Cardiac visualization systems for displaying 3-D images of cardiac voxel intensity distributions with optional physician interactive boundary tracing tools

• US 7,907,759 B2
• Filed: 01/25/2007
• Issued: 03/15/2011
• Est. Priority Date: 02/02/2006
• Status: Active Grant

• Current Assignee: Wake Forest University Health Sciences
• Original Assignee: Wake Forest University Health Sciences
• Inventors: D'Agostino, Ralph B., Hamilton, Craig A., Hundley, William Gregory
• Primary Examiner(s): Ahmed; Samir A
• Assistant Examiner(s): Fitzpatrick; Atiba O
• Application Number:
  US11/626,958
• Publication Number:
  US 20070236491A1
• Time in Patent Office: 1,510 Days
• Field of Search: 382128-134, 128920-930, 250455-465, 356 39- 49, 600407-414, 600424-426, 345581-618
• US Class Current: 382/128
• CPC Class Codes: A61B 5/0044 for the heart
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 6/466 adapted to display 3D data
• 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 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 6/541 involving acquisition triggered by a physiological signal
• CPC Class Codes: G01R 33/283 Intercom or optical viewing arrangements, structurally associated with NMR apparatus
• CPC Class Codes: G01R 33/546 Interface between the MR system and the user, e.g. for controlling the operation of the MR system or for the design of pulse sequences
• CPC Class Codes: G06T 2207/10088 Magnetic resonance imaging [MRI]
• CPC Class Codes: G06T 2207/20104 Interactive definition of region of interest [ROI]
• CPC Class Codes: G06T 2207/30048 Heart; Cardiac
• CPC Class Codes: G06T 7/0012 Biomedical image inspection
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics
• CPC Class Codes: Y10S 128/921 Diet management
• CPC Class Codes: Y10S 128/922 including image analysis
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data
• CPC Class Codes: Y10S 128/924 using artificial intelligence

Abstract

Physician interactive workstations with global cardiac voxel distribution visualization may also include one or more of a 3-D color scale image of a population of voxel in the heart and/or an electronic boundary-tracing tool configured to accept user input to electronically define at least one boundary of a target region of a heart in a medical image of a patient on a display. The workstation may be configured to evaluate intensity of voxels associated with tissue within the defined boundary of the target region of the heart whereby cardiotoxicity is evaluated.

Claims

1. A physician interactive workstation, comprising:

an interactive physician workstation;

a display in communication with the workstation, the display configured to show a 3-D diagnostic image of a patient'"'"'s heart illustrating substantially an entire population of voxels obtained from different CT or MRI slices, wherein voxel intensities are quantified and visually indicated in the 3-D image in color scale so that similar voxel intensities have similar color to visually emphasize the distribution of injured and/or dead cells,

wherein the display is configured to display a plurality of voxel intensity histograms of a plurality of regions of interest in the heart, the voxel intensity histograms defining voxel data used to generate the 3-D image of the heart, the plurality of voxel intensity histograms being selectively viewable by a clinician, and

wherein the display is configured to selectively present a 2-D compartmentalized model of the heart with a plurality of adjacent compartments in at least two of the following;

apical, mid and basal short axis slices of the heart, wherein voxel data from the histograms are used to populate the compartments of the model with measures of voxel intensity to provide visual data to allow a clinician to identify cell injury, cell death, cardiac injury and/or predict a likelihood of a negative cardiac event.

2. A workstation according to claim 1, wherein the workstation is configured to display a CMR (cardio Magnetic Resonance) medical image of the patient'"'"'s heart, and wherein the workstation further comprises an electronic boundary tracing tool configured to accept user input to electronically define at least one boundary of a target region of a heart in the medical image of the patient on the display.

3. A workstation according to claim 2, wherein the workstation is configured to evaluate intensity of voxels associated with tissue within the defined boundary of the target region of the heart to provide voxel intensity data used to generate the 3-D image and evaluate cardiotoxicity.

4. A workstation according to claim 3, wherein the electronic boundary tracing tool is configured to accept user input to define a plurality of adjacent regions of interest in a left ventricle myocardium, and wherein the workstation is configured to analyze a chemotherapeutic induced cardiotoxicity state of the patient based on intensity voxel data associated with the regions of interest.

6. A workstation according to claim 2, wherein the electronic boundary tracing tool is configured to accept user input to define a region of interest associated with background noise in the air, whereby voxel intensity data from the background noise region of interest is subtracted from voxel intensity data associated with the left ventricle.

7. A workstation according to claim 2, wherein the electronic boundary tracing tool comprises a graphic user interface (GUI).

8. A workstation according to claim 7, wherein the GUI is configured to accept freehand input of a user whereby the electronic tool traces the boundary based on the freehand manual input of the user.

9. A workstation according to claim 7, wherein the GUI is configured to provide at least one electronically selectable line or curve that can overlay a boundary of the target region of the heart, the electronically selectable line or curve having an electronically adjustable shape and/or size.

10. A workstation according to claim 7, wherein the line or curve comprises at least one electronically selectable closed spline curve that is electronically adjustable in shape and size using electronic control handles.

11. A workstation according to claim 7, wherein the GUI is configured to provide electronically selectable points that can be electronically placed along the boundary of the target region, wherein when the points have been positioned by the user on tissue associated with the target region in the heart, the system electronically connects the points to define the boundary.

12. A workstation according to claim 2, wherein the electronic tool is configured to trace regions of interest associated with a left ventricle myocardium in a left ventricular short axis CMR (cardio Magnetic Resonance) image view.

13. A workstation according to claim 1, wherein intensity voxel data in different compartments is derived from region of interest histograms of voxel intensity data and is spatially allocated to and visually illustrated in a visualization of a corresponding standardized compartment, wherein the model includes a plurality of different standardized segments for each of apical, mid and basal short axis slices of the heart.

14. A workstation according to claim 1, wherein the display is in communication with a cardiotoxicity status module that indicates whether an oncology patient has or is likely to have cardiotoxicity induced cardiac injury based on a voxel intensity distribution pattern in the 3-D image.

15. A workstation according to claim 14, wherein the cardiotoxicity status module is configured to predict a likelihood of cardiac injury based on locations of clusters of voxels of defined intensities associated with a future predicted decrease in LVEF when chemotherapy continues as currently administered.

21. A workstation according to claim 1, wherein the 2-D compartment model is a standardized 17-segment compartment model of a heart populated with voxel intensity data of the patient.

24. A workstation according to claim 1, wherein the 3-D image can identify a global cardiac injury associated with at least one of the following:

cardiotoxicity-induced cardiac injury, viral cardiomyopathy, alcoholic cardiomyopathy, postpartum cardiomyopathy and idiopathic dilated cardiomyopathy.

5. A physician interactive workstation, comprising:

an interactive physician workstation;

a display in communication with the workstation, the display configured to show a 3-D diagnostic image of a patient'"'"'s heart illustrating substantially an entire population of voxels obtained from different CT or MRI slices, wherein voxel intensities are quantified and visually indicated in the 3-D image in color scale so that similar voxel intensities have similar color to visually emphasize the distribution of injured and/or dead cells,

wherein the workstation is configured to display a CMR (cardio Magnetic Resonance) medical image of the patient'"'"'s heart, wherein the workstation further comprises an electronic boundary tracing tool configured to accept user input to electronically define at least one boundary of a target region of a heart in the medical image of the patient on the display, and wherein the electronic boundary tracing tool is configured to allow a user to draw an annulus encompassing a left ventricle myocardium as two separate closed curves such that an inner boundary line is drawn about an endocardial surface and an outer boundary line is drawn about an epicardial surface.

16. A method to present global injury data to a clinician, comprising:

quantifying intensities of substantially an entire population of voxel composition of heart muscle of a heart of a patient from a plurality of different CT or MRI slices;

identifying x, y and z coordinates of the quantified voxels;

generating a color scale 3-D image of the heart on a display using the identified coordinates and the corresponding quantified intensities of the voxels, the image visually illustrating in color a distribution of injured and/or dead cells in the 3-D image of the heart; and

accepting user input via a display with a Graphic User Interface (GUI) boundary tracing tool to draw an annulus encompassing a left ventricle myocardium on a CMR (cardio Magnetic Resonance) medical image as two separate closed curves such that an inner boundary line is drawn about an endocardial surface and an outer boundary line is drawn about an epicardial surface to electronically define at least one boundary of a target region of a heart in the medical image of the patient on the display.

17. A method according to claim 16, further comprising generating a visual 2-D compartmental model of the heart illustrating the different intensities of the population of voxels within respective compartments of the heart, wherein the model includes a plurality of different standardized segments for each of apical, mid and basal short axis slices of the heart.

23. A method according to claim 17, wherein the model is a standardized 17 segment model of the heart.

25. A method according to claim 16, further comprising identifying a global cardiac injury associated with at least one of the following using the 3-D image:

cardiotoxicity-induced cardiac injury, viral cardiomyopathy, alcoholic cardiomyopathy, postpartum cardiomyopathy and idiopathic dilated cardiomyopathy.

18. A system for non-invasively evaluating cardiac injury due to cardiotoxicity:

a signal processor circuit configured to generate a 3-D image of voxel data of a patient'"'"'s heart that visually illustrates, in color scale, differences in intensity of voxels associated with the heart and locations and intensity of clusters of voxels with similar intensity across at least a major portion of a population of voxels obtained from slices of a CMR or CT image of a patient'"'"'s heart, wherein voxels of intensity representing cell injury and cell death are visualized, and wherein the signal processor generates the 3-D image using a measure of intensity of the voxels correlated to corresponding x, y and z coordinates from the image slices,

wherein the signal processor circuit is configured to generate a plurality of voxel intensity histograms of a plurality of regions of interest in the heart, the voxel intensity histograms defining voxel data used to generate the 3-D image of the heart, the plurality of voxel intensity histograms being selectively viewable by a clinician,

wherein the signal processor circuit is configured to selectively present a 2-D compartmentalized model of the heart on a display, the model having with a plurality of adjacent compartments in at least two of the following;

apical, mid and basal short axis slices of the heart, and wherein the voxel data from the histograms are used to populate the compartments of the model with measures of voxel intensity to provide visual data to allow a clinician to identify cell injury, cell death, cardiac injury and/or predict a likelihood of a negative cardiac event.

19. A system according to claim 18, wherein the signal processor circuit is further configured to:

accept user input using a GUI comprising an electronic boundary tracing tool to allow a user to draw an annulus on a display that encompasses a left ventricle myocardium as two separate closed curves such that an inner boundary line is drawn about an endocardial surface and an outer boundary line is drawn about an epicardial surface, wherein the histograms are generated

based on boundary data from the boundary lines drawn with the GUI; and

electronically determine a likelihood of cardiac injury due to cardiotoxicity based on data from at least one of the histograms.

20. A system according to claim 18, wherein the 2-D compartment model includes a plurality of different standardized segments for each of apical, mid and basal short axis slices of the heart.

22. A system according to claim 18, wherein the 2-D compartment model is a 17 compartment model of the heart populated with patient voxel intensity data.

26. A system according to claim 18, wherein the signal processor is configured to identify a global cardiac injury associated with at least one of the following using the 3-D image:

cardiotoxicity-induced cardiac injury, viral cardiomyopathy, alcoholic cardiomyopathy, postpartum cardiomyopathy and idiopathic dilated cardiomyopathy.