Image processing device and X-ray diagnostic device

Abstract

To provide an image processing device capable of grasping a measurement position of a physiological index on a blood vessel image, a medical image diagnostic device and a blood pressure monitor.SOLUTION: An image processing device according to an embodiment includes an identification part and a display control part. The identification part identifies an acquisition position of an index about blood flow on an image including blood vessels collected by a medical image diagnostic device. The display control part displays the acquisition position on the image including the blood vessels, and displays the index on the display part in association with the acquisition position.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The embodiment of the present invention is an image processing device. and X-ray diagnostic equipment Regarding. [Background technology]

[0002] In recent years, the diagnosis of coronary stenosis is performed from both the viewpoints of "anatomical evaluation" that morphologically evaluates the presence or absence of stenosis and the degree of stenosis, and "physiological evaluation" that objectively evaluates the presence or absence of myocardial ischemia and the degree of myocardial ischemia. In addition, as physiological indices used in "physiological evaluation", FFR (Fractional Flow Reserve) and CFR (Coronary Flow Reserve) have been attracting attention. For example, FFR is an index that indicates the degree of myocardial ischemia caused by coronary artery stenosis, and is expressed as the ratio of the maximum coronary blood flow in the presence of stenosis to the maximum coronary blood flow in the absence of stenosis. In addition, CFR is an index that indicates the ability to increase coronary blood flow in response to an increase in oxygen demand in the myocardium, and is expressed as the ratio of coronary blood flow at rest to that at maximum reactive hyperemia.

[0003] Conventionally, these physiological indices are calculated by a specific measuring device. For example, the measuring device has a guide wire with a pressure sensor (pressure wire) and calculates the FFR by measuring the internal pressure of the coronary artery. Also, for example, the measuring device has a guide wire (Doppler wire) with an ultrasound probe attached to its tip and calculates the CFR by measuring the blood flow velocity of the coronary artery with the ultrasound probe. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Special Publication No. 2010-526556 [Patent Document 2] Special Publication No. 2004-528920 [Patent Document 3] Special Publication No. 2003-525067 [Patent Document 4] JP 2011-156321 A Summary of the Invention [Problem to be solved by the invention]

[0005] An object of the present invention is to provide an image processing device capable of grasping the measurement position of a physiological index on a blood vessel image. [Means for solving the problem]

[0006] The image processing device according to the embodiment includes an identification unit and a display control unit. The identification unit identifies an acquisition position of an index related to blood flow on an image including blood vessels collected by a medical image diagnostic device. The display control unit displays the acquisition position on the image including the blood vessels and causes the display unit to display the index in association with the acquisition position. [Brief description of the drawings]

[0007] [Figure 1] FIG. 1 is a diagram showing an overview of the first embodiment. [Diagram 2] FIG. 2 is a block diagram showing the overall configuration of the X-ray diagnostic apparatus according to the first embodiment. [Diagram 3] FIG. 3 is a diagram showing the arrangements of an X-ray diagnostic apparatus, a measurement apparatus, and an ECG (Electrocardiogram) measurement apparatus according to the first embodiment. [Figure 4] FIG. 4 is a diagram for explaining generation of a display image in the first embodiment. [Diagram 5] FIG. 5 is a diagram showing a display example in the first embodiment. [Figure 6] FIG. 6 is a diagram showing another display example in the first embodiment. [Figure 7] FIG. 7 is a diagram showing another display example in the first embodiment. [Figure 8] FIG. 8 is a diagram for explaining generation of a display image in the second embodiment. [Figure 9]FIG. 9 is a diagram for explaining generation of a display image in the third embodiment. [Figure 10] FIG. 10 is a diagram showing a display example in the third embodiment. [Figure 11] FIG. 11 is a diagram showing another display example in the third embodiment. [Figure 12] FIG. 12 is a diagram showing the arrangement of an X-ray diagnostic apparatus according to this embodiment. [Figure 13] FIG. 13 is a diagram showing the external appearance of the gantry unit shown in FIG. [Figure 14] FIG. 14 is a diagram showing a schematic diagram of a series of operations from DA image acquisition to completion of guidewire withdrawal in this embodiment. [Figure 15] 15 is a flowchart showing the processing procedure from catheter insertion to reference image selection in FIG. 14. [Figure 16] 16 is a diagram showing an example of a reference image selected in step S14 of FIG. 15. [Figure 17] 17 is a flowchart showing a processing procedure during a guidewire withdrawal period in FIG. 14. [Figure 18] FIG. 18 is an explanatory diagram of step S35 in FIG. [Figure 19] FIG. 19 is an explanatory diagram of step S36 in FIG. [Figure 20] FIG. 20 is an explanatory diagram of step S37 in FIG. [Figure 21] FIG. 21 is an explanatory diagram of the loop operation of steps S31-S38 in FIG. [Figure 22] 22 is a diagram showing an example of a display screen of the display in step S38 of FIG. 17. [Figure 23] 23 is a diagram showing an example of a display screen in which numerical values ​​of FFR values ​​are superimposed on a reference image instead of the mark string on the display screen of FIG. 22. [Figure 24] 24 is a diagram showing an example of a display screen switched from the display screen of FIG. 22, in which a mark string is superimposed on a perspective image. [Diagram 25] 25 is a diagram showing an example of a display screen in which numerical values ​​of FFR values ​​are superimposed on a fluoroscopic image instead of the mark string on the display screen of FIG. 22. [Figure 26] FIG. 26 is a side view of the guidewire. [Figure 27] FIG. 27 is a block diagram showing the configuration of an X-ray diagnostic apparatus according to the fourth embodiment. [Figure 28] FIG. 28 is a diagram showing a display example in the fourth embodiment. [Figure 29] FIG. 29 is a diagram showing the arrangements of an X-ray diagnostic apparatus, a measurement apparatus, and an ECG measurement apparatus according to a fifth embodiment. [Diagram 30] FIG. 30 is a diagram for explaining prediction of improvement in myocardial ischemia in the fifth embodiment. [Diagram 31] FIG. 31 is a diagram showing a display example in the fifth embodiment. [Diagram 32] FIG. 32 is a diagram showing an example of generation and display of a display image in another embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] Hereinafter, an image processing apparatus, a medical image diagnostic apparatus, and a blood pressure monitor according to the embodiments will be described with reference to the drawings. In the first to fifth embodiments, an X-ray diagnostic apparatus 100 will be described.

[0009] (First embodiment) FIG. 1 is a diagram showing an overview of the first embodiment. As shown in FIG. 1, in the first embodiment, while an X-ray diagnostic apparatus 100 collects an image including blood vessels of a subject P, a measurement apparatus 200 measures FFR, CFR, iFR (instant wave-free ratio), IMR (index of microcirculatory resistance), and the like. For example, an operator inserts a pressure sensor-equipped guide wire of the measurement apparatus 200 into a coronary artery of the subject P while viewing an image including blood vessels collected by the X-ray diagnostic apparatus 100, and measures intravascular pressure. In addition, the operator measures intravascular pressure at multiple positions in the coronary artery while appropriately moving the pressure sensor-equipped guide wire. Note that an image including blood vessels (hereinafter, referred to as a blood vessel image) refers to an image captured of blood vessels such as a coronary artery, and includes X-ray images collected under contrast and X-ray images collected without contrast. Also, for example, when collected by the X-ray diagnostic apparatus 100 under contrast, it means a contrast X-ray image, and when collected by the X-ray diagnostic apparatus 100 without contrast, it means a non-contrast X-ray image.

[0010] 1, the X-ray diagnostic device 100 stores a group of time-series blood vessel images collected during measurement of intravascular pressure in a storage unit. Meanwhile, the measurement device 200 calculates FFR, CFR, and the like based on the measurement data of the intravascular pressure. Then, the X-ray diagnostic device 100 associates the group of time-series blood vessel images collected during measurement of the intravascular pressure with the measurement data measured by the measurement device 200.

[0011] Specifically, the time series of blood vessel images collected by the X-ray diagnostic device 100 includes time information when each blood vessel image was captured. Meanwhile, the measurement data of intravascular pressure also includes time information when each measurement data was measured. Therefore, the X-ray diagnostic device 100 associates the blood vessel images with the measurement data using this time information, and extracts the blood vessel images corresponding to the time phase when the measurement data was measured from the blood vessel images. Then, the X-ray diagnostic device 100 identifies the tip of the guidewire by image analysis of the extracted blood vessel images, thereby identifying the measurement position of each measurement data, and displays an index calculated from the measurement data in association with the identified measurement position on the blood vessel image.

[0012] FIG. 2 is a block diagram showing the overall configuration of an X-ray diagnostic apparatus 100 according to the first embodiment. The X-ray diagnostic apparatus 100 according to the first embodiment is a medical image diagnostic apparatus that supports intravascular treatment using a catheter or the like while performing angiography, and the function of performing imaging processing can be realized using existing publicly known technology. As shown in FIG. 2, the X-ray diagnostic apparatus 100 includes a gantry unit 10 and a computer system 20. Also, as shown in FIG. 2, the gantry unit 10 includes a bed 11, a gantry 12, a C-arm 13, an X-ray source 14, an X-ray detector 15, and a display unit 16.

[0013] The bed 11 is movable in the vertical and horizontal directions, and a subject P is placed on it. The gantry 12 supports a C-arm 13. The C-arm 13 is rotatable in the direction of arrow R around the Z axis, and holds an X-ray source 14 and an X-ray detector 15 facing each other. The X-ray source 14 has an X-ray tube that irradiates X-rays, and a collimator. The X-ray detector 15 detects the X-rays that are irradiated from the X-ray source 14 and have passed through the subject P. The display unit 16 displays X-ray images generated by the computer system 20, etc.

[0014] The computer system 20 includes an input unit 21, an X-ray image storage unit 22, a control unit 23, an X-ray image capturing unit 24, a C-arm control unit 25, and an X-ray image generating unit 26.

[0015] The input unit 21 is a control panel, a foot switch, etc., and receives various operation inputs for the X-ray diagnostic apparatus 100 from an operator. The X-ray image storage unit 22 stores X-ray image data. The control unit 23 performs overall control of the X-ray diagnostic apparatus 100. The X-ray image capturing unit 24 controls the X-ray source 14, the X-ray detector 15, and the C-arm control unit 25 to collect X-ray images. The X-ray image capturing unit 24 also sends the collected X-ray images to the X-ray image generating unit 26. The C-arm control unit 25 controls the rotation of the C-arm 13 under the control of the X-ray image capturing unit 24. The X-ray image generating unit 26 generates X-ray images.

[0016] Fig. 3 is a diagram showing the configuration of an X-ray diagnostic apparatus 100, a measuring apparatus 200, and an ECG measuring apparatus 300 according to the first embodiment. Fig. 3 shows in detail a part of the configuration of the X-ray diagnostic apparatus 100 shown in Fig. 2 (a configuration for analyzing measurement data and X-ray images and displaying images and character strings), and the same units are given the same reference numerals and description thereof is omitted. Also, among the units included in the X-ray diagnostic apparatus 100 in Fig. 3, the units other than the display unit 16, the input unit 21, the X-ray image storage unit 22, and the X-ray image capturing unit 24 may be included in the control unit 23 shown in Fig. 2, etc.

[0017] The measuring device 200 and the ECG measuring device 300 can be realized by using existing known technology. First, the measuring device 200 measures intravascular pressure, etc., calculates FFR and CFR based on the measurement data obtained by the measurement, and transmits the calculated FFR and CFR to the X-ray diagnostic device 100 each time. Specifically, the intravascular pressure measuring unit 210 measures intravascular pressure, etc., and transmits the measurement data to the physiological index calculating unit 211. The physiological index calculating unit 211 calculates FFR and CFR based on the measurement data, and transmits the calculated FFR and CFR to the physiological index transmitting unit 212. The physiological index transmitting unit 212 transmits the FFR and CFR to the X-ray diagnostic device 100. In addition to the FFR and CFR, the physiological index transmitting unit 212 may transmit the measurement data itself measured by the intravascular pressure measuring unit 210 to the X-ray diagnostic device 100.

[0018] Furthermore, the ECG measurement device 300 measures an ECG and transmits the measured ECG to the X-ray diagnostic apparatus 100 each time. Specifically, the ECG measurement unit 310 measures an ECG and transmits the measured ECG to the ECG transmission unit 311. The ECG transmission unit 311 transmits the ECG to the X-ray diagnostic apparatus 100.

[0019] The X-ray diagnostic apparatus 100 associates a group of time-series X-ray images taken while measuring the measurement data with the measurement data, identifies the measurement position of the measurement data on the X-ray image, and displays the X-ray image indicating the measurement position on the display unit 16.

[0020] Specifically, the physiological index receiving unit 110 receives FFR and CFR from the measuring device 200 and stores them in the physiological index storage unit 111. The ECG receiving unit 112 receives ECG from the ECG measuring device 300 and stores them in the ECG storage unit 113. The time management unit 114 manages the correct time in the X-ray diagnostic device 100, and stores the communication time and shooting time in the communication / shooting time storage unit 115 every time communication is performed with the measuring device 200 or the ECG measuring device 300, or every time the X-ray image capturing unit 24 captures an X-ray image.

[0021] In the first embodiment, it is assumed that the X-ray diagnostic apparatus 100, the measuring apparatus 200, and the ECG measuring apparatus 300 are in a state in which the time is correctly set. Therefore, the X-ray diagnostic apparatus 100 synchronizes in time between various information received from the measuring apparatus 200 and the ECG measuring apparatus 300 and the X-ray image captured by the X-ray diagnostic apparatus 100 according to the time managed by the time management unit 114. However, the embodiment is not limited to this, and for example, the X-ray diagnostic apparatus 100 may transmit a time synchronization signal to the measuring apparatus 200 and the ECG measuring apparatus 300 to achieve the time synchronization.

[0022] Next, the specification unit 120 and the display control unit 130 will be described with reference to Fig. 4. Fig. 4 is a diagram for explaining generation of a display image in the first embodiment.

[0023] The identification unit 120 identifies the acquisition position of the index related to blood flow on the image including the blood vessel collected by the medical image diagnostic device. Specifically, the identification unit 120 identifies the measurement position of the measurement data on the X-ray image collected by the X-ray diagnostic device 100. More specifically, the measurement time image extraction unit 121 extracts the X-ray image (measurement time image) corresponding to the time phase at which the measurement data was measured from the time series X-ray images captured by the X-ray image capturing unit 24 and stored in the X-ray image storage unit 22. For example, the measurement time image extraction unit 121 associates these pieces of information collected at any time with each other using time information corresponding to the FFR or CFR received from the measurement device 200, time information corresponding to the ECG received from the ECG measurement device 300, and time information corresponding to the X-ray image. This allows the time synchronization of the information collected by different devices. Then, the measurement time image extraction unit 121 extracts an X-ray image having time information that is approximately the same as the time information corresponding to the FFR or CFR as an X-ray image corresponding to the time phase at which the measurement data was measured, and sends the extracted X-ray image to the intravascular pressure measurement position identification unit 122.

[0024] The intravascular pressure measurement position identifying unit 122 identifies the measurement position of the measurement data on the X-ray image (measurement time image) extracted by the measurement time image extracting unit 121. For example, the intravascular pressure measurement position identifying unit 122 identifies the measurement position by performing image analysis on the X-ray image extracted by the measurement time image extracting unit 121 and identifying the tip of the guide wire used for the measurement.

[0025] The tip of the guidewire can be identified using existing known techniques. For example, the intravascular pressure measurement position identifying unit 122 performs enhancement processing on the X-ray image to clarify the image of the guidewire. For example, the intravascular pressure measurement position identifying unit 122 performs nonlinear luminance conversion to reduce uneven density of the X-ray image, and then performs image filtering processing to extract components with high spatial frequencies. This image filtering processing removes global and smooth gradation and leaves only local and fine fluctuation components. Next, the intravascular pressure measurement position identifying unit 122 performs pattern extraction processing on the X-ray image to identify the image of the guidewire. For example, the intravascular pressure measurement position identifying unit 122 performs threshold processing and spatial filtering processing on pixel values. Then, the intravascular pressure measurement position identifying unit 122 extracts the image of the guidewire from the X-ray image, obtains a two-dimensional curve showing the shape of the image of the guidewire in the X-ray image, and extracts the tip coordinates of the guidewire located at the end of the two-dimensional curve based on the coordinate values ​​of each point of the two-dimensional curve.

[0026] The display control unit 130 displays the acquisition position on the image including the blood vessel, and displays an index on the display unit in association with the acquisition position. For example, the display control unit 130 displays the measurement position on the X-ray image, and displays the FFR and CFR in association with the measurement position. First, the cardiac cycle contrast image group extraction unit 141 of the periodic image processing unit 140 extracts a contrast image group (still image group) for one cardiac cycle in which the entire coronary artery is well contrasted from the time-series X-ray image group stored in the X-ray image storage unit 22, as shown in FIG. 4. For example, the cardiac cycle contrast image group extraction unit 141 compares the luminance value distribution of each X-ray image, and determines that the X-ray image group with a low luminance value is a contrast image group in which the coronary artery is well contrasted.

[0027] 4, the coronary artery branch identifying unit 142 extracts a coronary artery region from each contrast image of the contrast image group extracted by the cardiac cycle contrast image group extracting unit 141, and identifies the coronary artery branch. For example, the coronary artery branch identifying unit 142 extracts a coronary artery region from each contrast image and identifies the coronary artery branch based on the imaging conditions such as the angle of the C-arm 13, the pixel brightness value, its continuity, the blood vessel shape, the amount of change between contrast images of adjacent time phases, and the like. Note that the identification of the coronary artery branch can be realized using existing publicly known technology.

[0028] The stenosis portion identifying unit 143 identifies a stenosis portion within the coronary artery region extracted by the coronary artery branch identifying unit 142. For example, the stenosis portion identifying unit 143 identifies a stenosis portion based on the continuity of the blood vessel structure, in particular, on a change in blood vessel diameter. The identification of the stenosis portion can be realized using existing publicly known technology.

[0029] The inter-phase coronary artery branch / stenosis site mapping unit 144 associates the stenosis site identified in each contrast image of a group of contrast images corresponding to one cardiac cycle between different phases. This makes it possible to track the time-series displacement of the stenosis site on the X-ray image. For example, the inter-phase coronary artery branch / stenosis site mapping unit 144 calculates a warp field between contrast images. Warp field is a known image processing technique for performing nonlinear registration. For example, the inter-phase coronary artery branch / stenosis site mapping unit 144 extracts feature amounts from each contrast image and associates the extracted feature amounts between different phases to calculate a collection of three-dimensional vectors indicating the amount of pixel movement.

[0030] As shown in FIG. 4, the measurement data / stenosis site mapping unit 145 associates the measurement data with the stenosis site identified on the contrast image (periodic image) based on the measurement position identified on the X-ray image (measurement time image) by the intravascular pressure measurement position identifying unit 122. For example, the measurement data / stenosis site mapping unit 145 identifies a contrast image (periodic image) whose time phase coincides with the measurement time image from among a group of contrast images for one cardiac cycle using an ECG. Then, based on the measurement position identified on the X-ray image (measurement time image), the measurement data / stenosis site mapping unit 145 associates the FFR or CFR calculated from the measurement data measured at this measurement position with the stenosis site on the contrast image (periodic image) close to this measurement position. This allows the FFR or CFR to be displayed on each X-ray image included in the group of time-series X-ray images.

[0031] Meanwhile, the cardiac cycle corresponding image specifying unit 151 of the display image processing unit 150 specifies, using the ECG, which phase in one cardiac cycle the display image selected by the display image selecting unit 116 corresponds to. The display image selecting unit 116 may, for example, accept an instruction from the operator via the input unit 21 to appropriately select a display image from among the time-series X-ray images stored in the X-ray image storage unit 22. For example, in the first embodiment, the display image selecting unit 116 displays a selection menu (for example, "Patient List", "Examination List") of X-ray images stored in the X-ray image storage unit 22, accepts an instruction from the operator via the input unit 21, and selects a single contrast image (still image) as the display image.

[0032] The coronary artery branch identifying unit 152 extracts a coronary artery region from the contrast image of the time phase identified by the cardiac cycle corresponding image identifying unit 151 among the contrast image group extracted by the cardiac cycle contrast image group extracting unit 141, by a method similar to that of the coronary artery branch identifying unit 142, and identifies the coronary artery branch. The stenosis site identifying unit 153 identifies a stenosis site within the coronary artery region extracted by the coronary artery branch identifying unit 152, by a method similar to that of the stenosis site identifying unit 143.

[0033] As shown in Fig. 4, the display image mapping unit 154 associates the measurement positions identified on the contrast image (periodic image) with the display image. For example, the display image mapping unit 154 uses the WarpField calculated by the inter-phase coronary artery branch / stenosis site mapping unit 144 to identify (align) a position to which the measurement position identified on the contrast image (periodic image) has moved in the phase of the display image by a three-dimensional vector. Then, the display image mapping unit 154 identifies, on one display image, a plurality of measurement positions identified on contrast images of different phases. That is, the display image mapping unit 154 uses the WarpField to identify a position to which each measurement position has moved in the phase of the display image, thereby correcting a deviation between the single contrast image selected as the display image and each contrast image in which each measurement position has been identified.

[0034] The display image generating unit 155 generates a display image and displays it on the display unit 16. FIG. 5 is a diagram showing a display example in the first embodiment. As shown in FIG. 5, in the first embodiment, the display image generating unit 155 displays the measurement position of the measurement data on an X-ray image (still image) of a predetermined time phase, and displays a physiological evaluation index (e.g., FFR or CFR) calculated from the measurement data in association with the measurement position. The display image generating unit 155 further displays the stenosis rate in association with each stenosis site, thereby displaying the anatomical evaluation index and the physiological evaluation index on the same X-ray image. The display image generating unit 155 further displays information on the necessity of treatment (e.g., no treatment required, treatment required) as shown in FIG. 5. Note that the mark indicating the stenosis site (white circle in FIG. 5) may be displayed in a different color depending on, for example, the necessity of treatment, the stenosis rate, etc. Also, the character string and the frame surrounding the character string may be displayed in a different color depending on, for example, the necessity of treatment, the FFR or CFR value. For example, when a caution is required, the color may be displayed in red.

[0035] The treatment necessity criterion setting unit 117 sets a criterion for determining whether or not treatment is necessary. For example, the treatment necessity criterion setting unit 117 sets a criterion that "when any of the following conditions is satisfied: FFR<0.75, or CFR≦2.00, or stenosis rate≧50%, it is determined that 'treatment is necessary.'" The treatment necessity determination unit 118 determines whether or not treatment is necessary based on the criterion set by the treatment necessity criterion setting unit 117. The determination result by the treatment necessity determination unit 118 is sent to the display image generation unit 155.

[0036] Fig. 6 is a diagram showing another display example in the first embodiment. As shown in Fig. 6, in the first embodiment, the display image generating unit 155 may not only display various indices around the stenotic portion (display of various indices is omitted in Fig. 6), but may also display the blood vessel itself in color or shade depending on the measurement value such as the intravascular pressure. For convenience, Fig. 6 shows shades of color, but for example, it may be displayed in shades of "red" and "yellow" depending on the measurement value.

[0037] FIG. 7 is a diagram showing another display example in the first embodiment. As shown in FIG. 7, in the first embodiment, the display image generating unit 155 may display a tool for manually adjusting the result of automatic processing. That is, as described above, in the first embodiment, the stenosis part, the measurement position of the measurement data, and the like are automatically specified and displayed on the X-ray image, but there is a possibility that the result may not be displayed as expected. For such a case, the display image generating unit 155 displays a UI (User Interface) as shown in FIG. 7. For example, this UI extracts a vascular center line from the coronary artery branch specified by the coronary artery branch specifying unit 142, and displays the extracted vascular center line. The display image generating unit 155 accepts a sliding operation of a bar a indicating a measurement position and a mark b indicating a stenosis part on this vascular center line. That is, since both the measurement position and the stenosis part should exist on the vascular center line (a deviation from the center line within the vascular diameter is ignored), the display image generating unit 155 may provide a UI that allows sliding only on the vascular center line.

[0038] As described above, according to the first embodiment, the measurement position of the measurement data is displayed on the blood vessel image, so that the measurement position of the physiological index can be grasped on the blood vessel image. In this way, according to the first embodiment, the physiological evaluation result is displayed in association with the anatomical evaluation result. As a result, the operator can easily grasp, for example, at which position in the coronary artery the physiological evaluation index was obtained, which is effective not only in the case of a normal lesion but also in the case of a continuous lesion or a multi-vessel lesion.

[0039] Thus, according to the first embodiment, it is possible to display a physiological evaluation index linked to the position of stenosis in an X-ray image taken in real time during PCI (Percutaneous Coronary Intervention) or a past image stored in a workstation or the like. In addition, the values ​​of intravascular pressure and blood flow velocity measured to calculate the physiological evaluation index can also be displayed at the measured position. As a result, it is possible to evaluate the inducibility of myocardial ischemia due to coronary artery stenosis from both anatomical and physiological viewpoints on a single image, and it is also possible to perform a procedure while displaying the necessity of treatment and the treatment status during PCI. In addition, when a physiological evaluation value is displayed on a past examination image, it is possible to quantitatively compare the current status with the physiological status.

[0040] Second Embodiment In the second embodiment, a group of time-series X-ray images (moving images) captured in real time is assumed as the display image. Fig. 8 is a diagram for explaining the generation of the display image in the second embodiment. In this case, the display control unit 130 uses ECG to synchronize the group of contrast images (periodic images) with the group of display images in time, and displays the stenosis site identified on the contrast images (periodic images) and indices such as FFR and CFR at the correct positions on the display images.

[0041] Specifically, the cardiac cycle corresponding image specifying unit 151 of the display image processing unit 150 specifies, using the ECG, which phase in one cardiac cycle each display image included in the time series display image group corresponds to. Also, the display image mapping unit 154 associates the measurement position specified on the contrast image (periodic image) with each display image included in the time series display image group, as shown in FIG. 8. For example, the display image mapping unit 154 specifies (aligns) by a three-dimensional vector, to which position the measurement position specified on the contrast image (periodic image) has moved in the time phase of each display image, using the WarpField calculated by the inter-phase coronary artery branch / stenosis site mapping unit 144. Then, the display image mapping unit 154 specifies, on each display image, a plurality of measurement positions specified on the contrast images of different phases. In addition, when displaying the display image sequentially while measuring the measurement data, the display control unit 130 may first display one measurement position on the display image, and gradually display two measurement positions, then three measurement positions.

[0042] (Third embodiment) In the third embodiment, the display images are assumed to be time-series X-ray images (moving images) captured in real time and non-contrast images. FIG. 9 is a diagram for explaining the generation of the display images in the third embodiment. In this case, since the display images are non-contrast images, the vascular structure of the coronary artery is not displayed on the display images. For this reason, the display control unit 130 extracts structural information such as vascular contours from the contrast image (periodic image) group, and displays the extracted structural information superimposed on the display image group, which is a non-contrast image. Note that the display control unit 130 uses ECG to temporally synchronize the contrast image (periodic image) group and the display image group, and therefore can also temporally synchronize the structural information and the display images, and the displacement and deformation of the blood vessels are also reflected in the structural information.

[0043] Fig. 10 is a diagram showing a display example in the third embodiment. As shown in Fig. 10, in the third embodiment, the display control unit 130 displays physiological evaluation indexes, stenosis rate, necessity of treatment, etc. in association with measurement positions of measurement data on a non-contrast display image on which structural information such as vascular contours is superimposed.

[0044] Moreover, Fig. 11 is a diagram showing another display example in the third embodiment. As shown in Fig. 11, in the third embodiment, the display control unit 130 may not only display various indices around the stenosis on a non-contrast display image (display of various indices is omitted in Fig. 11), but may also display the blood vessel itself in color or shade in real time according to a measurement value such as an intravascular pressure.

[0045] Here, one use case of the X-ray diagnostic apparatus 100 as a medical image diagnostic apparatus according to the present application will be described. As described above, various indices are used as indices relating to blood flow, and these indices are used, for example, for early detection of vascular stenosis in a myocardial region that may cause myocardial infarction. As one example, the presence or absence of a vascular stenosis is determined from an evaluation of the reduction in blood flow caused by the stenosis, and when the value of FFR (hereinafter referred to as FFR value) is equal to or less than a reference value, the position is determined to be a stenosis.

[0046] Until now, the presence or absence of a vascular stenosis was judged by an operator operating the guidewire while looking at a display that displayed in real time X-ray images (e.g., X-ray fluoroscopic images) of a subject with a guidewire equipped with a pressure sensor inserted into the blood vessel, collected by an X-ray diagnostic device, and at the same time, looking at a display that displayed the FFR value calculated from the pressure value of the subject measured by the pressure sensor. However, since the FFR value and the blood vessel location where the pressure used to calculate the FFR value were measured were not associated, even if the operator judged the stenosis to be a stenosis from the FFR value, it was difficult to intuitively understand where in the blood vessel it was.

[0047] Therefore, by applying the technology of the present application to such a case, the spatial visibility of the index useful for diagnosing vascular stenosis is improved. Hereinafter, the X-ray diagnostic device 100 according to this use case will be described with reference to Figs. 12 to 26. Note that an index useful for diagnosing vascular stenosis is an index representing blood flow volume, and here, the FFR value will be described as a specific example. The FFR value is given as a ratio of pressure at an arbitrary point in a blood vessel to be diagnosed to pressure (blood flow pressure) at a point in the aorta. The pressure is measured by a pressure sensor 210a attached near the tip of the guidewire. Here, in this use case, the guidewire is inserted into the blood vessel under non-contrast fluoroscopic imaging. The fluoroscopic images are repeatedly collected at a fixed period such as 1 / 30 sec under continuous X-rays under fluoroscopic X-ray conditions (relatively low dose). An X-ray image captured under the fluoroscopic imaging by pulsed X-rays under X-ray imaging conditions (relatively high dose) triggered by an operator is called a captured image. The captured images collected while highlighting blood vessels with a contrast agent are the contrast images described above, and include, for example, DA images (digital angiography images) and DSA (digital subtraction angiography) images, which take the difference between DA images before and after the injection of a contrast agent to make blood vessels more visible.

[0048] As shown in FIG. 12, the X-ray diagnostic apparatus 100a includes a gantry unit 10a and a computer system 20a. As shown in FIG. 13, the gantry unit 10a has a C-arm 13a supported by a gantry 12a. The gantry unit 10a also has a C-arm control unit 25a, an X-ray source 14a, an X-ray detector 15a, and a high voltage generating unit 17a. The gantry unit 10a is also called a gantry unit. The computer system 20a is also called a system body. The gantry unit 12a is also called a C-arm support mechanism. The C-arm 13a is also called a C-arm. The C-arm control unit 25a is also called a rotation drive unit. The X-ray source 14a is also called an X-ray tube device. The X-ray detector 15a is also called an X-ray detection unit.

[0049] The computer system 20a includes an input unit 21a, a control unit 23a, an X-ray image capturing unit 24a, an X-ray image generating unit 26a, and an image processing device 30. The input unit 21a is also called an operation unit. The control unit 23a is also called a system control unit. The X-ray image capturing unit 24a is also called an imaging control unit. The X-ray image generating unit 26a is also called an image generating unit. The image processing device 30 includes an X-ray image storage unit 22a, an FFR value storage unit 111a, an FFR value input unit 110a, an image processing control unit 31, a position identification unit 120a, an FFR value selection unit 32, a mark generating unit 33, a display control unit 130a, and a display unit 16a. An external FFR value measurement device 200a is connected to the computer system 20a via the FFR value input unit 110a.

[0050] The FFR value storage unit 111a is an example of the above-mentioned physiological index storage unit 111. The FFR value input unit 110a is an example of the above-mentioned physiological index receiving unit 110. The position identifying unit 120a is an example of the above-mentioned identifying unit 120.

[0051] The control unit 23a comprehensively controls the operation of the entire apparatus, such as the imaging operation and image processing operation. The X-ray image capturing unit 24a controls the high voltage generating unit 17a, the X-ray detector 15a, the X-ray image generating unit 26a, and the C-arm control unit 25a to perform imaging operations according to instructions input by the operator via the input unit 21a.

[0052] The input unit 21a functions as a man-machine interface for the operator to input instructions to the X-ray diagnostic apparatus 100a. For example, the input unit 21a has a trackball, various switches, buttons, a mouse, a keyboard, a foot pedal, a touch panel, and the like for inputting various instructions, conditions, region of interest (ROI) setting instructions, various image quality conditions, imaging (fluoroscopy) condition setting instructions, and the like from the operator into the apparatus body. The input unit 21a may also include a wireless receiving unit and a wireless processing unit so that the operator can operate it from a remote location.

[0053] The gantry 12a supports the C-arm 13a so that it can rotate independently about three orthogonal axes. The C-arm control unit 25a generates power for rotating the C-arm 13a under the control of the X-ray imaging unit 24a. The C-arm 13a is equipped with an X-ray source 14a at one end. The X-ray source 14a is composed of an X-ray tube that generates X-rays by receiving a high voltage from the high voltage generation unit 17a, and an X-ray aperture that is attached to the X-ray irradiation window of the X-ray tube and limits the X-ray irradiation field. The C-arm 13a is equipped with an X-ray detector 15a at the other end. The X-ray detector 15a is attached facing the X-ray source 14a. The X-ray detector 15a is a two-dimensional device that detects X-rays that have passed through a subject, typically a flat panel detector (FPD).

[0054] The X-ray image generating unit 26a generates a two-dimensional spatial distribution of the intensity of the transmitted X-rays, that is, a two-dimensional X-ray image, based on the output from the X-ray detector 15a. The image processing control unit 31 receives a control signal from the control unit 23a, and controls components related to the image processing operation of the X-ray diagnostic device 100a in particular. The X-ray image storage unit 22a stores the X-ray images generated by the X-ray image generating unit 26a. For example, the X-ray image generating unit 26a stores data of a fluoroscopic image and data of a contrast image (e.g., a DA image, etc.). The following description will be given taking a DA image as an example of a contrast image. Here, the data of the fluoroscopic image and the data of the DA image are stored in association with the X-ray generation time code corresponding to the data and the heartbeat phase code at the time of the X-ray generation. Then, a specific DA image is selected as a reference image from the multiple DA images stored in the X-ray image storage unit 22a by the operator.

[0055] The position identifying unit 120a selects a live image having the same heartbeat phase as the heartbeat phase (reference phase) of the subject at the time of capturing the reference image as a processing target, and identifies the sensor position on the reference image (DA image) from the sensor position on the selected live image. The current tip area of ​​the guidewire is represented by a characteristic brightness on the live image. First, the position identifying unit 120a extracts the tip area of ​​the guidewire on the live image by threshold processing. Then, the position identifying unit 120a identifies the tip position from the shape characteristics or the moving direction of the extracted tip area. Furthermore, the position identifying unit 120a identifies the sensor position on the live image by shifting backward from the tip position of the guidewire by a distance specific to the guidewire, that is, the distance L (see FIG. 26) from the tip position of the guidewire to the mounting position of the pressure sensor 210a of the guidewire.

[0056] Next, the position specifying unit 120a specifies a sensor position on the reference image corresponding to the sensor position on the live image of the current frame. First, the position specifying unit 120a calculates the direction and distance of the sensor position specified in the live image of the current frame relative to the sensor position specified in the live image of the previous frame, using the sensor position specified in the live image of the previous frame as a reference. Then, the position specifying unit 120a specifies a sensor position on the reference image corresponding to the sensor position on the live image of the current frame by displacing the previous sensor position on the reference image by the calculated distance according to the calculated direction, using the calculated direction and distance. The initial sensor position on the reference image is set by the operator's designation on the reference image. The second and subsequent sensor positions on the reference image are specified according to the displacement (direction and distance) of the sensor position on the live image from the sensor position on the previous reference image, and the movement trajectory of the sensor position on the reference image is identified by repeating this in order.

[0057] The FFR value input unit 110a functions as an interface to the external FFR value measurement device 200a. The FFR value measurement device 200a measures the FFR value (myocardial partial flow reserve) as an index representing blood flow. The FFR value is classified into three categories: treatment required, necessity judgment required, and no treatment required, depending on the level of the FFR value. The FFR value measurement device 200a includes a pressure sensor 210a and an FFR value calculation unit 211a. The FFR value is calculated by the ratio of the pressure measurement value at each position in the blood vessel to the reference aortic pressure. The pressure measurement value at each position in the blood vessel is measured by the pressure sensor 210a attached to the guide wire. The FFR value calculation unit 211a calculates the FFR value by dividing the pressure measurement value at each position in the blood vessel measured by the pressure sensor 210a by the aortic pressure measurement value measured by the pressure sensor 210a. The FFR value data is output in association with a code representing the measurement time of the pressure measurement value at each position in the blood vessel by the pressure sensor 210a.

[0058] FFR value storage unit 111a stores a plurality of FFR value data input via FFR value input unit 110a. A code representing the measurement time of the pressure measurement value at each position in the blood vessel by pressure sensor 210a is associated with the plurality of FFR value data. FFR value selection unit 32 selects an FFR value at the same time or the closest time to the occurrence timing of the reference phase by referring to the measurement time code.

[0059] The mark generating unit 33 determines a mark having a color corresponding to the FFR value selected by the FFR value selecting unit 32. The mark has a substantially rectangular shape with a width according to a standard vascular diameter of the target blood vessel. The display control unit 130a cumulatively overlays the marks generated by the mark generating unit 33 on the reference image stored in the X-ray image storage unit 22a. The display unit 16a displays the reference image generated by the display control unit 130a and on which the marks are cumulatively overlaid.

[0060] FIG. 14 is a diagram showing the fluoroscopy procedure of this embodiment together with the procedure of the guidewire and the contrast agent injection. The outline of the sequence of operations according to this embodiment is as follows: (1) A vascular motion image is acquired with a contrast agent injected from a catheter inserted into the blood vessel of the subject. Digital angiography (DA) is typically used as the X-ray imaging technique at this time. (2) From the DA images repeatedly acquired in (1), a frame in which the subject's FFR target region is most well contrasted is displayed as a still image (reference image) on the reference monitor. (3) The FFR measurement target region is specified on the reference image according to the operator's instruction. (4) A guidewire with a pressure sensor is inserted to a target site within the FFR measurement target region. (5) While the guidewire is being pulled out, pressure (FFR value) is repeatedly measured via the pressure sensor. (6) The measured FFR value is superimposed on the reference image in different colors according to a threshold value.

[0061] During the above-mentioned (5) withdrawal period, the FFR value is repeatedly measured by the FFR value measurement device 200a. Usually, the measurement period of the FFR value is shorter than the frame period during X-ray fluoroscopy. The indwelling period and the withdrawal period may be continuous, or may be separated in time by interruptions in X-ray fluoroscopy.

[0062] Fig. 15 is a flow chart showing the procedure from catheter insertion to the end of DA image capture. First, the gantry 10a is moved to a position where the vascular region of the desired subject can be observed, and X-ray fluoroscopy conditions and image acquisition conditions are determined, in response to an instruction from the operator via the input unit 21a. Next, in response to an operation by the operator of the mouse or buttons of the input unit 21a, X-ray fluoroscopy operation is started under the control of the control unit 23a, and fluoroscopic images are acquired (S11). The X-ray fluoroscopy conditions are, for example, a lower X-ray dose than X-ray photography for acquiring mask images or contrast images. The fluoroscopic images are instantly displayed on the display unit 16a.

[0063] Under this X-ray fluoroscopy, the operator inserts the catheter to the target position (S12). Next, a DA imaging technique is selected and DA imaging is performed. At this time, a contrast agent is injected from an injector synchronized with the X-ray diagnostic device 100a, contrast images are repeatedly collected, and an area in which FFR measurement is to be performed is specified (S13). DA images are obtained using high-dose pulsed X-rays, and are usually repeated several times at any timing. Data of each DA image is stored in the X-ray image storage unit 22a in association with a code indicating the time of DA image acquisition and data on the subject's heartbeat phase at the time of acquisition. Note that the heartbeat phase data is supplied from an external electrocardiograph (not shown) connected to the X-ray diagnostic device 100a.

[0064] The multiple DA images are displayed in a list on the display unit 16a under the control of the display control unit 130a, and any one image suitable for stenosis diagnosis is selected as a reference image according to an instruction from the operator (S14). As illustrated in Fig. 16, the cardiac phase to which the reference image corresponds is explained as "AA%". The reference image may be selected based on the operator's criteria, such as an image with low noise or an image with a blood vessel region at the center of the image, or the X-ray diagnostic device 100a may have a function of calculating the brightness, noise, etc. of the image and may be automatically selected by the device.

[0065] Next, the guide wire with pressure sensor is operated to move the pressure sensor 210a attached to the tip of the guide wire to a target position in the blood vessel (a position determined by the operator on the DA image) and place it there.

[0066] The position (initial position) of the pressure sensor 210a is specified by the operator using the mouse on the reference image enlarged and displayed on the display unit 16a, and the initial sensor position on the reference image is registered (S15). The registered initial sensor position data is stored in the X-ray image storage unit 22a together with the reference image data. Note that the registered position only needs to be stored by the X-ray diagnostic device 100a as coordinates based on an arbitrary point on the image or reference image, and the registered position may or may not be displayed on the reference image.

[0067] FIG. 17 is a flow chart showing a processing procedure during the guidewire withdrawal period in FIG. 14. During the withdrawal period, control unit 23a executes X-ray fluoroscopy following the insertion period (S31). Fluoroscopy images (live images) are repeatedly generated at a fixed cycle by executing X-ray fluoroscopy. The data of the live images are stored in X-ray image storage unit 22a in association with a code representing the image generation time and data of the subject's heartbeat phase at the time of image generation. During the withdrawal period, pressure sensor 210a moves according to the guidewire withdrawal operation starting from the placement position. The guidewire is withdrawn little by little by the operator's operation, and during that time, FFR value measurement device 200a repeatedly measures FFR values ​​according to the output of pressure sensor 210a (S32). The data of the FFR values ​​are stored in FFR value storage unit 111a in association with a code representing the measurement time and data of the subject's heartbeat phase at the time of measurement.

[0068] In step S33, the image processing control unit 31 determines whether the heartbeat phase of a live image coincides with the heartbeat phase (AA%) of the reference image or is within a range of 5% around the heartbeat phase (AA%) each time the live image is generated. Here, the former is described for convenience. The data of the live image generated at a timing that coincides with the heartbeat phase (AA%) of the reference image is read from the X-ray image storage unit 22a by the image processing control unit 31 and supplied to the position specification unit 120a. The position specification unit 120a extracts the tip region of the guidewire from the supplied live image by threshold processing (S34). The sensor position is specified from the extracted tip region (S35). The pressure sensor 210a is attached at a position that is a distance L unique to the guidewire and rearward from the tip of the guidewire. For example, the sensor position is specified by correcting the distance L from the extracted tip region of the guidewire along the central axis of the guidewire.

[0069] As shown in Figures 18 and 19, the position identification unit 120a calculates the direction and distance of the sensor position An identified on the live image PIn of the current cardiac phase (AA%) relative to the sensor position An-1 identified on the live image PIn-1 of the previous cardiac phase (AA%) (S36).

[0070] Next, the sensor position on the current reference image is specified based on the calculated direction and distance, and further based on the sensor position on the previous reference image (S37). That is, as shown in Fig. 20, the position to which the sensor position Bn-1 on the previous reference image is displaced according to the calculated direction and distance is specified as the sensor position Bn on the current reference image. Note that the first sensor position B1 on the reference image is manually specified by the operator.

[0071] In this way, the sensor position on the reference image is successively specified according to the direction and distance calculated from the previous and current sensor positions specified on the live image from the sensor position on the reference image specified previously, thereby making it possible to suppress the increase in the deviation between the sensor position on the reference image and the sensor position on the live image. The main causes of this deviation are the body movement of the subject itself due to the time separation between the capture of the reference image and the generation of the live image, and further, the change in the anatomical position of the same part due to the fluctuation of the cardiac cycle even if the cardiac phase is the same.

[0072] Next, a mark having a color corresponding to the FFR value measured at the time that coincides with or is closest to the generation time of the currently processed live image is superimposed on the reference image at the sensor position identified in S37 (S38). The FFR value is calculated from the ratio of the pressure measurement value to the aortic pressure value, so it is generally given as a value between 0 and 1. The FFR value from 0 to 1 is divided into multiple intervals, and a color is assigned to each interval in advance.

[0073] Steps S31-S38 are repeated via step S39 until the fluoroscopy is completed, during which the marks generated in succession are cumulatively superimposed on the reference image.

[0074] Fig. 21 shows a time chart showing the repetition of steps S31-S38. During the extraction period, the reference image DAref is steadily displayed, and marks M1, M2, M3... are cumulatively superimposed on the reference image DAref in colors corresponding to the FFR values ​​k1, k2, k3... of the same phase AA% at the respective sensor positions B1, B2, B3... as the cardiac cycle repeats. As shown in Fig. 22, the reference image is displayed on the same screen together with the fluoroscopic image (live image) and the time chart of the FFR values.

[0075] As described above, according to this use case, the measurement position of an index such as an FFR value useful for diagnosing vascular stenosis can be confirmed on the reference image, and the spatial visibility of the FFR value can be improved, thereby enhancing the usefulness. That is, according to this embodiment, the FFR value can be displayed as a mark on an X-ray image of a subject into which a guidewire equipped with a pressure sensor 210a is inserted, superimposed on a blood vessel location where a pressure used for calculating the FFR value is measured, so that the FFR value on the blood vessel can be intuitively confirmed, and the accuracy of measuring a vascular stenosis portion by an operator can be expected to be improved. Furthermore, in this embodiment, the sensor position on the reference image is continuously specified from the sensor position on the reference image specified last time according to the direction and distance calculated from the previous and current sensor positions specified on the live image, thereby suppressing the increase in the deviation between the sensor position on the live image, which is the actual FFR measurement position, and the sensor position on the displayed reference image.

[0076] The display mode of the FFR value on the reference image can be modified in various ways. For example, as shown in Fig. 23, when the operator performs a specific operation on the input unit 21a at any timing during FFR value measurement, the FFR value at that time may be displayed numerically in a balloon at the sensor position on the reference image at that time. Also, as shown in Fig. 24, it may be possible to switch the target on which the mark is superimposed from the reference image to a live image (fluoroscopic image). Furthermore, as shown in Fig. 25, it may be possible to switch the numerical display of the FFR value from the reference image to the live image (fluoroscopic image) and superimpose it.

[0077] In the above embodiment, the fluoroscopic images are repeatedly collected at a constant period such as 1 / 30 sec under continuous X-rays. However, the embodiment is not limited to this, and the fluoroscopic images may be collected by irradiating X-rays at a constant time interval. In this case, the fluoroscopic images are collected at a constant time interval while the guide wire is gradually pulled out by the operator. Then, the display control unit 130a displays a mark on the reference image or the fluoroscopic image at the sensor position at the time when the fluoroscopic image was collected. The measurement of the FFR value may be repeatedly performed by the FFR value measurement device 200a according to the output of the pressure sensor 210a, or may be performed in accordance with the timing of the fluoroscopic image. This can reduce the radiation exposure of the subject.

[0078] (Fourth embodiment) In the fourth embodiment, the treatment state is further displayed. Fig. 27 is a block diagram showing the configuration of an X-ray diagnostic apparatus 100 according to the fourth embodiment. As shown in Fig. 27, the X-ray diagnostic apparatus 100 according to the fourth embodiment further includes each unit for displaying and updating the treatment state in real time.

[0079] The guidewire tip position tracking unit 161 identifies the tip position of the guidewire in real time in the X-ray image captured in real time. The tip position of the guidewire can be identified using existing known technology, as with the intravascular pressure measurement position identifying unit 122.

[0080] The stenosis site stent detection unit 162 extracts a treatment instrument, such as a stent or a balloon, corresponding to the stenosis site from the X-ray image. For example, the stenosis site stent detection unit 162 performs image analysis based on the tip position of the guidewire identified by the guidewire tip position tracking unit 161 to extract the treatment instrument. This extraction of the treatment instrument can also use existing publicly known technology, as with the intravascular pressure measurement position identification unit 122, but it is necessary to recognize the shape of the treatment instrument before extracting it from the image.

[0081] The treatment state determination unit 163 determines the treatment state based on whether or not a treatment instrument has been placed at the stenosis site on the image. For example, when the treatment state determination unit 163 determines that a treatment instrument has been placed as a result of detection by the stenosis site stent detection unit 162, the treatment state determination unit 163 determines that the treatment has been completed. On the other hand, when the treatment state determination unit 163 determines that a treatment instrument has not been placed, the treatment state determination unit 163 determines that the treatment has not been completed.

[0082] Fig. 28 is a diagram showing a display example in the fourth embodiment. In the fourth embodiment, the display control unit 130 further displays information indicating the treatment state (such as "treated" or "untreated") according to the determination result by the treatment state determination unit 163, as shown in Fig. 28.

[0083] Fifth embodiment In the fifth embodiment, information on prediction of myocardial ischemia improvement accompanying treatment is further displayed. Fig. 29 is a diagram showing the configuration of an X-ray diagnostic apparatus 100, a measurement apparatus 200, and an ECG measurement apparatus 300 according to the fifth embodiment. As shown in Fig. 29, the X-ray diagnostic apparatus 100 according to the fifth embodiment further includes each unit for predicting improvement of myocardial ischemia in real time accompanying treatment of a stenotic site and displaying the predicted result.

[0084] The ischemia analysis image storage unit 164 stores an ischemia analysis result image such as myocardial perfusion. For example, the ischemia analysis result image is a CT (Computed Tomography) image, a combined image of a CT image and a SPECT (Single Photon Emission Computed Tomography) image, or the like, and is an image captured by an X-ray CT device or a SPECT device. In the fifth embodiment, it is assumed that alignment has already been completed between the X-ray image captured by the X-ray diagnostic device 100 and the ischemia analysis result image stored in the ischemia analysis image storage unit 164. This alignment can be realized using existing known technology, and can be realized based on information such as imaging conditions such as the angle of the C-arm 13, the brightness distribution of a Ray-Sum image (sum value projection image), and the shapes of the heart and coronary arteries.

[0085] The ischemia inducibility estimation unit 165 estimates the ischemia inducibility indicating the degree to which ischemia is induced by stenosis. For example, the relationship between which coronary artery controls which myocardial region is known anatomically. Therefore, the ischemia inducibility estimation unit 165 calculates the ischemia inducibility (e.g., induction rate) for each position in the ischemic myocardium based on the relationship between the FFR of the stenosis on the coronary artery controlling a certain myocardial region and the range and degree of ischemia in the myocardial region.

[0086] The FFR is information received from the measurement device 200, and the range and degree of ischemia are information obtained from an ischemia analysis result image. For example, when multiple stenosis sites exist in one coronary artery, the ischemia inducibility estimation unit 165 may calculate the induction rate by weighting the multiple FFRs. Note that the ischemia inducibility estimation unit 165 learns in advance an algorithm for calculating the ischemia inducibility from the relationship between the FFR and the range and degree of ischemia, and calculates the ischemia inducibility by inputting this information into the algorithm.

[0087] The ischemia improvement prediction unit 166 predicts in real time the improvement of myocardial ischemia associated with treatment of the stenotic region, using the ischemia inducibility estimated by the ischemia inducibility estimation unit 165. In the case of a multi-vessel lesion or multiple lesions, treatment is performed in order starting from the stenotic region with the highest ischemia inducibility, but the treatment result may not achieve the expected improvement of ischemia. In order to evaluate the treatment result during treatment, in the fifth embodiment, the FFR is measured each time the stenotic region is treated, and the ischemia inducibility estimation unit 165 recalculates the ischemia inducibility using the remeasured FFR.

[0088] The ischemia improvement prediction unit 166 obtains the difference between the ischemia inducibility calculated before the treatment and the ischemia inducibility calculated after the treatment for each position in the ischemic myocardium, and predicts the improvement of myocardial ischemia at each position in the ischemic myocardium. The display control unit 130 further displays an ischemia analysis result image together with the X-ray image, and also displays the prediction result (i.e., the predicted degree of improvement) on the ischemia analysis result image.

[0089] FIG. 30 is a diagram for explaining prediction of myocardial ischemia improvement in the fifth embodiment. The graph of signal values ​​shown in FIG. 30 shows signal values ​​of ischemia analysis results such as myocardial perfusion. These signal values ​​are analyzed from parameters such as contrast agent arrival peak time (TTP (Time To Peak)), myocardial blood volume (MBV (Myocardial Blood Volume)), and mean transit time (MTT (Mean Transit Time)). For example, as shown in FIG. 30, the display control unit 130 displays contour lines indicating the rate of ischemia improvement associated with a change in FFR from "0.50" to "0.90" by treatment of stenosis 1.

[0090] FIG. 31 is a diagram showing a display example in the fifth embodiment. In the fifth embodiment, as shown in FIG. 31, in addition to the X-ray image on which the measurement data and the like are superimposed, the ischemia analysis result image is also displayed on the display unit 16. Then, the display control unit 130 displays the contour lines c on the ischemia analysis result image before the treatment, for example, as shown in FIG. 31. Note that, in the fifth embodiment, the contour lines c are lines drawn according to the magnitude of the difference before and after the treatment. Also, for example, the display control unit 130 may assign a dark color when the difference before and after the treatment is large, and assign a light color when the difference before and after the treatment is small. Also, the embodiment is not necessarily limited to the contour lines, and may be displayed by changing the color on a pixel-by-pixel basis, for example.

[0091] In this way, by displaying the predicted improvement on the ischemia analysis result image, the person involved in the treatment can visually confirm the extent and degree of ischemia improvement. Since complex screen operations are difficult during catheterization procedures, efficient evaluation is possible. For example, if the FFR becomes high following treatment of a stenotic site, it indicates that the extent and degree of ischemia in the myocardium associated with that stenotic site will improve.

[0092] (Other embodiments) The embodiments are not limited to those described above, and may be embodied in various other different forms.

[0093] In the above-mentioned embodiment, the case where an actually measured index is used as an index related to blood flow has been described. However, the embodiment is not limited to this, and for example, a simulation index such as CT-FFR may be used. FIG. 32 is a diagram showing an example of generation and display of a display image in another embodiment. For example, as shown in FIG. 32, the control unit 23 in the X-ray diagnostic device 100 generates a three-dimensional blood vessel model based on CT volume data at the time of the first diagnosis. Then, the control unit 23 calculates the value of FFR at each position in the generated three-dimensional blood vessel model. The calculation of the value of FFR at each position in the three-dimensional blood vessel model can be realized using existing publicly known technology.

[0094] Then, as shown in Fig. 32, the display control unit 130 displays the calculation position of the FFR value calculated by the control unit 23 on the X-ray image (contrast image or non-contrast image) of the same subject from which the CT volume data was collected, and displays the calculated FFR value (CT-FFR: 0.7 in the figure) in association with the calculation position. Here, the X-ray diagnostic device in the present application is capable of processing 4D data. That is, the control unit 23 generates a three-dimensional blood vessel model from each of the CT volume data collected over time, and calculates the FFR value at each position.

[0095] Then, the display control unit 130 uses the ECG to identify volume data corresponding to the time phase of each X-ray image of a series of X-ray images (contrast images or non-contrast images) collected consecutively, and displays the FFR value calculated using the identified volume data in association with the calculated position on the X-ray image. This allows the FFR value at each position in each time phase of the multiple X-ray images to be grasped before actually measuring. Furthermore, as shown in FIG. 32, when various indices are actually measured during treatment, the display control unit 130 simultaneously displays the result of the simulation at the time of diagnosis, "CT-FFR: 0.7", in addition to the actual measurement values ​​"FFR: 0.8, CFR: 4.00". This allows easy comparison between the simulation values ​​and the actual measurement values, enabling subsequent diagnoses to be performed efficiently.

[0096] In the above-mentioned embodiment, the X-ray diagnostic device 100 is described as an example of the medical image diagnostic device, but the embodiment is not limited thereto. The present invention can be similarly applied to other medical image diagnostic devices such as an ultrasound diagnostic device, a magnetic resonance imaging device, and a nuclear medicine imaging device. The present invention may also be applied to an image processing device other than the medical image diagnostic device. In this case, for example, the image processing device receives various information from a measurement device or a medical image diagnostic device, or receives input from an operator, and performs the same processing as the above-mentioned identification unit 120 and the display control unit 130 using the various information. Here, the image processing device is, for example, a workstation, an image server or viewer of a PACS (Picture Archiving and Communication System), various devices of an electronic medical record system, etc. The present invention may also be applied to a measurement device (blood pressure monitor) other than the medical image diagnostic device and the image processing device. In such a case, for example, the measurement device has a monitor for displaying images. The measurement device receives various information from the medical image diagnostic device, or receives input from an operator, and performs the same processing as the above-mentioned identification unit 120 and the display control unit 130 using the information. Here, the blood pressure monitor is, for example, a central peripheral venous blood pressure monitor.

[0097] In addition, the present invention is not limited to the above-mentioned embodiment, and various forms can be appropriately combined as follows. First, the linkage of the display image with the photographing may be linked in real time (displaying the measurement position on the image being photographed), or linked offline (displaying the measurement position on the image collected in advance), or may be linked with an image stored in another device (for example, a workstation). The display image may be a 2D image or a chronological 2D image, as well as a 3D image or a 4D image. The display image may be a contrast image, a non-contrast image, or an image during contrast (including an image that is not completely contrasted). The target image for processing may be an X-ray image, a CT image, a SPECT image, or an image collected by other medical image diagnostic devices. The method for determining the treatment state may be the above-mentioned image analysis, a method for detecting a change in intravascular pressure, or a method for having the operator input the treatment state. In addition, methods for achieving temporal synchronization between various information received from measuring devices 200, etc. and X-ray images include a method of simply achieving synchronization at each time, and a method of achieving synchronization by extracting only the time around the time when the internal pressure around the stenosis was measured, rather than synchronizing the entire time at which the data is saved.

[0098] In the above-described embodiment, the FFR and CFR are used as examples of blood flow-related indices, but the embodiment is not limited thereto. For example, other indices customized from these may be used.

[0099] In the above-described embodiment, it is assumed that the imaging direction of the C-arm is fixed, but the embodiment is not limited to this. The above-described various processes may be performed again in response to a change in the imaging direction of the C-arm.

[0100] Furthermore, in the above-described embodiment, a coronary artery is assumed, but the embodiment is not limited to this and can be similarly applied to other blood vessels.

[0101] According to at least one of the image processing device, medical image diagnostic device, and blood pressure monitor of the above-described embodiments, the measurement position of a physiological index can be grasped on a blood vessel image. (Appendix 1) An identification unit that identifies an acquisition position of a blood flow index on an image including a blood vessel collected by a medical image diagnostic device; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; An image processing device comprising: (Additional Note 2) The identification unit identifies each of the acquisition positions of the plurality of indices acquired sequentially at different time phases on an image including a blood vessel corresponding to the time phase at the time of acquisition, The image processing device described in Appendix 1, characterized in that the display control unit further identifies a corresponding position on an image including blood vessels at a specified time phase for each acquisition position identified on an image including blood vessels corresponding to the time phase at the time of acquisition, and displays each index in correspondence with each identified position. (Appendix 3) The image processing device described in Appendix 2, characterized in that the display control unit calculates the amount of pixel movement between images of different time phases, and uses the calculated amount of movement to further identify, for each acquisition position, a corresponding position on an image including blood vessels of a specified time phase. (Appendix 4) The image processing device according to any one of Appendices 1 to 3, wherein the identification unit extracts an image including blood vessels corresponding to a time phase at the time of acquisition from a group of time-series images including blood vessels collected by the medical image diagnostic device, and identifies the acquisition position by identifying the tip of an instrument used for the acquisition through image analysis of the extracted image including blood vessels. (Appendix 5) The image processing device according to any one of Appendices 1 to 4, characterized in that the display control unit causes the indicator to be displayed on the display unit in correspondence with an acquisition position identified on an image including blood vessels collected in advance by a medical image diagnostic device, or an acquisition position identified on an image including blood vessels collected in real time by a medical image diagnostic device. (Appendix 6) The image processing device described in any one of Appendices 1 to 5, characterized in that when the display control unit displays the acquisition position on an image including non-contrast blood vessels, structural information extracted from an image including contrast blood vessels is superimposed on the image including non-contrast blood vessels. (Appendix 7) The device further includes a treatment necessity determination unit that determines whether or not treatment of the stenotic site is necessary based on the index related to the blood flow, The image processing device according to any one of claims 1 to 6, wherein the display control unit further causes the display unit to display the judgment result of the necessity of treatment in association with the acquisition position. (Appendix 8) The apparatus further includes a treatment status determination unit that determines a treatment status by analyzing an image including the blood vessel, 8. The image processing device according to claim 1, wherein the display control unit further causes the display unit to display the judgment result of the treatment state in association with the acquisition position. (Appendix 9) The device further includes a prediction unit that predicts improvement in ischemia associated with treatment based on the blood flow index, The image processing device described in any one of Appendices 1 to 8, characterized in that the display control unit further displays an image indicating the degree of ischemia together with the image including the blood vessels on the display unit, and further displays a prediction result on the image indicating the degree of ischemia. (Supplementary Note 10) The identification unit identifies a position of a pressure sensor inserted into the subject via a guide wire from each of a plurality of fluoroscopic images selected from a series of fluoroscopic images of the subject by using threshold processing, and identifies a position on a photographed image of the subject corresponding to the identified position of the pressure sensor based on a displacement of a position of the pressure sensor on the fluoroscopic images; The image processing device described in Appendix 1, characterized in that the display control unit causes a mark representing an index derived from the output of the pressure sensor to be superimposed on the captured image in accordance with the identified position on the captured image and displayed on the display unit. (Supplementary Note 11) The image processing device according to Supplementary Note 10, further comprising a selection unit that selects a fluoroscopic image to be used for identifying the position of the pressure sensor from the series of fluoroscopic images. (Supplementary Note 12) The image processing device according to Supplementary Note 11, wherein the selection unit selects a fluoroscopic image to be used for identifying the position of the pressure sensor from the series of fluoroscopic images based on a cardiac phase at the time of capturing the captured image. (Supplementary Note 13) The image processing device according to Supplementary Note 12, wherein the selection unit selects a fluoroscopic image generated at a timing of a cardiac phase substantially the same as a cardiac phase at the time of capturing the captured image as the fluoroscopic image to be used for identifying the position of the pressure sensor. (Supplementary Note 14) The image processing device according to Supplementary Note 10, wherein the mark has a color corresponding to the indicator. (Supplementary Note 15) The image processing device according to Supplementary Note 10, wherein the mark is cumulatively superimposed on the captured image. (Appendix 16) An imaging unit that captures an image of a subject and collects images including blood vessels; An identification unit that identifies an acquisition position of an index related to blood flow on the image including the blood vessel; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; A medical image diagnostic apparatus comprising: (Appendix 17) A means for acquiring an index related to blood flow; an identification unit that identifies an acquisition position of the index acquired by the acquisition means on an image including a blood vessel acquired by a medical image diagnostic device; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; A blood pressure monitor comprising:

[0102] Although some embodiments of the present invention 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, and modifications 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. [Explanation of symbols]

[0103] 100 X-ray diagnostic equipment 120 Specific section 130 Display control unit

Claims

1. An identification unit that identifies an acquisition position of an index related to blood flow on an image including blood vessels collected by a medical image diagnostic device; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by the device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, The image processing device is characterized in that, when the display control unit receives an instruction from a user to display a first blood flow index corresponding to a first acquisition position, which is any one of the multiple acquisition positions, the display control unit displays the first blood flow index on an image including the blood vessel displayed on the display unit in a display form associated with the first acquisition position of the blood vessel and at a position that does not overlap with the first acquisition position, and also displays a graph showing the blood flow index so that changes over time in the blood flow index can be grasped.

2. The image processing device described in Claim 1, characterized in that the graph showing the index regarding blood flow shows values ​​measured according to the output of the device at the time of collecting the fluoroscopic image.

3. An image processing device as described in claim 1 or 2, characterized in that the identification unit identifies the acquisition position based on the tip of the device depicted on the X-ray image.

4. An identification unit that identifies an acquisition position of a blood flow index on an image including blood vessels collected by a medical image diagnostic device; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by the device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, The image processing device is characterized in that, when the display control unit receives an instruction from a user to display a first blood flow index corresponding to a first acquisition position, which is any one of the multiple acquisition positions, the display control unit displays the first blood flow index on an image including the blood vessel displayed on the display unit in a display form associated with the first acquisition position of the blood vessel and at a position that does not overlap with the first acquisition position, and also displays a time chart showing the blood flow index.

5. An identification unit that identifies an acquisition position of a blood flow index on an image including blood vessels collected by a medical image diagnostic device; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by the device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, The image processing device is characterized in that, when the display control unit receives an instruction from a user to display a first blood flow index corresponding to a first acquisition position which is any one of the multiple acquisition positions, the display control unit displays the first blood flow index in a display form associated with the first acquisition position of the blood vessel on an image including the blood vessel displayed on the display unit, and displays a numerical value in a speech bubble at the first acquisition position, and also displays a time chart showing the blood flow index.

6. An acquisition unit that acquires a fluoroscopic image of a subject and an image including blood vessels of the subject captured under contrast; An identification unit that identifies an acquisition position of an index related to blood flow on the image including the blood vessel; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by a device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, The display control unit, when receiving an instruction from a user to display a first blood flow index corresponding to a first acquisition position which is any one of the multiple acquisition positions, displays the first blood flow index on an image including the blood vessel displayed on the display unit in a display form associated with the first acquisition position of the blood vessel and at a position which does not overlap with the first acquisition position, and also displays a graph showing the blood flow index so that a change over time in the blood flow index can be grasped.

7. An acquisition unit that acquires a fluoroscopic image of a subject and an image including blood vessels of the subject captured under contrast; An identification unit that identifies an acquisition position of an index related to blood flow on the image including the blood vessel; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by a device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, when the display control unit receives an instruction from a user to display a first blood flow index corresponding to a first acquisition position which is any one of the multiple acquisition positions, the display control unit displays the first blood flow index on an image including the blood vessel displayed on the display unit in a display form associated with the first acquisition position of the blood vessel and at a position which does not overlap with the first acquisition position, and also displays a time chart showing the blood flow index.

8. An acquisition unit that acquires a fluoroscopic image of a subject and an image including blood vessels of the subject captured under contrast; An identification unit that identifies an acquisition position of an index related to blood flow on the image including the blood vessel; a display control unit that displays the acquisition position on an image including the blood vessel and causes a display unit to display the indicator in association with the acquisition position; Equipped with the identification unit identifies a plurality of acquisition positions of the index related to the blood flow by a device on the fluoroscopic image, and identifies a plurality of positions on the image including the blood vessel corresponding to the identified plurality of acquisition positions, when the display control unit receives an instruction from a user to display a first blood flow index corresponding to a first acquisition position which is any one of the multiple acquisition positions, the display control unit displays the first blood flow index in a display form associated with the first acquisition position of the blood vessel on an image including the blood vessel displayed on the display unit, and displays a numerical value in a speech bubble at the first acquisition position, and also displays a time chart showing the blood flow index.

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