Systems, devices, and methods for non-invasive image-based plaque analysis and risk determination
Systems and methods of facilitating determination of risk of coronary artery disease (CAD) based at least in part on one or more measurements derived from non-invasive medical image analysis. The methods can include accessing a non-invasive generated medical image, identifying one or more arteries, identifying, regions of plaque within an artery, analyzing the regions of plaque to identify low density non-calcified plaque, non-calcified plaque, or calcified plaque based at least in part on density, determining a distance from identified regions of low density non-calcified plaque to one or more of a lumen wall or vessel wall, determining embeddedness of the regions of low density non-calcified plaque by one or more of non-calcified plaque or calcified plaque, determining a shape of the more regions of low density non-calcified plaque, and generating a display of the analysis to facilitate determination of one or more of a risk of CAD of the subject.
1. A computer-implemented method of determination of fractional flow reserve and assessment of ischemia based at least in part on one or more measurements derived from non-invasive medical image analysis, the computer-implemented method comprising:
accessing, by a computer system, a medical image of a subject, wherein the medical image of the subject is obtained non-invasively;
analyzing, by the computer system, the medical image of the subject to identify one or more coronary arteries;
determining, by the computer system, one or more stenosis measurements based on analysis of the identified one or more coronary arteries in the medical image of the subject, the one or more stenosis measurements comprising coronary lumen area (A) and subtended myocardial mass (M);
determining, by the computer system, non-invasive fractional flow reserve (FFR non-invasive ) for the identified one or more coronary arteries based at least in part by applying the one or more stenosis measurements to
FFR
n
o
n
-
i
n
v
a
s
i
v
e
=
Y
0
*
A
b
A
M
b
M
,
wherein Y 0 comprises a constant, and wherein b A and b M comprise exponential coefficients; and
generating, by the computer system, an assessment of ischemia based at least in part on the determined non-invasive fractional flow reserve for the identified one or more coronary arteries,
wherein the computer system comprises a computer processor and an electronic storage medium.
2. The computer-implemented method of claim 1 , wherein the determined non-invasive fractional flow reserve is determined using allometric scaling.
3. The computer-implemented method of claim 1 , wherein Y 0 , b A , and b M are derived from analysis of retrospective medical images and invasive FFR measurements (FFR invasive ).
4. The computer-implemented method of claim 1 , wherein Y 0 , b A , and b M are derived using an equation relating coronary lumen area (A) and subtended myocardial mass (M) to FFR invasive .
5. The computer-implemented method of claim 4 , wherein the equation comprises
FFR
invasive
=
Y
0
*
A
b
A
M
b
M
.
6. The computer-implemented method of claim 4 , wherein the equation comprises log (FFR invasive )=b A *log (A)−b M *log (M)+log (Y 0 ).
7. The computer-implemented method of claim 1 , wherein the coronary lumen area comprises minimal lumen area.
8. The computer-implemented method of claim 1 , wherein the generated assessment of ischemia is generated based at least in part on comparison to one or more reference values of the determined non-invasive fractional flow reserve.
9. The computer-implemented method of claim 1 , further comprising generating, by the computer system, a graphical representation of the generated assessment of ischemia for the identified one or more coronary arteries.
10. The computer-implemented method of claim 1 , further comprising generating, by the computer system, a recommended treatment for the subject based at least in part on the generated assessment of ischemia for the identified one or more coronary arteries.
11. A computer-implemented method of determination of fractional flow reserve and assessment of ischemia based at least in part on one or more measurements derived from non-invasive medical image analysis, the computer-implemented method comprising:
accessing, by a computer system, a medical image of a subject, wherein the medical image of the subject is obtained non-invasively;
analyzing, by the computer system, the medical image of the subject to identify one or more coronary arteries;
determining, by the computer system, one or more stenosis measurements (S) based on analysis of the identified one or more coronary arteries in the medical image of the subject, the one or more stenosis measurements (S) comprising one or more of subtended coronary lumen volume, minimal lumen area, minimal lumen diameter, or distal lumen diameter;
determining, by the computer system, one or more normal measurements (N) based on analysis of the identified one or more coronary arteries in the medical image of the subject, the one or more normal measurements (N) comprising one or more of subtended coronary length, subtended myocardium, proximal lumen diameter, or proximal lumen area;
determining, by the computer system, non-invasive fractional flow reserve (FFR non-invasive ) for the identified one or more coronary arteries based at least in part by applying the one or more stenosis measurements (S) and the one or more normal measurements (N) to
FFR
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n
-
i
n
v
a
s
i
v
e
=
Y
S
*
S
b
_
S
Y
N
*
N
b
_
N
,
wherein Y S comprises a constant, and wherein b_S and b_N comprise exponential coefficients; and
generating, by the computer system, an assessment of ischemia based at least in part on the determined non-invasive fractional flow reserve for the identified one or more coronary arteries,
wherein the computer system comprises a computer processor and an electronic storage medium.
12. The computer-implemented method of claim 11 , wherein the determined non-invasive fractional flow reserve is determined using allometric scaling.
13. The computer-implemented method of claim 11 , wherein Y S , b_s, and b_N are derived from analysis of retrospective medical images and invasive FFR measurements (FFR invasive ).
14. The computer-implemented method of claim 13 , wherein Y S , b_s, and b_N are derived from using
FFR
invasive
=
Y
S
*
S
b
_
S
Y
N
*
N
b
_
N
.
15. The computer-implemented method of claim 11 , wherein the distal lumen diameter comprises a diameter beyond an area of coronary stenosis of interest in the identified one or more coronary arteries.
16. The computer-implemented method of claim 11 , wherein the proximal lumen diameter and proximal lumen area are measured at a point along a coronary tree proximal to a coronary lesion of interest, wherein the point along the coronary tree is unaffected by coronary stenosis of interest.
17. The computer-implemented method of claim 11 , wherein the generated assessment of ischemia is generated based at least in part on comparison to one or more reference values of the determined non-invasive fractional flow reserve.
18. The computer-implemented method of claim 11 , further comprising generating, by the computer system, a graphical representation of the generated assessment of ischemia for the identified one or more coronary arteries.
19. The computer-implemented method of claim 11 , further comprising generating, by the computer system, a recommended treatment for the subject based at least in part on the generated assessment of ischemia for the identified one or more coronary arteries.
20. The computer-implemented method of claim 11 , wherein the medical image is obtained using an imaging technique comprising one or more of computed tomography (CT), x-ray, ultrasound, echocardiography, magnetic resonance (MR) imaging, optical coherence tomography (OCT), nuclear medicine imaging, positron-emission tomography (PET), single photon emission computed tomography (SPECT), or near-field infrared spectroscopy (NIRS).
21. A system for determining fractional flow reserve and assessment of ischemia based at least in part on one or more measurements derived from non-invasive medical image analysis, the system comprising:
one or more computer readable storage devices configured to store a plurality of computer executable instructions; and
one or more hardware computer processors in communication with the one or more computer readable storage devices and configured to execute the plurality of computer executable instructions in order to cause the system to:
access a medical image of a subject, wherein the medical image of the subject is obtained non-invasively;
analyze the medical image of the subject to identify one or more coronary arteries;
determine one or more stenosis measurements based on analysis of the identified one or more coronary arteries in the medical image of the subject, the one or more stenosis measurements comprising coronary lumen area (A) and subtended myocardial mass (M);
determine non-invasive fractional flow reserve (FFR non-invasive ) for the identified one or more coronary arteries based at least in part by applying the one or more stenosis measurements to
FFR
n
o
n
-
i
n
v
a
s
i
v
e
=
Y
0
*
A
b
A
M
b
M
,
wherein Y 0 comprises a constant, and wherein b A and b M comprise exponential coefficients; and
generate an assessment of ischemia based at least in part on the determined non-invasive fractional flow reserve for the identified one or more coronary arteries.
22. The system of claim 21 , wherein the determined non-invasive fractional flow reserve is determined using allometric scaling.
23. The system of claim 21 , wherein Y 0 , b A , and b M are derived from analysis of retrospective medical images and invasive FFR measurements (FFR invasive ).
24. The system of claim 21 , wherein Y 0 , b A , and b M are derived using an equation relating coronary lumen area (A) and subtended myocardial mass (M) to FFR invasive .
25. The system of claim 24 , wherein the equation comprises
FFR
invasive
=
Y
0
*
A
b
A
M
b
M
.
26. The system of claim 24 , wherein the equation comprises log (FFR invasive )=b A *log (A)−b M *log (M)+log (Y 0 ).
27. The system of claim 21 , wherein the coronary lumen area comprises minimal lumen area.
28. The system of claim 21 , wherein the generated assessment of ischemia is generated based at least in part on comparison to one or more reference values of the determined non-invasive fractional flow reserve.
29. The system of claim 21 , wherein the system is further caused to generate a graphical representation of the generated assessment of ischemia for the identified one or more coronary arteries.
30. The system of claim 21 , wherein the system is further caused to generate a recommended treatment for the subject based at least in part on the generated assessment of ischemia for the identified one or more coronary arteries.