JP5537072B2 - Medical image display apparatus and X-ray CT apparatus - Google Patents

Description

  The present invention relates to a medical image display device that displays changes over time of a region of interest as a single image based on image data captured continuously or intermittently using a contrast agent, and this medical image display The present invention relates to an X-ray CT apparatus provided with the apparatus.

  An observation site of a subject imaged by a medical imaging apparatus such as an X-ray CT apparatus or a magnetic resonance imaging apparatus is drawn as a two-dimensional image or a three-dimensional image on a computer terminal through image processing. However, the subject does not always maintain the same state, and the shape and pixel value of the portion to be rendered change with the passage of time as the organ moves due to the heartbeat or peristalsis.

  In the case of suspected hepatocellular carcinoma such as an organ with a lesion accompanying the change over time, a contrast medium is injected into the blood vessel of the subject, and a large number of images are continuously or intermittently in the same region. Is taken. Based on the captured images, the lesions in the organs can be discovered or observed by observing differences in the degree of penetration of the contrast medium that travels in the bloodstream and reaches the target organ. It has been carried out to determine whether it is benign or malignant (for example, see Patent Document 1).

  The method of continuously obtaining images of the target site using a contrast agent is called dynamic scanning, and the amount, concentration, injection speed, and imaging timing after injection are used to obtain a temporal image suitable for observation. Ingenuity has been paid. Usually, when a certain time has passed after the injection of the contrast medium (for example, between 10 seconds to several minutes), that is, it is estimated that the contrast medium reaches the target site and the desired phase image is obtained. Scanning is performed by irradiating X-rays at the timing.

  There are various theories as to which timing is best to obtain an image, but as an example, a case where dynamic scanning is applied to diagnosis in the liver region will be described.

When the temporal change of the CT value due to the contrast agent is observed at the site of interest such as the liver, when the contrast agent reaches the observation site after the injection of the contrast agent, the CT value of that site increases rapidly. Will fall. This time variation of the CT value is referred to as TDC (Time Density Curve). If the horizontal axis is time, and the vertical axis is the increase unit (EU) of the CT value, FIG. 11 is obtained. Note that the TDC peak is referred to as the first phase, and the passage of a certain time after the peak is referred to as the latter phase. FIG. 11 shows two types of TDCs, TypeA and TypeB. In Type A, when the CT value peak in the early phase passes, the CT value suddenly decreases and becomes gentle, and in the late phase, the CT value becomes low. On the other hand, Type B does not show a rapid decrease in CT value even after the peak, and continues to maintain a high CT value even in the later phase, and it takes time until the CT value decreases. Therefore, when the CT values of a certain site of interest (site suspected of being a lesion) in the early phase and the late phase are displayed in shades, it can be seen that there are two types as shown in FIG. Here, FIG. 12A shows Type A in which the CT value in the early phase is high but the CT value in the late phase is low, and FIG. 12B shows that the CT value in the early phase is high and continues in the late phase. Type B that maintains a high CT value is shown.

  As shown in FIG. 13, such a state is displayed as a difference in CT values of a part suspected to be a lesion (a target part) even if the images have the same cross section. That is, FIG. 13A is a cross-sectional image of the early phase, and FIG. 13B is a cross-sectional image of the late phase. “A” indicates Type A, and two “B” and “C” at both ends indicate Type B. Therefore, in the image obtained at the timing of the early phase and late phase taken at the optimal time for observation, the observer should indicate a state close to either Type A or Type B for the site suspected of being a lesion (attention site). The nature of the lesion is differentiated by seeing it. Incidentally, it is said that malignant tumors exhibit Type A appearance, and benign hemangiomas and the like exhibit Type B appearance.

JP-A-10-127621

  Recently, the X-ray CT apparatus has made it possible to perform high-speed scanning (eg, 0.35 seconds) in multiple slices by increasing the number of rows of X-ray detectors (eg, 320 rows). In addition, images of multiple time phases and multiple slices can be obtained continuously by dynamic scanning. However, if there are multiple sites of interest in those images, especially when they are in a position where they cannot be displayed on a single cross-section, or when the time phase presenting the state desired for diagnosis is not the same, The problem was supposed to arise.

That is,
[1] It is necessary to search for at least two images displaying the region of interest from the early phase and the late phase, and observe each image.

[2] When there are a plurality of sites of interest, the first phase and the later phase must be observed for a plurality of sites of interest, which is complicated.

[3] If the site of interest is not on the same cross section, many images must be extracted and observed, which is further complicated.

[4] If there is no best contrast state at the same time phase, it becomes more complicated, or if it is not noticed, there is a risk that accurate discrimination will be hindered.

  For this reason, an observer (for example, a doctor who interprets images) changes the display section of the image, or sends and returns the image many times to change the time phase, and displays the images one by one for observation. Therefore, a long time is required for diagnosis, and the burden on the observer increases.

  The present invention has been made to solve such problems.

To solve the problems in the above, the invention of claim 1 includes an image data storage means a plurality of image data save obtained continuously or intermittently for a predetermined time by injecting a contrast medium, this ROI setting means for setting a ROI common to the plurality of image data for at least one of the plurality of image data stored in the image data storage means, and within the ROI set by the ROI setting means A time-varying image creating means for creating a time-varying image in which the pixel values are extracted for each of the plurality of image data, and an image based on the extracted pixel values is arranged in a band shape over time, and the time-varying image creation The time-varying image created by the means
And a display means for displaying the medical image display device.

The invention described in Claim 7 is the by injecting a contrast medium X-ray CT apparatus for obtaining continuously or intermittently a plurality of image data for a predetermined time, the image data save the plurality of image data A storage means, a ROI setting means for setting a ROI common to the plurality of image data for at least one of the plurality of image data stored in the image data storage means, and the ROI setting means A time-varying image creating means for extracting pixel values within the set ROI, creating a time-varying image in which images based on the extracted pixel values are arranged in a band shape over time, and the time-varying image creating means And a medical image display device having display means for displaying the time-varying image .

  According to the first or sixth aspect of the present invention, since the state change of the site of interest with the passage of time is displayed as an image, the state can be intuitively grasped. Further, even when there are a plurality of sites of interest and these sites of interest are not on the same cross section, they can be observed simultaneously. Therefore, it is possible to shorten the time taken for interpretation, and to greatly reduce the burden on the doctor who interprets the interpretation.

It is a functional block diagram which shows the structure of the X-ray CT apparatus as one Embodiment of this invention. It is explanatory drawing of the cross-sectional image by which ROI was set to the attention site | part. It is explanatory drawing of the image which arranged and displayed the image in ROI for every passage of time. It is explanatory drawing which showed the cross-sectional image in which ROI was set about the beginning of imaging | photography start, and after a predetermined time passes from imaging | photography start. It is explanatory drawing explaining displaying a time-change image about three different ROIs on one screen. It is explanatory drawing explaining the line segment set to ROI. It is the flowchart explaining the flow of a process until a time-change image is produced and displayed. FIG. 7 is a flowchart specifically illustrating ROI setting steps. It is explanatory drawing which showed an example of the display screen which displayed the time-change image with 2D image. It is explanatory drawing which showed an example of the display screen which displayed the time-change image with the MPR image. It is a characteristic figure explaining time change of CT value by injection of contrast media. It is explanatory drawing explaining the difference in the lightness and darkness of the image obtained by a first phase and a latter phase. It is explanatory drawing explaining the difference in the cross-sectional image in a first phase and a latter phase.

  Hereinafter, an embodiment of a medical image display apparatus and an X-ray CT apparatus according to the present invention will be described in detail with reference to FIGS.

  In the diagnosis of a subject using an X-ray CT apparatus, dynamic imaging using a contrast agent is performed on a portion suspected of being a lesion in order to observe not only the morphology but also the temporal blood flow dynamics. We may pay attention to how it is dyed by the agent and how it changes after it is strongly dyed. In general, in the abdomen, especially in the liver, etc., the difference in staining changes between the early phase and the late phase indicates whether the suspected tumor site is benign such as hemangioma or malignant such as hepatocellular carcinoma It is considered as one of the materials that do An image used for such a diagnosis may use a plurality of time phases as well as data of a certain temporary phase. Further, the attention site is not limited to one location, and may be a plurality.

  With the advent of multi-slice, high-speed scanning X-ray CT systems using multi-row X-ray detectors, information in four dimensions including the time axis as well as two and three dimensions can be obtained from the subject. It became so. However, it is difficult to intuitively grasp the four-dimensional concept, and the method of expression is being questioned along with the management of a huge amount of data.

  Therefore, in the present invention, using a plurality of volume data connected in the time direction, that is, 4D volume data, the temporal change of the region of interest is expressed as a two-dimensional image including the time axis, and the position in the slice direction. It is intended to generate an image that allows a user to intuitively capture four-dimensional data by simultaneously displaying a plurality of regions of interest that are different from each other on the same screen.

  FIG. 1 is a functional block diagram showing a configuration of an X-ray CT apparatus as an embodiment of the present invention. The X-ray CT apparatus 10 is roughly composed of a scan unit 10a and a console unit 10b. ing.

  The scan unit 10a irradiates the subject P with X-rays, collects X-ray projection data transmitted through the subject P, and outputs the collected data to the console unit 10b. A generator 2, an X-ray detector 3, and a data acquisition unit (DSA) 4 are provided.

  The X-ray tube 1 is a device that generates X-rays irradiated to the subject P, and the X-ray detector 3 is a device that detects X-rays transmitted through the subject P. The X-ray tube 1 and the X-ray detector 3 are fixed to a rotating ring (not shown) that rotates continuously at a high speed at positions facing each other with the subject P in between.

  The high voltage generator 2 is a device that generates X-rays by supplying a tube current and a tube voltage to the X-ray tube 1 according to a control signal from the console unit 10b. The data collection unit 4 is a device that amplifies the X-ray detection signal detected by the X-ray detector 3 and converts it into a digital signal, and the converted digital signal is output to the console unit 10b as raw data.

  The console unit 10b is a device that receives raw data from the scan unit unit 10a and creates and displays an image of the subject P. The console unit 10b includes a control device 20, a display device 30, an input device 40, and an image processing device 100. Yes.

  The control device 20 is a device that organically controls each device constituting the scan unit portion 10a and the console portion 10b with a CPU as a main body, and the display device 30 is a display device composed of a liquid crystal panel, a display, etc. An image created by the processing apparatus 100 is displayed. The input device 40 is an input device having a keyboard, a mouse, and the like, and is used for designating an image to be displayed and an image to be selected, a region of interest (ROI) for creating a time-change image to be described later, and the like. Is done.

  The image processing apparatus 100 is an apparatus that processes the raw data collected by the scan unit 10a to create and store image data of the subject P, and includes an image database 110, a preprocessing unit 120, and a reconstruction unit 130. An image processing unit 140 and a time-change image creating unit 150.

  The image database 110 is a database that stores raw data collected by the scan unit 10a, 4D volume data created from the raw data, and the like, and stores a plurality of image data created for each scan. The preprocessing unit 120 performs correction processing on the raw data output from the scan unit unit 10a to generate projection data, and the reconstruction unit 130 reconstructs image data from the projection data generated by the preprocessing unit 120. Perform the process. The image processing unit 140 is a processing unit that reads the 4D volume data stored in the image database 110 and calculates the change in density (EU) of the image in the ROI designated by the input device 40. Based on the data in the ROI processed by the image processing unit 140, the image creation unit 150 creates an image that changes over time with time. In addition, when a plurality of ROIs are designated, a time-change image is created for all ROIs.

  Next, the concept of creating and displaying a time-varying image from image data obtained by dynamic scanning in the X-ray CT apparatus configured as described above will be described.

  It is assumed that 4D volume data connected in the time direction obtained by dynamic scanning is already stored in the image database 110. Therefore, first, a cross-sectional image in which the site of interest is displayed is read from the image database 110 and displayed on the display device 30. FIG. 2A shows an example of a cross-sectional image displayed on the display device 30. This cross-sectional image may be a 2D image, or a cross-sectional conversion (MPR: multi-planar) such as a coronal image, a sagittal image, or an axial image. reconstruction) images. Then, an ROI as shown in FIG. 2B is set for the target region of the cross-sectional image. If there are a plurality of sites of interest, a plurality of ROIs are set, and three ROIs are set in the 2D image, as indicated by reference signs ROI1, ROI2, and ROI3 in FIG.

  By setting the ROI, an image at the position of the internal line is extracted to the image processing unit 140. Thereafter, the image processing unit 140 calculates and extracts the density change of the image at the position of the internal line for the same ROI with the passage of time for the image at the same cross-sectional position. If the images extracted by the image processing unit 140 are displayed side by side as time elapses, a time-change image as shown in FIG. 3 is obtained. Here, FIG. 3 (a) is an image extracted at a position surrounded by a certain ROI and displayed side by side along the time axis, and FIG. 3 (b) is at the position of the line of that ROI. Only images are extracted and displayed side by side in the same way. As described above, according to FIG. 3, it can be seen that the contrast medium is lost and the density of the image is changing with the passage of time.

  Note that the time-varying image shown in FIG. 3 is displayed as an intermittent image although it is along the passage of time. Therefore, when a time-change image as shown in FIG. 3B is created when the number of tomographic images collected with the passage of time is large, the image should be a continuous belt-like image along the time axis. Based on this, in the present invention, the time-varying image creation unit 150 displays a time-varying image on the same screen at the same time even for a plurality of ROIs or when those ROIs are in a position where they cannot be displayed on one cross section. Making it possible.

  FIG. 4 shows a cross-sectional image similar to FIG. 2A in which the ROI is set. FIG. 4A is a cross-sectional image at the beginning of imaging, that is, the previous phase, and FIG. It is a cross-sectional image of the latter phase when 30 seconds have passed. Here, when the contrast agent flows into the ROI1, ROI2, and ROI3 portions shown in FIG. 4 (a), the CT value of that portion increases. On the other hand, when attention is paid to the ROI1, ROI2, and ROI3 portions shown in FIG. 4B, the contrast agent flows out for ROI1 and the CT value of the portion decreases, whereas contrast for ROI2 and ROI3. It can be seen that a high CT value is still shown because the agent remains.

  The change in CT value of each line segment of ROI1, ROI2, and ROI3 with the passage of time is collected and accumulated by the time-change image creating unit 150. Then, if an instruction is given from the input device 40, it is displayed on the display device 30 as a time-change image as shown in FIG. Here, the horizontal axis is time, the height of the time-varying image is the length of the line segment in each ROI, and the CT value of the line segment is represented as the shading of the image. Therefore, the inflow and outflow of the contrast medium in the set ROI portion can be seen as a change in the shade of the image with the passage of time.

  This time-varying image can be simultaneously displayed on the same screen even if the cross-sectional positions are different if an ROI is set in advance for a necessary part. In addition, the magnitude | size (length) and direction (inclination) of ROI can be set suitably. 6 illustrates the types of ROIs, FIG. 6A shows an ROI having one line segment, FIG. 6B shows an ROI having two line segments in different directions, and FIG. (C) shows an ROI having three line segments with different directions. Then, the CT values (pixel values) of the line segments in the set ROI are calculated in order from the end, and when there are a plurality of line segments, the average value or the addition value is obtained.

  Next, the above-described processing flow will be further described with reference to the flowcharts shown in FIGS. FIG. 7 shows an outline of the overall processing flow from extracting the cross-sectional image displaying the region of interest and setting the ROI, and creating and displaying the time-varying image in the set ROI. FIG. 8 shows a process for designating the size, direction, and number of line segments at the time of setting the ROI, and the calculation method when a plurality of line segments are set.

  When performing diagnosis based on image data obtained by dynamic imaging using an X-ray CT apparatus, first, as shown in FIG. 7, the target region of the subject stored in the image database 110 is selected. The included 4D volume data is selected (step 1), and the display mode is determined whether the cross-sectional image to be displayed is a 2D image or an MPR image based on the data (step 2). After the display mode is determined, a cross-sectional image including the region of interest is displayed on the display device 30 in the designated mode (step 3). Therefore, an ROI is set to a particularly notable portion of the displayed cross-sectional image using the input device 40 (step 4). This ROI setting procedure is shown in FIG. 8 and will be described in detail later.

  When the setting of the ROI in step 4 is completed, the above-described time-change image is created from the position of the designated line segment in the ROI (step 5). The time-change image created here is, for example, as shown in FIG. 3B. If the number of tomographic images acquired with the passage of time is large, this time-change image is as shown in FIG. A continuous belt-like image is formed along the time axis. Then, the created time-change image is displayed on the display device 30 together with the cross-sectional image (step 6).

  In this way, a time-change image for one ROI is created and displayed together with a cross-sectional image. When setting a plurality of ROIs, the process proceeds to step 7 and the operations from step 3 to step 6 are repeated. Become. For example, when three ROIs are set for a 2D image, for example, a time-change image as shown in FIG. 5 is created, and this time-change image is displayed on the display device 30 together with the cross-sectional image.

  Returning to step 4, the details of the ROI setting procedure will be described.

  FIG. 8 is a detailed breakdown of the ROI setting procedure in step 4. That is, for the cross-sectional image displayed on the display device 30, the ROI is set at a site of particular interest using the input device 40 (step 41), and then the ROI size is adjusted ( Step 42). Since the ROI size corresponds to the length of the line segment in the ROI, it is determined whether or not this length is appropriate (step 43), and the adjustment in step 42 is repeated until it becomes appropriate. If the length of the line segment becomes appropriate, the process proceeds to step 44, the inclination of the line segment in the ROI is adjusted, and it is determined whether the inclination is appropriate (step 45). Repeat the adjustment at 44.

  Since the inclination of one line segment is determined in step 45, next, in order to set the number of line segments to a desired number, it is determined in step 46 whether the number of line segments in the ROI is a desired number. If it is insufficient, the process proceeds to step 47, where one line segment in the ROI is added, and the inclination of the added line segment is also adjusted in steps 44 and 45. This operation is repeated until the number of line segments in the ROI reaches the desired number, and the process proceeds to step 48 when the desired number is reached.

  In step 48, it is determined whether the number of line segments in the ROI is one or more. If the number of line segments is 1, the CT value of the line segment is created when creating the time-varying image in step 5 shown in FIG. An instruction is issued to the image processing unit 140 so as to calculate (pixel values) in order from the end. On the other hand, if there are a plurality of line segments in the ROI, the process proceeds to step 49 to determine whether the calculation of the CT value (pixel value) is an addition value or an average value for all the line segments. To step 5.

  Thus, for example, if three ROIs (ROI1, ROI2, ROI3) are set in a 2D image and a time-varying image for each ROI is created, a time-varying image as shown in FIG. The 2D image is displayed on the display device 30 as shown in FIG. 9, for example. Further, if three ROIs (ROI1, ROI2, ROI3) are set in the MPR image and a time-varying image for each ROI is created, the MPR image is displayed on the display device 30 as shown in FIG. At the same time, a time-change image is displayed.

  In FIG. 9 and FIG. 10, a slider with a triangle is displayed on the time axis of the time-varying image. However, the 2D image and the MPR image displayed on the screen have the time phase indicated by the slider. It is a thing. Then, by specifying the time phase by moving the slider to the left or right, it is possible to display the 2D image or MPR image of that time phase.

  As described above in detail, according to the present invention, since the change in state of the region of interest over time is displayed as a two-dimensional image, an observer such as a doctor can intuitively grasp the situation. it can. In addition, when there are multiple sites of interest, especially when they are in a position where they cannot be displayed on one cross-section, or when the time phases presenting the states to be used for diagnosis are not the same, which position and which time phase Can be displayed as a time-varying image on one screen.

  Therefore, it becomes extremely easy to distinguish the nature of the lesioned part from the temporally-changed image and the site of interest suspected to be a lesion, and the burden on the observer can be greatly reduced. Furthermore, even if the contrast density peak is short, the time-varying image can be observed without missing the optimal timing, so if the amount of contrast agent is determined based on the previous phase, the amount of contrast agent used Can be reduced.

  The present invention is not limited to the above-described embodiment, and can be implemented with various modifications within the scope of the gist. For example, the number of ROIs is not limited to three, and any number may be set, and a band-like time-change image may be created and displayed for the set ROI.

DESCRIPTION OF SYMBOLS 10 X-ray CT apparatus 20 Control apparatus 30 Display apparatus 40 Input apparatus 100 Image processing apparatus 110 Image database 140 Image processing part 150 Time-change image preparation part

Claims (7)

An image data storage means a plurality of image data save obtained continuously or intermittently for a predetermined time by injecting a contrast medium,
For at least one of the plurality of image data stored in the image data storage means, a ROI setting unit for setting the ROI which is common to the plurality of image data,
Extracting pixel values in the ROI set by the ROI setting means for each of the plurality of image data, and creating a time-varying image in which images based on the extracted pixel values are arranged in a band shape over time. Image creation means;
Display means for displaying the time-change image created by the time-change image creation means;
A medical image display device comprising: By the ROI setting unit, if the different ROI of position is set, aging image produced by the temporal change image creating means, to claim 1, characterized in that it is listed for each ROI The medical image display device described. 3. The medical image display device according to claim 1, wherein the pixel value extracted by the time-varying image creating means is for a predetermined line segment in the ROI. 4. . 4. The medical image display apparatus according to claim 3, wherein the pixel value extracted by the time-varying image creation means is an average value or an addition value for a plurality of line segments in the ROI. The display means, according to claim 1 to claim 4, characterized in that displaying the temporal change image created by the temporal change image forming means, together with the two-dimensional cross-sectional image or MPR image based on the plurality of image data The medical image display device according to any one of the above. Input means for designating a position on the time axis of the time-varying image displayed on the display means;
The medical image display apparatus according to claim 5, wherein the display unit displays the two-dimensional cross-sectional image or the MPR image at a position on a time axis designated by the input unit. In an X-ray CT apparatus that obtains a plurality of image data continuously or intermittently over a predetermined time by injecting a contrast agent,
An image data storage means save the plurality of image data,
For at least one among said plurality of image data stored in the image data storage means, a ROI setting unit for setting the ROI which is common to the plurality of image data,
A time-varying image creating means for extracting a pixel value in the ROI set by the ROI setting means and creating a time-varying image in which images based on the extracted pixel values are arranged in a band shape over time ;
Display means for displaying the time-change image created by the time-change image creation means;
An X-ray CT apparatus comprising: a medical image display apparatus having:

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