Method of and apparatus for predicting computed tomography contrast enhancement with feedback

• US 5,687,208 A
• Filed: 05/15/1996
• Issued: 11/11/1997
• Est. Priority Date: 10/06/1995
• Status: Expired due to Term

• Current Assignee: Bayer Healthcare LLC (Bayer AG)
• Original Assignee: BHB General Partnership, LLC
• Inventors: Heiken, Jay P., Brink, James A., Bae, Kyongtae T.
• Primary Examiner(s): Porta, David P.
• Assistant Examiner(s): Bruce, David Vernon
• Application Number:
  US08/648,495
• Time in Patent Office: 545 Days
• Field of Search: 364/413.15, 364/413.14, 378/8, 378/95, 378/901
• US Class Current: 378/8
• CPC Class Codes: A61B 6/507 for determination of haemodynamic parameters, e.g. perfusion CT
• CPC Class Codes: A61M 2005/14292 Computer-based infusion planning or simulation of spatio-temporal infusate distribution
• CPC Class Codes: G16H 20/17 delivered via infusion or injection
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: Y10S 378/901 Computer tomography program or processor

Abstract

A method and apparatus are disclosed for predicting prior to injection an organ specific contrast enhancement in a patient for a preselected contrast injection protocol for pre-determining a computed tomography scan. The invention is preferably implemented in a computer program which creates a mathematical model of human cardiovascular physiology in a hypothetical patient with a specific body habitus subjected to the pre-selected contrast injection protocol. The predicted contrast enhancement is then displayed for operator approval and may be then used to control a CT scanner or contrast injector system, to perform the injection and scan with the pre-selected injection protocol and scan parameters. The mathematical model includes models of organs and vessels using differential equations to describe mass transport of contrast agent through the cardiovascular system. Also disclosed are a method and apparatus for predicting optimum injection protocol for contrast agent by analyzing the predicted enhancement levels and updating the injection protocol until acceptable enhancement levels are predicted as well as a method and apparatus for determining an optimum scan interval when enhancement levels are predicted to exceed a threshold level for a time period greater than the scan duration. Further disclosed is a method and apparatus for monitoring a region of interest in the patient different from the region to be scanned after injection to calibrate the mathematical model and more accurately predict enhancement levels in the tissue to be scanned and calculate the optimum scan parameters.

Claims

1. A method of determining a set of parameters for an injection protocol for scanning a tissue in a patient using computed tomography, the patient having a plurality of patient specific parameters, wherein the tissue to be scanned is enhanced with an intravascularly injected contrast agent, comprising the steps of:

generating a tissue enhancement function comprising a tissue enhancement level for the tissue to be scanned as a function of an elapsed time after injection based on the patient specific parameters and a specified injection protocol; and

determining the set of injection protocol parameters for an optimum scan based on the predicted tissue enhancement function.

2. The method of claim 1 wherein the step of determining the set of parameters for an optimum scan includes using the predicted tissue enhancement function to thereby determine an injection flow rate and a contrast volume which is predicted to cause the tissue enhancement level to exceed a pre-selected threshold value.

3. The method of claim 2 further comprising the step of adjusting the set of parameters until the tissue enhancement level is predicted to exceed the threshold value.

4. The method of claim 3 wherein the set of parameters is sequentially adjusted until the predicted tissue enhancement function is maintained above the threshold value for a time period at least approximately equal to a specified scan duration.

5. The method of claim 4 wherein the step of adjusting the set of parameters includes selecting the injection flow rate and selecting the injection volume.

6. The method of claim 1 wherein the step of determining a set of parameters for an optimum scan includes determining an optimum scan interval equal to a specified scan duration during which the predicted tissue enhancement function is the greatest.

7. The method of claim 6 wherein the step of determining the optimum scan interval includes integrating the predicted enhancement function for successive intervals equal to the specified scan duration and selecting an interval having the greatest integration value as the optimum scan interval.

8. The method of claim 1, further comprising the steps of:

predicting prior to injecting the contrast agent a regional enhancement level as a function of an elapsed time after injection for a region of interest in the patient based on the patient specific parameters and specified injection protocol;

initiating the injection protocol;

sequentially measuring an actual enhancement level in the region of interest at predetermined elapsed times after initiating the injection to generate an actual regional enhancement function;

calculating a correction factor based on the relationship between the predicted regional enhancement function and the actual regional enhancement function; and

using the correction factor to calibrate the predicted tissue enhancement function.

9. The method of claim 8 wherein at least one of the plurality of patient specific parameters has an unknown value and wherein the step of predicting a regional enhancement function includes the steps of:

providing a mathematical model of a cardiovascular system, the model mathematically describing transport of the contrast agent through the cardiovascular system;

inputting a plurality of alternatives for the unknown patient parameter into the model to generate a set of alternative regional enhancement functions with the set comprising a member for each alternative; and

selecting a predicted regional enhancement function from the set of alternative regional enhancement functions.

10. The method of claim 9 wherein the step of selecting a predicted regional enhancement function from the set of alternative regional enhancement functions comprises the steps of:

comparing the actual regional enhancement function to the members of the set of alternative regional enhancement functions; and

selecting from the set of alternative regional enhancement functions the member which most closely resembles the actual enhancement function.

11. The method of claim 10 wherein the step of selecting the member from the set of alternative regional enhancement functions includes the steps of:

graphing the members of the set of alternative regional enhancement functions;

graphing the actual regional enhancement function;

integrating the actual regional enhancement graph from start to a predetermined time after injection;

determining which member of the alternative regional enhancement graphs at the predetermined time has an integrated area closest to the integrated area of the actual regional enhancement graph at the predetermined time.

12. The method of claim 9 wherein the tissue to be scanned is distinct from the region of interest and wherein the step of using the correction factor to calibrate the predicted tissue enhancement function includes the steps of:

inputting into the mathematical model the alternative chosen for the unknown patient parameter which was used to generate the predicted regional enhancement function; and

generating a revised predicted tissue enhancement function.

13. The method of claim 12 wherein the step of determining a set of parameters for an optimum scan includes the step of:

using the revised predicted tissue enhancement function to determine an optimum scan delay to cause the onset of the scanning of the tissue to coincide with a threshold enhancement level in the tissue.

14. The method of claim 8 wherein the step of sequentially measuring an actual enhancement level is performed using low-dose pre-scanning of the region of interest.

15. The method of claim 9 wherein the region of interest is the tissue to be scanned.

16. The method of claim 9 wherein said mathematical model is embodied in a computer program.

17. A contrast injector system comprising:

a contrast injector;

a computer having a memory connected to said contrast injector for controlling its operation; and

a computer program in said computer memory, said computer program having means for predicting a structure specific CT enhancement level in a patient having a specific patient habitus based on a specified injection protocol.

18. The contrast injector of claim 17, wherein said computer program comprises:

means for predicting prior to implementing the injection protocol a tissue enhancement level as a function of elapsed time based on the injection protocol and the specific patient habitus; and

means for determining an optimum injection flow rate and an optimum contrast volume based on the predicted tissue enhancement level.

19. The contrast injector of claim 18 wherein the computer program further comprises:

means for accepting an input including a revised injection rate and a revised contrast volume;

means for revising the predicted tissue enhancement level based on the revised injection flow rate and the revised contrast volume.

20. The contrast injector of claim 19 wherein the computer program includes means for implementing the injection protocol using the revised injection flow rate and revised contrast volume.

21. The contrast injector of claim 20 wherein the contrast injector is in communication with a computed tomography machine and wherein the computer program includes means for signaling the computed tomography machine to perform a scan.

22. A computed tomography system for scanning a tissue in a patient, the patient having a plurality of patient specific parameters, wherein the tissue to be scanned is enhanced with an intravascularly injected contrast agent, the system comprising:

a computed tomography machine;

an injector system in communication with the computed tomography machine;

a computer having a memory, the computer in communication with both the injector system and the computed tomography machine for coordinating their operation; and

a computer program in the computer memory, the computer program having means for predicting prior to injecting the contrast agent a tissue enhancement level for the tissue based on the patient specific parameters and a selected injection protocol.

23. The system of claim 22 wherein the computer program includes:

means for determining an optimum injection protocol for injection of the contrast agent; and

means for implementing the optimum injection protocol.

24. The system of claim 22 further comprising means for monitoring actual regional enhancement levels in a region of interest in the patient after initiation of the injection protocol.

25. The system of claim 24 wherein the computer program includes means for receiving and analyzing the regional enhancement levels to thereby confirm the predicted tissue enhancement level.

26. The system of claim 25 wherein the computer program includes means for revising the predicted tissue enhancement level based on the regional enhancement level.

27. A computer being programmed for predicting a structure specific CT enhancement level in a patient for a given patient habitus and a specific contrast injection protocol comprising:

a computer having a memory;

a computer program in said memory, the program having means for accepting patient specific information and contrast specific information which affect physiological parameters of contrast enhancement and means for computing and outputting structure specific enhancement levels as a function of an elapsed time after injection.

28. The computer of claim 27 wherein the computer program further comprises:

means for optimizing the injection protocol to thereby cause at least a threshold contrast enhancement level over a predetermined scan duration; and

means for communicating the optimum injection protocol to an injector.

29. The computer of claim 27 wherein the computer program includes:

means for determining a set of scan parameters for an optimum scan based on the computed enhancement levels;

means for communicating the set of scan parameters to a CT scan machine.

30. The computer of claim 27 wherein the computer program includes means for monitoring actual enhancement levels in a region of interest to thereby confirm the computed enhancement levels.

31. A method for determining an injection protocol for injecting a contrast agent into a patient for enhancing a tissue desired to be scanned with computed tomography, the method comprising the steps of:

generating a plurality of predicted tissue enhancement functions based on different patient parameters; and

selecting one of said predicted tissue enhancement functions as being close to expected based upon feedback from a low dose scan of a region of interest.

32. The method of claim 31 wherein the selecting step includes the steps of generating from said low dose scan an actual tissue enhancement function of said region of interest, integrating said actual tissue enhancement function over a predetermined time period, comparing said integrated value with corresponding integrated values for each of the predicted tissue enhancement functions and selecting as desired the predicted tissue enhancement function with the closest integrated value.

33. The method of claim 32 further comprising the steps of determining a patient parameter based upon the selected predicted tissue enhancement function, and determining a predicted tissue enhancement function for the tissue to be scanned based at least in part on said determined patient parameter.

34. The method of claim 31 wherein the low dose scan is of a tissue different than the tissue desired to be scanned.

37. The method of claim 31 further comprising the steps of implementing said method in a computer, and performing a CT scan using said determined injection protocol.

35. A method for determining an injection protocol for injecting a contrast agent into a patient for enhancing a tissue desired to be scanned with computed tomography, the method comprising the steps of:

generating a predicted tissue enhancement function;

selecting a threshold level; and

adjusting the injection protocol until the tissue enhancement function remains greater than the threshold level for a time period at least equal to a desired scan duration.

36. The method of claim 35 further comprising the steps of determining an optimal scan start time and end time by integrating the tissue enhancement function for successive scan duration intervals contained within the portion wherein the threshold is exceeded, and choosing as optimal the integrated interval having the greatest value.

38. The method of claim 35 further comprising the steps of implementing said method in a computer, and performing a CT scan using said determined injection protocol.