Diagnostically useful results in real time
Method for real-time vascular modeling and assessment. Modeling, in some embodiments, comprises receiving a plurality of 2-D angiographic images of a portion of a vasculature of a subject, and processing the images to automatically detect 2-D features, for example, paths along vascular extents, which are projected into 3-D to determine homologous features among blood vessels and construct 3-D vascular extents and determine other vascular characteristics. Assessment, in some embodiments, comprises processing models selectively different from one another to produce one or more vascular indexes which indicate a diagnostic preference, for example, to perform a medical intervention such as a stent implantation. Speed is achieved, for example, by the method being optimized for determining the effects of a medical intervention. In some embodiments, results are produced quickly enough to allow use of the method to perform PCI within the same catheterization used to perform diagnostic imaging.
1. A method for vascular assessment during a session of vascular catheterization of a subject, the method comprising:
receiving a plurality of 2-D angiographic images imaging a portion of a vasculature of the subject, wherein the portion of a vasculature comprises a stenosis, and wherein the plurality of 2-D angiographic images are obtained during the session;
producing, by automatic processing of the 2-D angiographic images while the subject is catheterized, a vascular tree model based on estimated dimensions of the portion of the vasculature determined from the 2-D angiographic images;
determining automatically while the subject is catheterized, based on said vascular tree model, an index quantifying a capacity for restoration of flow by opening the stenosis; and
displaying information indicative of the index to enable treatment of the stenosis while the subject is catheterized.
2. The method of claim 1 , wherein said index comprises calculations based on change of a vascular width.
3. The method of claim 1 , wherein said automatic processing is performed within ten thousand trillion computational operations.
4. The method of claim 1 , wherein the vascular tree model includes a radially detailed 3-D representation of a vascular wall.
5. The method of claim 1 , wherein said determining automatically and said automatic processing comprise formation of the vascular tree model, which does not include dynamic flow modelling.
6. The method of claim 1 , wherein said determining automatically comprises linear modelling of vascular flow characteristics from the vascular tree model.
7. The method of claim 1 , wherein said vascular tree model represents vascular width as a function of vascular extent.
8. The method of claim 1 , wherein said vascular tree model comprises at least 3 branch nodes between vascular segments of the portion of the vasculature.
9. The method of claim 1 , wherein said vascular tree model comprises vascular centerlines and vascular widths therealong.
10. The method of claim 1 , wherein said vascular tree model is produced within 5 minutes.
11. The method of claim 1 , further comprising calculating an FFR characteristic for at least one vascular segment of the vascular tree model.
12. The method of claim 11 , wherein calculating said FFR characteristic comprises:
producing a second vascular tree model based on said vascular tree model, the second vascular tree model including at least a virtual revascularization of the stenosis; and
comparing the second vascular tree model and the vascular tree model.
13. The method of claim 12 , wherein said comparing comprises obtaining a ratio of flow modeled in the second vascular tree model and the vascular tree model for said at least one vascular segment.
14. The method of claim 12 , wherein said FFR characteristic is calculated within 10 seconds of producing the second vascular tree model.
15. The method of claim 11 , wherein said FFR characteristic is a predictor of a pressure measurement-determined FFR index with a sensitivity of at least 95%.
16. A method for vascular assessment during a session of vascular catheterization of a subject, the method comprising:
receiving a plurality of 2-D angiographic images imaging a portion of a vasculature of the subject, wherein the portion of a vasculature comprises a stenosis, and wherein the plurality of 2-D angiographic images are obtained during the session;
producing, by automatic processing of the 2-D angiographic images, a vascular tree model modeling the portion of the vasculature;
determining automatically, based on said vascular tree model, an index quantifying a capacity for restoration of flow by opening the stenosis,
receiving a further plurality of 2-D angiographic images after the producing the vascular tree model; and
producing a modified version of the vascular tree model based on the further plurality of; images,
wherein the receiving, producing the vascular tree model, determining, further imaging, and producing the modified version of the vascular tree model occur while the subject remains in the session and catheterized.
17. The method of claim 1 , wherein said producing occurs interactively with the ongoing vascular catheterization of said subject.
18. The method of claim 11 , wherein said calculating of an FFR characteristic occurs interactively with the ongoing vascular catheterization of said subject.
19. A system for vascular assessment during a session of vascular catheterization of a subject, the system comprising:
a computer communicatively connected and configured to receive, from an angiographic imaging device, a plurality of 2-D images captured during the session while the subject is catheterized, the plurality of 2-D images imaging a portion of a vasculature of the subject comprising a; stenosis,
wherein the computer is further configured to calculate a vascular tree model from the plurality of 2-D images while the subject remains in the session and catheterized, the vascular tree model based on estimated dimensions of the portion of the vasculature determined from the 2-D images, and
wherein the computer is also configured to determine an index of vascular function which indicates a capacity for restoration of flow by opening of the stenosis based on said vascular tree model, and also while the subject remains in the session and catheterized.
20. The system of claim 19 , wherein determination based on said vascular tree model calculated from the plurality of 2-D images comprises generation of a second vascular tree model derived from said vascular tree model calculated from the plurality of 2-D images by widening a modeled vascular width in the region of the stenosis.