CN114677492B - Coronary microcirculation hemodynamics simulation analysis method and device - Google Patents
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Abstract
本发明公开了一种冠状动脉微循环血流动力学仿真分析方法及装置，包括以下步骤：1)获取对象的冠状动脉CT血管造影图像；2)基于对象特定的冠状动脉CT血管造影图像，进行冠状动脉三维重建，得到对象相应的冠状动脉三维几何模型；3)对所述的冠状动脉三维几何模型进行网格划分及边界条件设定；4)实测冠状动脉全部或部分分支IMR值，根据对象实测IMR值对上述边界条件进行修正；5)对所述的冠状动脉三维几何模型进行血流动力学仿真分析，计算和可视化所述的冠状动脉三维几何模型的血流速度分布和压力分布，实现对象整个冠状动脉微循环系统全面展示。本发明将IMR值与计算流体力学相结合，降低了有创手术的医疗风险和手术成本。
The present invention discloses a coronary microcirculation hemodynamics simulation analysis method and device, comprising the following steps: 1) obtaining a coronary CT angiography image of an object; 2) based on the coronary CT angiography image specific to the object, performing a three-dimensional reconstruction of the coronary artery to obtain a corresponding three-dimensional geometric model of the coronary artery of the object; 3) performing grid division and boundary condition setting on the three-dimensional geometric model of the coronary artery; 4) measuring the IMR value of all or part of the branches of the coronary artery, and correcting the above boundary conditions according to the measured IMR value of the object; 5) performing hemodynamics simulation analysis on the three-dimensional geometric model of the coronary artery, calculating and visualizing the blood flow velocity distribution and pressure distribution of the three-dimensional geometric model of the coronary artery, and realizing a comprehensive display of the entire coronary microcirculation system of the object. The present invention combines the IMR value with computational fluid dynamics, reducing the medical risks and surgical costs of invasive surgery.
Description
Technical Field
The invention relates to the field of hemodynamic simulation analysis, in particular to a method and a system for simulated analysis of coronary microcirculation hemodynamic.
Background
Methods for clinically assessing the state of coronary microcirculation are largely divided into non-invasive and invasive types. The noninvasive evaluation is mainly performed by methods such as transthoracic Doppler echocardiography, single photon emission computer tomography, myocardial magnetic resonance imaging and the like, but the noninvasive evaluation method is greatly influenced by the level of operators, the resolution of equipment and the technical means, and is difficult to accurately evaluate the microcirculation state.
The pressure guide wire is utilized to invasively measure the microcirculation resistance index (Index ofMicrocirculatory Resistance, IMR) so as to quantitatively evaluate the coronary microcirculation resistance, is not easily influenced by the change of the hemodynamics, has the advantages of good repeatability, strong specificity, high reliability and the like, and becomes a gold standard for evaluating the coronary microcirculation diseases clinically.
The pressure guide wire mainly used in clinic at present is provided with a baroreceptor and a temperature-sensitive receptor at a position 3cm away from the tail end, and the guide wire body is provided with another temperature-sensitive receptor. The guidewire was delivered to the distal epicardial coronary artery and baroreceptor readings (Pd) were recorded. By directing the catheter to inject normal saline at room temperature, the time (T) between two temperature-sensitive receptors of the liquid is recorded according to a thermal dilution curve, and the product of Pd and T is the IMR. The IMR measurement operation is complex, only the IMR corresponding to a certain blood vessel is generally measured clinically, and even if the IMR of a plurality of blood vessels is measured, the whole coronary microcirculation system of the subject is difficult to comprehensively evaluate.
Disclosure of Invention
In view of the above, the invention provides a simulation analysis method and device for coronary artery microcirculation hemodynamics, aiming at the problem of difficult overall evaluation of the state of the whole coronary artery microcirculation system in the prior art.
In a first aspect, a method for simulating and analyzing coronary artery microcirculation hemodynamics includes the steps of:
1) Acquiring a coronary artery CT angiography image of a subject;
2) Based on the CT angiography image of the specific coronary artery of the object, carrying out three-dimensional reconstruction of the coronary artery to obtain a three-dimensional geometrical model of the coronary artery corresponding to the object;
3) Performing grid division and boundary condition setting on the three-dimensional geometric model of the coronary artery;
4) The actual measurement of all or part of the branch IMR values of the coronary arteries, and the boundary conditions are corrected according to the actual measurement of the IMR values of the object;
5) And carrying out hemodynamic simulation analysis on the three-dimensional geometric model of the coronary artery, and calculating and visualizing the blood flow velocity distribution and the pressure distribution of the three-dimensional geometric model of the coronary artery to realize comprehensive display of the whole coronary artery microcirculation system of the subject.
Compared with the prior art, the method has the following advantages:
(1) The invention combines the IMR value with computational fluid dynamics, and realizes the hemodynamic simulation of a specific coronary artery microcirculation system of an object through boundary condition correction;
(2) The coronary artery hemodynamic simulation method adopted by the invention can intuitively represent the flow velocity and pressure distribution of the coronary artery, and simultaneously non-invasively measure the hemodynamic parameters such as the flow velocity, the pressure, the coronary artery blood flow reserve, the wall shear stress and the like, thereby reducing the medical risk and the operation cost of invasive operation;
(3) The invention realizes the hemodynamic simulation of the object-specific coronary artery microcirculation system, provides help for explaining the influence of the coronary artery microcirculation change on the hemodynamic parameters such as blood flow, pressure, FFR and the like, and is beneficial to researching the contribution of coronary artery microcirculation disturbance on myocardial ischemia from the aspects of hydrodynamics and coronary artery physiology.
In a refinement, in step 2), the three-dimensional reconstruction of the coronary artery comprises a left coronary artery three-dimensional geometry starting from the left coronary artery inlet and extending to the branching distal end of the left anterior descending branch (LAD) and the left circumflex branch (LCX), and a right coronary artery three-dimensional geometry starting from the right coronary artery inlet and extending to the branching distal end of the Right Coronary Artery (RCA). And identifying and analyzing epicardial stenosis and plaque, and determining the real lumen boundary of the coronary artery to obtain a three-dimensional geometrical model of the coronary artery.
As an improvement, between steps 2) and 3), i.e. after obtaining the object-specific three-dimensional geometric model of the coronary arteries, before meshing, the object-specific three-dimensional geometric model of the coronary arteries is preprocessed by pruning the distal branches with blurry or too small diameters (diameter <1 mm) in view of the resolution of the coronary artery CT angiography images, correcting local error topologies (spikes, hollows, etc.), global smoothing the geometric model, and finally cutting the vessel model perpendicular to the local vessel centerline to generate the inlet and outlet of the coronary artery geometric model as the locations for the inflow and outflow of blood.
As an improvement, in step 3), the meshing and boundary condition setting respectively comprise performing fine meshing, discretizing the model into unstructured tetrahedral units, setting the inlet boundary condition as mean arterial pressure, setting the outlet boundary condition as far-end real microcirculation resistance value, and applying no-slip and solid wall conditions to the vessel wall.
As an improvement, in step 4), the boundary condition correction includes:
a. For simulation of the normal coronary artery microcirculation state of a subject, namely IMR is less than or equal to 25 mmHg.s, the real microcirculation resistance value in the normal microcirculation state is distributed to all branch outlets according to the corrected Mory law, and the corrected Mory law formula is as follows:
wherein, Q 1,Q2,D1,D2 is the flow and diameter of two distal branches at the bifurcation, respectively;
b. Simulation of the subject coronary artery microcirculation disturbance state, i.e. IMR >30 mmHg.s, assigning TMR CMD value under the microcirculation disturbance state to lesion branch outlet, calculation of TMR CMD is based on assumption of IMR and TMR linear relation, and is obtained by multiplying normal TMR value by correction factor lambda, i.e.:
TMRCMD=TMR·λ#
wherein TMR is the real microcirculation resistance value in the normal microcirculation state, lambda is a correction factor, TMR CMD is the microcirculation resistance value in the coronary artery microcirculation disturbance state;
The calculating method of the correction factor lambda is the ratio of the measured IMR value of the object to the normal IMR cut-off value, namely:
Wherein IMR S is the measured IMR value of the subject, IMR n is the normal IMR cut-off value, and in the method, IMR n is defined as 25 mmHg.s.
In a refinement, in step 5), the hemodynamic analysis includes assuming the blood is an incompressible Newtonian fluid, and the computational fluid dynamics (Computational Fluid Dynamics, CFD) modeling is based on an incompressible continuity equation and a Navier-Stokes equation:
And
Wherein, Is the three-dimensional velocity vector of the fluid, ρ is the fluid density, p is the pressure, μ is the blood flow viscosity, and t is the time.
The coronary artery microcirculation hemodynamic simulation analysis device comprises a processor, a memory, a touch display and a power supply, wherein the memory is used for storing instructions, the processor is used for calling the instructions in the memory and executing any one of the first aspect or any one of the possible implementation manners of the first aspect, and the touch display is used for displaying coronary artery CT angiography images, three-dimensional geometric models of the coronary arteries and hemodynamic simulation analysis results and performing interactive operation.
As an improvement, the simulation analysis device for the coronary artery microcirculation hemodynamics further comprises a deep learning module, wherein the deep learning module is used for meshing of the three-dimensional geometric model of the coronary artery, and the rapid and automatic meshing is realized by establishing the deep learning model.
As an improvement, the coronary artery microcirculation hemodynamic simulation analysis device further comprises a 5G communication module, wherein the 5G communication module is used for acquiring a target coronary artery CTA image from the CT imaging equipment in real time and transmitting an analysis result back to the electronic medical record system after the hemodynamic simulation analysis is finished.
Drawings
FIG. 1 is a flow chart of a method of simulated analysis of coronary microcirculation hemodynamics of the present invention;
FIG. 2 is a coronary CT angiography image in an embodiment of the invention;
FIG. 3 is a schematic view of reconstructing a three-dimensional geometric model of a coronary artery in an embodiment of the present invention;
FIG. 4 is a schematic diagram of a three-dimensional geometric preprocessing model of a coronary artery in an embodiment of the invention;
FIG. 5 is a flow velocity profile of a hemodynamic simulation of a microcirculation disturbance in an embodiment of the present invention;
fig. 6 is a pressure distribution of a hemodynamic simulation of a microcirculation disturbance in an embodiment of the present invention.
Detailed Description
The invention will be further described with reference to the drawings and specific examples, but the invention is not limited to these examples only. The invention is intended to cover any alternatives, modifications, equivalents, and variations that fall within the spirit and scope of the invention. In the following description of preferred embodiments of the invention, specific details are set forth in order to provide a thorough understanding of the invention, and the invention will be fully understood to those skilled in the art without such details.
As shown in fig. 1, the hemodynamic simulation method of the coronary artery microcirculation disturbance based on the microcirculation resistance index of the present invention comprises the following steps:
(1) Acquiring a CTA image and an IMR value of an object:
the method comprises the steps of obtaining a plurality of layers of CTA scanning data samples of an object, wherein a 128-layer computed tomography scanner is used for CTA image acquisition, the equipment resolution is 192 x 0.5mm, the scanning matrix is 512 x 512, and a CTA image is stored in a DICOM mode. Measuring the distal coronary pressure P d by using a pressure guide wire with the diameter of 0.014 inch, injecting normal saline into the coronary artery pellets in the maximum hyperemia state, obtaining the average transit time T mn according to a thermal dilution curve, and calculating to obtain an IMR value;
(2) The three-dimensional model reconstruction of the coronary artery of the object CTA image is realized:
And loading CTA data into the chemicals software to reconstruct the three-dimensional geometrical model of the coronary artery of the object. The geometric model includes the ascending aorta, left coronary artery trunk (LMCA), left anterior descending branch (LAD), left circumflex branch (LCX), right Coronary Artery (RCA), and other observable tiny branches. And at the editable three-view interface, using a coronary artery semiautomatic segmentation tool, selecting the position of an aorta at the coronary artery opening as a starting point, selecting the position of the farthest branches of the left and right observable coronary arteries as an ending point, automatically creating a blood vessel path along the trend of the coronary artery blood vessel, and segmenting the lumen of the coronary artery. Based on the difference of CTA image pixel gray values of different tissues, calcified plaques are manually identified and segmented, and finally the model is repaired by operations such as matrix reduction, contour element reduction and the like, so that a real three-dimensional geometrical model of the coronary artery is obtained, as shown in figure 2.
(3) Model preprocessing to obtain a high-quality three-dimensional geometric model of the coronary artery:
The three-dimensional geometrical model of the coronary artery of the object is imported into Geomagic Studio software, the fuzzy or smaller (diameter <1 mm) distal branches are removed, the error geometrical structure such as holes, nails, self-intersection points, triangular faces and the like are modified, and global smoothing processing is carried out. Then, the inlet and outlet of the model are determined, and the blood vessel is cut perpendicular to the central line of the local blood vessel, so that the approximately round coronary inlet and outlet with flat surfaces are obtained.
(4) Grid division and boundary condition setting of a coronary artery model:
The processed coronary artery model was grid-partitioned using ANSYS software, which required to complete the dependency check on grid density, using unstructured tetrahedral grids with a global maximum cell length defined as 3mm and the maximum cell lengths of the model inlet, outlet and vessel walls defined as 0.1mm, and 0.2mm, respectively. Appropriate boundary conditions were assigned at the inlet and outlet of the model, the coronary artery inlet set to an average aortic pressure of 110mmHg and the coronary artery outlet set to the calculated TMR CMD1 value. The no-slip condition applies to the vessel wall.
In one possible embodiment, the clinical measurement of IMR is 78mmhg·s, and the correction factor λ 1 is determined based on the following equation:
Wherein IMR S is a subject-specific clinical IMR measurement, IMR n is a normal IMR cutoff, in this method defined as 25mmhg·s, calculated as λ 1 =3.12.
The true microcirculation resistance value TMR in the normal congestion state was set to 6mmhg·s·ml -1, and TMR CMD1 of this example was calculated as:
TMRCMD1＝λ·TMR＝3.12×6mmHg·s·mL-1＝18.72mmHg·s·mL-1
(5) Numerical method of coronary artery model and CFD simulation:
blood flow simulation was performed using ANSYS software, with blood modeled as an incompressible newtonian fluid, employing an incompressible continuity equation and the Navier-Stokes equation:
wherein, Is the three-dimensional velocity vector of the fluid, ρ is the fluid density, set to 1050kg/m 3, p is the pressure, μ is the blood flow viscosity, set to 0.0035Pa, and t is the time.
And solving a continuity equation and a Navier-Stokes equation through CFD to obtain the flow velocity distribution and the pressure distribution of the coronary microcirculation disturbance model, wherein the flow velocity distribution and the pressure distribution are respectively shown in figures 3 and 4.
The embodiment of the invention provides a simulation analysis device for coronary artery microcirculation hemodynamics, which comprises a processor, a memory, a touch display and a power supply, wherein the memory is used for storing instructions, the processor is used for calling the instructions in the memory and executing any one possible implementation mode of the first aspect or the first aspect, and the touch display is used for displaying coronary artery CT angiography images, a three-dimensional geometric model of the coronary artery and a simulation analysis result of the hemodynamics and performing interactive operation. The coronary artery microcirculation hemodynamic simulation analysis device is communicated with the image archiving and communication system PACS through a network, and can acquire the CTA image of the coronary artery of the subject in real time.
In one possible design, the coronary microcirculation hemodynamic simulation analysis device further comprises a deep learning module, wherein the deep learning module is used for meshing of the three-dimensional geometric model of the coronary artery, and rapid and automatic meshing is realized by establishing the deep learning model.
In one possible design, the coronary artery microcirculation hemodynamic simulation analysis device further comprises a 5G communication module, which is used for acquiring the CTA image of the coronary artery of the subject from the CT imaging device in real time and transmitting the analysis result back to the electronic medical record system after the hemodynamic simulation analysis is finished.
The foregoing is illustrative of the preferred embodiments of the present invention, and is not to be construed as limiting the claims. The present invention is not limited to the above embodiments, and the specific structure thereof is allowed to vary. In general, all changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.
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