and display cardiac function indices and related information simply, easily, and at low cost, and can grasp the relationships related to the evaluation of cardiac function at once. Therefore, the ultrasound diagnostic device 1 improves the operability of acquiring cardiac function indices, and can improve the throughput of diagnosis of cardiac function.

[0070] (First Modification) In the first embodiment, the cardiac function index is defined over all phases of one cardiac cycle of the subject P by the boundary detection function 371, the tracking function 373, the boundary position acquisition function 375, and the index acquisition function 377. In contrast, in this modification, the tracking function 373 is not used, and the boundary positions in the two cardiac phases, the ED phase and the ES phase, indicated by the boundary detection function 371 are automatically detected, and the cardiac function index is defined using the detected boundary positions. In this modification, a time change curve is not obtained as the output of the index acquisition function 377, but a list of representative cardiac function indexes defined below can be displayed. In addition, although not shown in particular, in this modification, instead of the time change curve shown on the right side of FIG. 1, a list of representative cardiac function indexes is displayed together with an A4C image having a display of a region of interest indicating a group of cardiac cavity positions in each cardiac chamber in the ES phase. For this reason, in this modification, it is preferable to display a list of the following representative cardiac function indexes together with the A4C image on the display 15. In this case, the A4C image on the left side is displayed in the ED phase or a moving image of the A4C image is displayed.

[0071] In order to clarify the differences from the first embodiment, in the following definition formulas, a prime (') is added to the symbols indicating cardiac function indicators. LVEF'=100*(LVED volume - LVES volume) / LVED volume [%] LAEF'=100*(LAES volume - LAED volume) / LAES volume [%] RAEF'=100*(RAES volume-RAED volume) / RAES volume [%] RVFAC'=100*(RVED lumen area - RVES lumen area) / RVED lumen area [%] LVGLS'=100*(LV circumference (ES) - LV circumference (ED)) / LV circumference (ED) [%] RVFWSL'=100*(RV free wall length (ES) - RV free wall length (ED)) / RV free wall length (ED) [%] LASr'=100*(LA perimeter (ES) - LA perimeter (ED)) / LA perimeter (ED) [%] RASr'=100*(RA perimeter (ES) - RA perimeter (ED)) / RA perimeter (ED) [%] LAVI'=LAESV / body surface area [mL / m 2 ] where LAESV = LAES volume [mL] RAVI'=RAESV / body surface area [mL / m 2 ] Where, RAESV = RAESV volume [m] TAPSE' = D(ED) - D(ES) [mm] where D(t) = |Dap(t) - Dtv(t)| [mm]

[0072] The index acquisition process in this modification is a process procedure excluding the process of step S204 shown in Fig. 2. The process of step S205 is a process of acquiring boundary positions of multiple cardiac chambers in the ED phase and the ES phase. Steps S206 to S209 are a process of acquiring size information and strain index values ​​using the boundary positions of multiple cardiac chambers in the ED phase and the ES phase, and acquiring cardiac function indexes and related indexes.

[0073] According to the ultrasound diagnostic device 1 of this modification, cardiac function indices and related indices can be obtained using the boundary positions of multiple cardiac chambers in the ED phase and the ES phase without executing the tracking function 373. This makes it possible to reduce the calculation cost, such as the calculation time, involved in obtaining the cardiac function indices and related indices, and further improve the throughput of diagnosis regarding cardiac function. Other effects of this modification are similar to those of the first embodiment, and therefore will not be described.

[0074] (Second Modification) In this modification, the time change curves output from the index acquiring function 377 are divided for each heart chamber, the time axes are aligned, and displayed on the display 15. That is, the cardiac function indexes output by the index acquiring function 377 are graphs showing the time change curves of the cardiac function indexes, and the display 15 displays the graphs corresponding to the multiple heart chambers to be displayed with the same display size of the time axes.

[0075] FIG. 4 is a diagram showing an example in which only the GLS curve is displayed as a time-varying curve. FIG. 4 also shows an example in which the maximum peak time difference max-dt (20 msec in the diagram) between the detected heart chambers and the maximum peak value difference max-dp (+50% in the diagram) are displayed together with the GLS curve. In the table shown in FIG. 4, the maximum value between the heart chambers is set as max, and the minimum value is set as min. Therefore, the max-min value of the peak time corresponds to max-dt, and the max-min value of the peak value corresponds to max-dp. Note that, although FIG. 4 shows only the GLS curve as a time-varying curve, the time-varying curve (size curve) of size information (lumen volume, lumen area) of each of the multiple heart chambers may be displayed on the display 15, or both the GLS curve and the size curve may be displayed on the display 15 according to the heart chamber.

[0076] According to the ultrasound diagnostic device 1 of this modification, the output of the cardiac function index acquired by the index acquisition function 377 is a graph showing a time-varying curve of the cardiac function index, and the display size of the time axis of the multiple graphs corresponding to the multiple cardiac chambers to be displayed (detected cardiac chambers) is aligned and displayed. As a result, according to the ultrasound diagnostic device 1, even in a case where a maximum of eight graphs are displayed, the overlapping of the graphs is reduced, and the visibility of the graphs by the user can be improved. Therefore, according to this modification, the throughput of the diagnosis regarding cardiac function can be further improved. Other effects of this modification are similar to those of the first embodiment, and therefore will not be described.

[0077] (Third Modification) When one heartbeat is set as the time domain as described in the first embodiment, the size curve and the GLS curve are displayed as graphs as shown in FIG. 3 of the first embodiment and FIG. 4 of the second modification. At this time, the state of contraction of a series of cardiac chambers, called PQRS of an electrocardiogram, is divided into the left and right of the graph. In this modification, the time domain is set to at least two cardiac beats. That is, the apical four-chamber moving image used in the index acquisition process in this modification corresponds to an ultrasonic moving image collected over two cardiac beats or more. At this time, the index acquisition function 377 outputs a graph showing the time change curve of the cardiac function index over at least two cardiac cycles or more. Therefore, in this modification, the display 15 displays the output of a graph of two cardiac cycles or more when, for example, the ventricle and the atrium are included in the multiple cardiac chambers to be displayed.

[0078] Fig. 5 is a diagram showing an example of the display of this modified example. Fig. 5 shows an example in which only a GLS curve is displayed as a time-varying curve on a graph display in a superimposed format for multiple heart chambers as in the first embodiment, and the time domain is set to two heart beats. Note that, as an application example of the main figure, although not shown, a time domain of two or more heart beats may be used in a divided graph for multiple heart chambers as in the second modified example.

[0079] According to the ultrasonic diagnostic device 1 of this modification, the output of the cardiac function index acquired by the index acquisition function 377 is a graph showing a time-varying curve of the cardiac function index, and when the ventricle and the atrium are included in the multiple cardiac chambers to be displayed (detected cardiac chambers), the graph output of two or more cardiac cycles is displayed. As a result, according to the ultrasonic diagnostic device 1, a series of contractions of the atrium, whose contraction starts based on the P wave, and the ventricle, whose contraction starts based on the R wave, in the same heartbeat, called PQRS, can be obtained as a continuous graph display. Therefore, according to this modification, the throughput of diagnosis regarding cardiac function can be further improved. Other effects of this modification are similar to those of the first embodiment, and therefore will not be described.

[0080] (Fourth Modification) In this modification, the value of the secondary index (association index) showing the association between the cardiac chambers is averaged between heartbeats to obtain a stable output. For example, in cases such as atrial fibrillation, it is recommended to average the measured values ​​between multiple heartbeats, and the importance of this modification increases. In this modification, a basic series of processes in the index acquisition process described in the first embodiment is performed on an ultrasound diagnostic device described in JP 2008-302920 A that realizes 2DST in real time. An index acquisition function 377 uses the boundary position in the apical four-chamber moving image acquired in real time to output the average value of the association index between multiple heartbeats.

[0081] For example, when a button for executing an index acquisition process is pressed during execution of an ultrasound scan on the subject P, the boundary detection function 371 detects boundary positions related to a plurality of cardiac chambers in the ultrasound image displayed on the display 15. At this time, the index acquisition function 377 acquires cardiac function indexes using the detected boundary positions. The display 15 displays the acquired cardiac function indexes in real time. Next, when an ultrasound image in a frame next to the ultrasound image related to the detection of the boundary position is acquired, the tracking function 373 tracks the boundary position in the ultrasound image in the next frame. At this time, the index acquisition function 377 acquires cardiac function indexes using the tracked boundary position. In addition, the display 15 displays the acquired cardiac function indexes in real time. When the above process is executed over one heartbeat, the boundary position acquisition function 375 acquires the boundary position over one heartbeat based on the tracking result by the tracking function 373. At this time, the index acquisition function 377 acquires related indexes using the determined boundary position. The display 15 displays the acquired related indexes in real time.

[0082] Furthermore, the index acquiring function 377 outputs the average value of the associated index over a plurality of heartbeats using the boundary position in the apical four-chamber moving image acquired in real time. Specifically, the index acquiring function 377 acquires the value of a secondary index (e.g., dt_LV-LA) indicating the association between the heart chambers for each heartbeat. The index acquiring function 377 then averages and outputs the value of the secondary index over a predetermined heartbeat period (e.g., 10 heartbeats). In this way, the value of the secondary index (moving average value) averaged over a past predetermined period for each heartbeat is output in real time. At this time, the display 15 updates the displayed moving average value to the newly output moving average value, for example, in response to the output of the moving average value.

[0083] According to the ultrasound diagnostic device 1 of this modification, the boundary positions in the apical four-chamber moving image acquired in real time are used to output and display the average value of the related index over a plurality of heartbeats. According to the ultrasound diagnostic device 1 of this modification, the cardiac function index and related indexes of the subject P can be grasped in real time with a simple operation. Furthermore, according to the ultrasound diagnostic device 1 of this modification, for example, since it is recommended to average the measured values ​​over a plurality of heartbeats in cases such as atrial fibrillation, the throughput of the cardiac function evaluation and diagnosis of the subject P can be improved. Other effects of this modification are similar to those of the first embodiment, and therefore description thereof will be omitted.

[0084] As an application example of the first embodiment, the A4C moving image used in the index acquisition process may be an image obtained by a TTE (transthoracic) probe or an image obtained by a TEE (transesophageal) probe. In addition, it is possible to combine the present application with an apparatus capable of real-time 3D scanning, which obtains volume data by electronic scanning with a two-dimensional array probe. In this case, not only the A4C moving image obtained by 2D scanning, but also the A4C moving image may be extracted from volume moving image data including the heart by MPR (Multi Planar Reconstruction: planar transformation) and applied to the present application. At this time, for example, the image generating circuit 29 detects a cross section (apical four-chamber cross section) corresponding to A4C in the volume moving image data, and extracts a planar transformation moving image corresponding to the detected apical four-chamber cross section from the volume moving image data. The extracted apical four-chamber moving image is a planar transformation moving image extracted from the volume moving image data including the heart of the subject P. Even when the A4C moving image by MPR is input, the basic concept of the present application can be extended. Therefore, it can be understood that the present invention provides the effect of making it possible to grasp the relationship between the left and right sides of the heart and the relationship between the atrioventricular chambers with a simple one-touch operation that activates a series of processes.

[0085] Second embodiment The difference between the second embodiment and the first embodiment is that the index acquisition process realized in the first embodiment is performed by a medical image analysis device. The medical image analysis device is realized by, for example, a server device connected to a modality via a network. Note that the various functions executed by the medical image analysis device may be realized by various servers within a hospital, such as a PACS (Picture Archiving and Communication Systems) server.

[0086] 6 is a diagram showing an example of the configuration of the medical image analysis device 20. The medical image analysis device 20 includes an index acquisition function (index acquisition unit) 377 that simultaneously acquires multiple cardiac function indexes related to at least two or more chambers including the left ventricle and the right ventricle among the multiple cardiac chambers in the apical four-chamber motion image of the subject P, using boundary positions of the multiple cardiac chambers in the apical four-chamber motion image including one or more heartbeats, and a display 15 (display unit) that displays at least one or more of the multiple cardiac function indexes.

[0087] In the index acquisition process by the medical image analysis device 20, the apical four-chamber moving image to be analyzed is, for example, an ultrasound moving image or a cine magnetic resonance moving image. When the apical four-chamber moving image is an ultrasound moving image, the medical image diagnostic device 5 corresponds to a conventional ultrasound diagnostic device. At this time, the communication interface 31 outputs the apical four-chamber moving image input from the conventional ultrasound diagnostic device to the processing circuit 37. Also, when the apical four-chamber moving image is a cine magnetic resonance moving image, the medical image diagnostic device 5 corresponds to a conventional magnetic resonance imaging device. At this time, the communication interface 31 outputs the cine magnetic resonance moving image input from the magnetic resonance imaging device to the processing circuit 37.

[0088] When the apical four-chamber moving image input from the medical image diagnostic device 5 is volume data, the image processing circuit 21 detects the apical four-chamber cross section in the volume data by a known region detection process. Next, the image processing circuit 21 executes MPR processing based on the volume data and the detected apical four-chamber cross section to generate a two-dimensional apical four-chamber moving image (MPR moving image) corresponding to the apical four-chamber cross section. The image processing circuit 21 outputs the two-dimensional apical four-chamber moving image to the processing circuit 37.

[0089] The processing procedure and effects of the index acquisition process in the second embodiment are similar to those in the first embodiment, and therefore the description will be omitted. In addition, various functions executed in the medical image analysis layer may be mounted on a magnetic resonance imaging device. In addition, as a modified example of the second embodiment, the medical image analysis device 20 may be realized by a workstation or cloud computing. In this case, the input interface 13 and the display 15 may be connected to a network as, for example, a client device. In addition, the communication interface 31, the memory 33, and the processing circuit 87 may be mounted on a server on the network.

[0090] When the technical ideas in the various embodiments and the various modified examples are realized by a medical image analysis program, the medical image analysis program causes a computer to simultaneously acquire multiple cardiac function indices related to at least two or more chambers including the left ventricle and the right ventricle among the multiple cardiac chambers in the apical four-chamber moving image of the subject P including one or more heartbeats using the boundary positions of the multiple cardiac chambers in the apical four-chamber moving image of the subject P, and display at least one or more of the multiple cardiac function indices on the display 15. For example, the index acquisition process can also be realized by installing the image analysis program in a computer in a PACS server or integrated server in a hospital information system, an ultrasound diagnostic device 1, or the like, and expanding them on a memory. At this time, the program capable of causing a computer to execute the method can also be stored in a storage medium such as a magnetic disk (hard disk, etc.), an optical disk (CD-ROM, DVD, etc.), or a semiconductor memory and distributed. The processing procedure and effects of the medical image analysis program are the same as those of the embodiments, and therefore will not be described.

[0091] According to at least one of the embodiments and modified examples described above, the relationship between the left and right sides of the heart and the relationship between the atrioventricular chambers can be grasped with simple operations and using an inexpensive device.

[0092] Although several embodiments have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other forms, and various omissions, substitutions, modifications, and combinations of embodiments can be made without departing from the spirit of the invention. These embodiments and their modifications are included in the scope of the invention and its equivalents as described in the claims, as well as in the scope and spirit of the invention.

[0093] Regarding the above-described embodiments, the following supplementary notes are disclosed as one aspect and optional features of the invention. (Appendix 1) an index acquiring unit that simultaneously acquires a plurality of cardiac function indexes related to at least two or more chambers including the left ventricle and the right ventricle among the plurality of cardiac chambers in the apical four-chamber moving image of the subject using boundary positions of the plurality of cardiac chambers in the apical four-chamber moving image including one or more heartbeats; A display unit that displays at least one of the multiple cardiac function indexes; An ultrasound diagnostic device comprising: (Appendix 2) The index acquisition unit may simultaneously acquire the plurality of cardiac function indexes related to the four chambers in the apical four-chamber moving image. (Appendix 3) The display unit may simultaneously display the cardiac function indices relating to the cardiac chambers. (Appendix 4) The apical four-chamber moving image may be an ultrasound moving image. (Appendix 5) a boundary detection unit that automatically detects a group of boundary positions indicating boundary positions for the plurality of cardiac chambers in at least one cardiac phase based on the apical four-chamber motion image; a tracking unit that tracks the group of boundary positions in the apical four-chamber moving image of a remaining cardiac phase different from a cardiac phase related to the automatic detection of the group of boundary positions; a boundary position acquiring unit that acquires boundary positions of the plurality of cardiac chambers over at least one or more heartbeat intervals by tracking the group of boundary positions; The device may further include: (Appendix 6) The cardiac function index may include lumen volume and volume change rate for the left ventricle, left atrium and right atrium, and may include lumen area and area change rate for the right ventricle. (Appendix 7) The cardiac function index may include a global longitudinal strain (GLS) of the entire wall for the left ventricle, left atrium and right atrium among the multiple heart chambers, and may include a GLS of the free wall for the right ventricle among the multiple heart chambers. (Appendix 8) The cardiac function index may include a left atrial volume index for the left atrium, and may include a systolic tricuspid annular movement distance for the right ventricle. (Appendix 9) The display unit may display a cardiac chamber whose boundary position is automatically detected from the apical four-chamber moving image. (Appendix 10) The output of the cardiac function index may be a graph showing a time-varying curve of the cardiac function index, The display unit may display the plurality of graphs corresponding to the plurality of cardiac chambers to be displayed with the same display size of the time axis. (Appendix 11) The output of the cardiac function index may be a graph showing a time-varying curve of the cardiac function index, The display unit may display graphical output for two or more cardiac cycles when the multiple cardiac chambers to be displayed include a ventricle and an atrium. (Appendix 12) The index acquisition unit may acquire at least one of a peak time difference between index values ​​related to cardiac function of the multiple heart chambers or a difference in peak values ​​of the index values ​​during the same heart beat as an associated index indicating an index of cardiac function related to the multiple heart chambers. (Appendix 13) The index acquiring unit may output an average value of the associated index over a plurality of heartbeats by using the boundary position in the apical four-chamber moving image acquired in real time. (Appendix 14) The apical four-chamber moving image may be a reformatted moving image extracted from volumetric moving image data including the subject's heart. (Appendix 15) an index acquiring unit that simultaneously acquires a plurality of cardiac function indexes related to at least two or more chambers including the left ventricle and the right ventricle among the plurality of cardiac chambers in the apical four-chamber moving image of the subject using boundary positions of the plurality of cardiac chambers in the apical four-chamber moving image including one or more heartbeats; A display unit that displays at least one of the multiple cardiac function indexes; A medical image analysis device comprising: (Appendix 16) The apical four-chamber motion image may be an ultrasound motion image or a cine magnetic resonance motion image. (Appendix 17) On the computer, using boundary positions of a plurality of cardiac chambers in an apical four-chamber moving image of a subject including one or more heartbeats, simultaneously acquiring a plurality of cardiac function indices related to at least two of the plurality of cardiac chambers in the apical four-chamber moving image, the at least two including the left ventricle and the right ventricle; displaying at least one of the plurality of cardiac function indexes on a display; A medical image analysis program that makes this possible. [Explanation of symbols]

[0094] 1. Ultrasound diagnostic equipment 11 Ultrasound probe 13 Input Interface 15 Display 17 Electrocardiograph 19. Device body 20 Medical image analysis equipment 21 Image processing circuit 23 Transmitting and receiving circuit 25 B-mode data generation circuit 27 Doppler data generation circuit 29 Image Generation Circuit 31 Communication Interface 33 Memory 35 Control circuit 37 Processing circuit 371 Boundary detection function 373 Tracking Function 375 Boundary position acquisition function 377 Index acquisition function

Claims

[Claim 1] an index acquiring unit that simultaneously acquires a plurality of cardiac function indexes related to at least two or more of the plurality of cardiac chambers in the apical four-chamber moving image of the subject, the at least two of the plurality of cardiac chambers in the apical four-chamber moving image including one or more heartbeats, the at least two of the plurality of cardiac chambers in the apical four-chamber moving image including the left ventricle and the right ventricle; A display unit that displays at least one of the plurality of cardiac function indexes; An ultrasound diagnostic device comprising:

Images