Fractional flow reserve measurement based on coronary angiographic images

描述（由申请人提供）：冠状动脉造影是确定冠状动脉解剖和评估动脉粥样硬化的标准方法。然而，使用视觉估计来评估冠状动脉疾病和管腔狭窄的严重程度有明确的局限性。这些限制包括由于冠状动脉狭窄病变的主观视觉分级而导致的观察者内部和观察者之间的巨大差异。在中度冠状动脉病变（30%-70%直径狭窄）的情况下尤其如此，冠状动脉造影在区分引起缺血的中度冠状动脉病变和非引起缺血的冠状动脉病变方面非常有限。此外，病理结果显示，冠状动脉造影估计的冠状动脉狭窄严重程度与死后心脏狭窄病变的实际严重程度之间缺乏相关性。由于标准冠状动脉造影的主要局限性，需要一种功能测量狭窄严重程度的方法，如心导管术中可获得的分数血流储备测量。除了常规冠状动脉造影获得的解剖数据外，分级血流储备测量将提供有价值的功能信息。本研究计划的目的是将第一次通道分布算法与区域管腔容积测量技术相结合，开发一种定量分级血流储备的技术，并在心导管实验室实现。更具体地说，目的是：(1)研究动脉腔容积总和可用于预测冠状动脉树最大充血流量的假设。(2)探讨了利用血管造影图像的管腔容积和测量血流之和可以测量血流储备分数的假设。(3)在人体研究心导管实验室实施分流储备测量技术。本研究结果将为定量患者冠状动脉狭窄严重程度提供改进的生理方法。这种量化技术可用于测量接受标准冠状动脉造影的患者的血流储备分数。公共卫生相关性。血管造影是确定冠状动脉解剖和评估动脉粥样硬化的标准方法。然而，使用视觉估计来评估冠状动脉疾病和管腔狭窄的严重程度有明确的局限性。这些限制包括由于冠状动脉狭窄病变的主观视觉分级造成的较大的观察者可变性。在中度冠状动脉病变（30%-70%直径狭窄）的情况下尤其如此，血管造影在区分冠状动脉病变是否是胸痛的原因方面非常有限。由于标准冠状动脉造影的主要局限性，需要一种功能测量狭窄严重程度的方法，如心导管术中可获得的分数血流储备测量。除了常规冠状动脉造影获得的解剖数据外，分级血流储备测量将提供有价值的功能信息。本研究计划的目的是将区域血流量和管腔容积测量技术相结合，开发一种定量定量血流储备的技术，并在心导管实验室实施。本研究结果将为量化患者冠状动脉狭窄严重程度提供改进的生理学方法。这种量化技术可用于测量接受标准冠状动脉造影的患者的血流储备分数。

DESCRIPTION (provided by applicant): Coronary arteriography is the standard method for determination of coronary anatomy and assessment of atherosclerosis. However, there are definite limitations to the use of visual estimation to assess the severity of coronary artery disease and luminal stenosis. These limitations include the large intraobserver and interobserver variability that result from subjective visual grading of coronary stenotic lesions. This is especially true in the case of an intermediate coronary lesion (30%-70% diameter stenosis), where coronary arteriography is very limited in distinguishing ischemia-producing intermediate coronary lesions from non- ischemia-producing ones. Furthermore, pathologic findings have shown a lack of correlation between the severity of coronary stenosis as estimated from coronary arteriogram and the actual severity of stenotic lesions measured in postmortem hearts. Because of the major limitations of standard coronary arteriography, a method for functional measure of stenosis severity such as measurement of fractional flow reserve obtainable during cardiac catheterization is desirable. The fractional flow reserve measurement would provide valuable functional information in addition to the anatomical data obtained during routine coronary arteriography. The purpose of this research plan is to develop a technique for quantification of fractional flow reserve by combining the first pass distribution algorithm with regional lumen volume measurement technique and its implementation in the cardiac catheterization laboratory. More specifically, the aims are: (1) Investigation of the hypothesis that the sum of arterial lumen volume can be used to predict the maximum hyperemic blood flow into the coronary artery tree. (2) Investigation of the hypothesis that fractional flow reserve can be measured using the sum of lumen volume and measured blood flow from angiographic images. (3) Implementation of the fractional flow reserve measurement technique in the cardiac catheterization laboratory for human studies. The results of this research will provide improved physiological methods of quantitating coronary artery stenosis severity in patients. This quantification technique could be used to measure fractional flow reserve in patients undergoing standard coronary arteriography. PUBLIC HEALTH RELEVANCE. Angiography is the standard method for determination of coronary anatomy and assessment of atherosclerosis. However, there are definite limitations to the use of visual estimation to assess the severity of coronary artery disease and luminal stenosis. These limitations include the large observer variability that result from subjective visual grading of coronary stenotic lesions. This is especially true in the case of an intermediate coronary lesion (30%-70% diameter stenosis), where angiography is very limited in distinguishing whether a coronary lesions is the cause of chest pain. Because of the major limitations of standard coronary arteriography, a method for functional measure of stenosis severity such as measurement of fractional flow reserve obtainable during cardiac catheterization is desirable. The fractional flow reserve measurement would provide valuable functional information in addition to the anatomical data obtained during routine coronary arteriography. The purpose of this research plan is to develop a technique for quantification of fractional flow reserve by combining the regional blood flow and lumen volume measurement technique and its implementation in the cardiac catheterization laboratory. The results of this research will provide improved physiological methods for quantification of coronary artery stenosis severity in patients. This quantification technique could be used to measure fractional flow reserve in patients undergoing standard coronary arteriography.