Method and apparatus for volumetric cardiac computed tomography imaging

• US 20040082846A1
• Filed: 10/25/2002
• Published: 04/29/2004
• Est. Priority Date: 10/25/2002
• Status: Active Grant

• Current Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Steinberg, Ammon, Heuscher, Dominic J., Shreter, Uri, Johnson, Peter C., Chandra, Shalabh
• Granted Patent: US 7,289,841 B2
• Time in Patent Office: Days
• US Class Current: 600/410
• CPC Class Codes: A61B 5/02014 Determining aneurysm
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 6/027 characterised by the use of a particular data acquisition trajectory, e.g. helical or spiral
• CPC Class Codes: A61B 6/032 Transmission computed tomography [CT]
• CPC Class Codes: A61B 6/481 involving the use of contrast agents
• CPC Class Codes: A61B 6/503 for diagnosis of the heart
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/507 for determination of haemodynamic parameters, e.g. perfusion CT

Abstract

In a diagnostic cardiac imaging session of a patient'"'"'s heart using a computed tomography imaging scanner (10) and a cardiac cycle monitor (42), a diagnostic objective (100) is received. Survey imaging (104) of the heart is performed to determine optimized imaging parameter values for the received diagnostic objective (100). Monitor imaging (108) of a limited portion of the heart is performed during influx of a contrast agent (22) using a low patient x-ray exposure condition to detect a trigger condition. Volume imaging (110) of the heart responsive to detection of the trigger condition is performed using the optimized imaging parameter values to obtain volumetric imaging data. Cardiac cycle data is recorded during at least a portion of the survey imaging (104), the monitor imaging (108), and the volume imaging (110). High resolution reconstructing (130) of at least some volumetric imaging data is performed to produce high resolution image representations (132).

Claims

1. An apparatus for performing a diagnostic cardiac imaging session of a patient'"'"'s heart, the apparatus comprising:

a survey imaging means for survey imaging the heart to determine optimized imaging parameter values for a received diagnostic objective;

a monitor imaging means for monitor imaging a limited portion of the heart during influx of a contrast agent using a low patient x-ray exposure condition to detect a trigger condition;

a volume imaging means for volume imaging the heart responsive to detection of the trigger condition using the optimized imaging parameter values to obtain volumetric imaging data;

a cardiac cycle recording means for recording cardiac cycle data during at least a portion of the survey imaging, the monitor imaging, and the volume imaging; and

a volumetric reconstructing means for high resolution reconstructing at least a portion of the volumetric imaging data to produce high resolution image representations of at least a portion of the heart.

2. The apparatus as set forth in claim 1, wherein the received diagnostic objective is selected from a group consisting of:

a coronary artery analysis,

a ventricular functional analysis,

a contrast agent delivery analysis, and

a qualitative visual cardiac review.

3. The apparatus as set forth in claim 1, wherein the cardiac cycle recording means includes:

an electrocardiograph;

a means for checking an electrocardiographic signal prior to the survey imaging; and

a means for identifying a defective electrocardiograph lead connection based on the checking.

4. The apparatus as set forth in claim 1, wherein the imaging parameter values optimized by the survey imaging means include:

a helical pitch for the volume imaging selected based on a cardiac cycle period extracted from the cardiac cycle data and a survey image, and

a dimension of the heart.

5. The apparatus as set forth in claim 1, wherein the monitor imaging means includes:

a means for computing a contrast agent density corresponding to each monitor image for a region of interest;

a means for computing and monitoring a time derivative of the contrast agent density based on temporally successive monitor images; and

a means for detecting the trigger condition as a selected time derivative of the contrast agent density.

6. The apparatus as set forth in claim 1, further including:

a cardiac phase selection means for selecting one or more optimal cardiac phases by rapidly reconstructing a portion of imaging data acquired during at least one of the trigger imaging and the volume imaging and selecting one or more optimal cardiac phases based on the rapidly reconstructed data and the cardiac cycle data that are optimal with respect to the diagnostic objective, wherein the volumetric reconstruction means reconstructs the optimal cardiac phases.

7. The apparatus as set forth in claim 6, wherein the monitor imaging means images a selected slice that intersects at least three main coronary arteries over at least one cardiac cycle of the heart, and the cardiac phase selection means includes:

a means for computing a motion of a selected coronary artery based on the monitor images; and

a means for identifying a cardiac phase for which the selected coronary artery has a low velocity based on the computed artery motion and corresponding cardiac cycle data.

8. The apparatus as set forth in claim 7, wherein the means for computing a motion of a selected coronary artery includes:

an edge-detection means for identifying edges of the selected coronary artery in each monitor image.

9. The apparatus as set forth in claim 6, wherein the cardiac phase selection means includes:

a low resolution reconstructing means for reconstructing volume images at a plurality of cardiac phases that span a cardiac cycle using a low voxel resolution; and

a means for selecting the one or more optimal cardiac phases based on the low voxel resolution volume images.

10. The apparatus as set forth in claim 9, wherein the means for selecting the one or more optimal cardiac phases includes:

an animation means for generating a CINE animation loop comprising the low voxel resolution volume images and for displaying the CINE animation loop.

11. The apparatus as set forth in claim 9, wherein the cardiac phase selection means further includes:

a reference reconstructing means for reconstructing a volume image at a reference cardiac phase using a high voxel resolution to generate a reference selection image;

a display means for displaying the reference selection image to a user for user selection of a region of interest therein; and

a means for computing a motion of the region of interest in the low voxel resolution volume images, the selecting means selecting one or more optimal cardiac phases in which the region of interest has limited motion.

12. The apparatus as set forth in claim 11, wherein a linear dimension ratio of the high voxel resolution to the low voxel resolution is 2:

1, and a volume dimension ratio of the high voxel resolution to the low voxel resolution is 8;

1.

13. The apparatus as set forth in claim 6, further including:

a processing means for performing a quantitative analysis on the reconstructed image representations corresponding to the optimal cardiac phases.

14. The apparatus as set forth in claim 13, wherein the processing means includes:

a ventricular functional analysis means for performing a ventricular functional analysis;

a contrast delivery analysis means for performing contrast delivery analysis;

a coronary artery analysis means for performing a coronary artery analysis; and

a selection means for selectively invoking at least one of the ventricular functional analysis means, the contrast delivery analysis means, and the coronary artery analysis means based on the diagnostic objective.

15. The apparatus as set forth in claim 13, wherein the volumetric reconstructing means produces volumetric images for a plurality of cardiac phases spanning at least a cardiac cycle period, the processing means including:

a means for integrating a ventricular volume for each cardiac phase of the plurality of cardiac phases; and

a means for computing a blood movement parameter of the ventricle for the cardiac cycle period based on the ventricular volumes of the plurality of cardiac phases.

16. The apparatus as set forth in claim 15, wherein the processing means further includes:

a means for segmenting voxels corresponding to ventricular walls for each of the plurality of cardiac phases; and

a means for estimating ventricular wall motion throughout the cardiac cycle period from the segmenting.

17. The apparatus as set forth in claim 13, wherein the volumetric reconstructing means produces a volumetric image for a selected cardiac phase in which the heart has limited motion, the processing means including:

a means for displaying a rendering of the high resolution volumetric image;

a means for identifying non-coronary regions including at least a sternum, a chest wall, and a spine in the high resolution volumetric image;

a sculpting means for removing the non-coronary regions from the rendering to expose coronary regions of interest;

an input means for receiving seed points on the sculpted rendering from a user, the seed points selecting a coronary vessel; and

a tracking means for tracking the selected coronary vessel starting from at least one seed point to sculpt out the selected coronary vessel.

18. The apparatus as set forth in claim 17, wherein the processing means further includes:

a means for projecting the sculpted coronary vessel onto a plurality of non-parallel planes to produce a plurality of projection views of the sculpted coronary vessel; and

a means for identifying a stenosis based on the projection views.

19. The apparatus as set forth in claim 1, wherein the volumetric reconstructing means reconstructs substantially all the volumetric imaging data to produce volumetric imaging data spanning a full cardiac cycle, the apparatus further including:

a cardiac review means for displaying a matrix of image slices of the high resolution image representations, the matrix including a horizontal axis indexing one of a spatial slice position and a cardiac phase, the matrix further including a vertical axis indexing the other of the spatial slice position and the cardiac phase, the displaying further including user-interactive horizontal and vertical scroll bars by which a user can scroll through the matrix of image slices.

20. The apparatus as set forth in claim 19, wherein the cardiac cycle recording means includes an electrocardiograph, and the cardiac review means further includes:

a means for displaying an electrocardiographic data graph together with the matrix of image slices, the electrocardiographic data graph including a graph cursor, wherein user selection of an image in the matrix causes the graph cursor to move to a corresponding electrocardiographic datum, and wherein user movement of the graph cursor to a selected electrocardiographic datum causes the matrix of image slices to include a corresponding image slice.

21. The apparatus as set forth in claim 19, wherein the cardiac review means further includes:

a database of view parameter sets, each view parameter set being optimized for viewing a selected anatomical feature;

wherein the displaying further includes a set of user selections corresponding to the view parameter sets, activation of a user selection by the user causing the matrix of image slices to be displayed using a selected one of the view parameter sets that corresponds to the activated user selection.

22. The apparatus as set forth in claim 1, further including:

a report generating means for selecting one of a plurality of diagnostic cardiac imaging session report forms, the selected report form corresponding to the diagnostic objective, and for integrating at least one exemplary high resolution image representation into the selected report form.

23. The apparatus as set forth in claim 1, further including:

a means for monitoring the cardiac cycle data during the volume imaging to detect an abnormal cardiac event, wherein the volume imaging means adjusts the volume imaging responsive to the abnormal cardiac event to reduce an effect of the abnormal cardiac event on the high resolution reconstructing.

24. The apparatus as set forth in claim 23, wherein the volume imaging means adjusts the volume imaging by discarding a portion of the volumetric imaging data that is acquired during the abnormal cardiac event, and interpolating volumetric imaging data to compensate for the discarded portion of the volumetric imaging data.

25. A method for performing a diagnostic cardiac imaging session of a patient'"'"'s heart using a computed tomography imaging scanner and a cardiac cycle monitor, the method comprising:

survey imaging the heart to determine optimized imaging parameter values for a received diagnostic objective;

monitor imaging a limited portion of the heart during influx of a contrast agent using a low patient x-ray exposure condition to detect a trigger condition;

volume imaging the heart responsive to detection of the trigger condition using the optimized imaging parameter values to obtain volumetric imaging data;

recording cardiac cycle data during at least a portion of the survey imaging, the monitor imaging, and the volume imaging; and

volumetric reconstructing at least a portion of the volumetric imaging data to produce high resolution image representations of at least a portion of the heart.

26. The method as set forth in claim 25, wherein the monitor imaging includes:

computing a contrast agent density corresponding to each monitor image for a region of interest;

monitoring a time derivative of the contrast agent density based on temporally successive monitor images; and

detecting the trigger condition as a selected time derivative of the contrast agent density.

27. The method as set forth in claim 25, further including:

rapidly reconstructing a portion of imaging data acquired during at least one of the trigger imaging and the volume imaging to select one or more optimal cardiac phases that are optimal with respect to the diagnostic objective, the volumetric reconstructing step reconstructing the optimal cardiac phases.

28. The method as set forth in claim 27, wherein the monitor imaging monitors a selected slice that intersects at least three main coronary arteries over at least one cardiac cycle of the heart, and the step of rapidly reconstructing to select one or more optimal cardiac phases includes:

computing a motion of a selected coronary artery based on the monitor images; and

based on the computed artery motion and corresponding cardiac cycle monitoring data, identifying a cardiac phase for which the selected coronary artery has a low velocity.

29. The method as set forth in claim 27, wherein the step of rapidly reconstructing to select one or more optimal cardiac phases includes:

reconstructing volume images at a plurality of cardiac phases that span a cardiac cycle using a low voxel resolution; and

selecting the one or more optimal cardiac phases based on the low voxel resolution volume images.

30. The method as set forth in claim 25, wherein a processing sequence is performed, the processing sequence being selected based upon the diagnostic objective from a group of sequences consisting of:

(A) rapidly reconstructing a portion of imaging data acquired during at least one of the trigger imaging and the volume imaging to select one or more optimal cardiac phases for the volumetric reconstructing and quantitatively analyzing the reconstructed cardiac phases to obtain quantitative parameter values corresponding to the diagnostic objective, and

(B) displaying a matrix of slices of the high resolution image representations including a horizontal axis indexing one of a slice position and a cardiac phase and a vertical axis indexing the other of the slice position and the cardiac phase.

31. The method as set forth in claim 30, wherein the quantitative analyzing of the sequence (A) performs a quantitative analysis selected based upon the diagnostic objective from a group consisting of:

a ventricular functional analysis,

a contrast delivery analysis, and

a coronary artery analysis.

32. A cardiac computed tomography imaging apparatus for performing a diagnostic cardiac imaging session, the apparatus comprising:

a computed tomography imaging scanner that acquires imaging data of a patient'"'"'s heart;

an electrocardiograph that acquires electrocardiographic data to monitor a cardiac phase of the patient'"'"'s heart; and

an imaging controller that communicates with the imaging scanner and the electrocardiograph to coordinate the diagnostic cardiac imaging session, the imaging controller performing an imaging session method including;

survey imaging the heart to determine optimized imaging parameter values for a received diagnostic objective,

monitor imaging a limited portion of the heart during influx of a contrast agent using a low patient x-ray exposure condition to detect a trigger condition,

volume imaging the heart responsive to detection of the trigger condition using the optimized imaging parameter values to obtain volumetric imaging data,

recording electrocardiographic data during at least a portion of the survey imaging, the monitor imaging, and the volume imaging, and

high resolution reconstructing at least a portion of the volumetric imaging data to produce high resolution image representations of at least a portion of the heart.

33. The apparatus as set forth in claim 32, wherein the imaging controller include:

an audio waveform memory that stores a plurality of voice messages including a voice message instructing the patient to perform a breath hold; and

an audio speaker for communicating selected voice messages to the patient during the imaging session.