DE102007046454A1 - Method for image representation of treatment necessitous section of vessel, particularly stenosis vessel section, involves using pre-interventional received three dimensional volume data set of vessel - Google Patents

Abstract

The method involves using a pre-interventional received three dimensional volume data set (1,9) of a vessel (2), and the marking (8) of a process of a vessel section (3) in the three dimensional representation of the three dimensional volume data set. The pre-interventional marked three dimensional volume set data is registered with a two dimensional image data set or a three dimensional image set receives with an x-ray device during the intervention for receiving fluoroscopic image (11) of the vessel.

Description

The The invention relates to a method for imaging a treatment-requiring Section of a vessel, in particular a stenosed vessel section, with one located in the vessel, in leading to this medical instrument, on a screen.

to Treatment of low, medium and high grade stenoses, for example the coronary arteries, is over a guidewire usually a catheter inserted over the occlusion can be widened. The guidewire can through the narrowed, but open vessel lumen be performed the orientation of the introduced Catheter is predetermined. In addition, it is possible by contrast injection the residual vascular lumen remains angiographic by fluoroscopy two-dimensional (2-D) represent. When using Two-level systems (biplane systems) can be made from the two projections a three-dimensional (3-D) course of the vessel is calculated and displayed so that the doctor on this while the movement of the guidewire or the catheter can orientate. However, the image is problematic at complete closed vessel sections (CTO = cronic total occlusion). Because as a result of the complete vascular occlusion is not about contrast media visible feasible residual lumen available. Here only remains the possibility of the Course of the complete closed vessel section estimate. This will be done first the distal vessel section over the Collateral supply of arterial blood retrograde by contrast administration shown angiographically in 2-D and used as a reference image. In a second step, the proximal portion, which is up to the Closure as in the healthy organism supplied antegrade via the coronary artery is, preferably also after contrast administration fluo roscopically shown. To set the catheter, this is now up to the Stenosis pushed, after which the fluoroscopic images with the contrasted distal vessel section superimposed from the reference image become. While the advancement of the catheter or guidewire requires the user estimate whether it is still inside the vessel walls by trying with the catheter tip on a connecting line between the proximal and distal vessel section to stay. The occluded vessel section itself, which is known calcified and has added, is in the fluoroscopically recorded, invasive images can not be seen why as described the user of this more or less long piece of the vessel in his Assess the course of the reference image and the overlaying fluoroscopic images. This can happen during Moving the catheter causes problems as the user relatively easy from the real ideal line that he can not see but estimate must, deviate, in particular, after having to penetrate the closure relatively strong has to push. A perforation of the vessel before the stenosis or in the stenosed section is therefore due to lack of information about the real course of the vessel section in individual cases possible.

Of the The invention is thus based on the problem of specifying a method which allows an image representation of a vessel in need of treatment in its full length and the user so the optical control of the leadership of a medical instrument, so a guidewire or a catheter under fluoroscopic monitoring, offers.

• – Verwendung eines prä-interventionell aufgenommenen 3-D-Volumendatensatzes des Gefäßes,
• – Markierung des Verlaufs zumindest des Gefäßabschnitts in einer 3-D-Darstellung des 3-D-Volumendatensatzes,
• – Registrierung des prä-interventionellen markierten 3-D-Volumendatensatzes mit einem mit einer Röntgeneinrichtung, die während der Intervention zur Aufnahme von Fluoroskopiebildern des Gefäßes samt Gefäßabschnitt dient, aufgenommenen 2-D-Bilddatensatz oder einem weiteren 3-D-Volumenbilddatensatz,
• – kontinuierliche Aufnahme von interventionellen Fluoroskopiebildern mit der Röntgeneinrichtung und kontinuierliche lage- und orientierungsgerechte Überlagerung der einzelnen, zumindest das medizinische Instrument zeigenden Fluoroskopiebilder mit dem markierten, mit den Fluoroskopiebildern registrierten 3-D-Volumendatensatz zumindest im Bereich des markierten Gefäßabschnitts derart, dass im Überlagerungsbild der Verlauf des Gefäßabschnitts als Bildmarkierung sichtbar ist.

To solve this problem, a method for imaging a section of a vessel requiring treatment, in particular a stenosed vessel section, with a medical instrument located in the vessel and to be guided thereon is provided on a screen, with the following steps:

• Use of a pre-interventionally recorded 3-D volume data set of the vessel,
• Marking the course of at least the vessel section in a 3-D representation of the 3-D volume data set,
• Registration of the pre-interventional labeled 3-D volume data set with a 2-D image data set or a further 3-D volume image data set recorded with an X-ray device which serves during the intervention for taking fluoroscopic images of the vessel together with the vessel section,
• Continuous recording of interventional fluoroscopy images with the X-ray device and continuous overlaying of the individual fluoroscopy images pointing at least the medical instrument with the marked 3-D volume data set registered with the fluoroscopic images at least in the region of the marked vessel segment such that the overlay image of FIG Course of the vessel section is visible as a picture mark.

The method according to the invention is based on the use of different image data sets which are superimposed. The starting point is a pre-interventionally recorded 3-D volume data set of the vessel, which is, for example, a 3-D data set recorded with a computer tomograph or a magnetic resonance device, primarily an angiographic data set. This was taken at a time prior to the pending intervention, with the term "pre-interventional" being used at any point in time indirectly before placing the medical instrument, switches off. In this 3-D volumetric data set, the entire vessel is visible. In computed tomography or magnetic resonance images, strongly calcified sections, such as those normally present in a chronic stenosis, are also very clearly visible with a suitable choice of the gray scale mean value and the window limit values. That is, based on this volume data set, a three-dimensional reconstruction of the entire Gefä ßes, including the stenosed vessel portion, in its real form and its real history is possible.

In one next Step is now the course of at least the need of treatment Vessel section, so in the case of a stenosis just the section of the stenosis itself, in a 3-D representation of the 3-D volume data set marks what z. B. on a suitable screen marking agent can be done if this is done by the user, where the user both a doctor and a technician or technical Staff can be. In any case, therefore, a definition of the vessel section in terms of its location, length and course in the 3-D volume data set.

This pre-interventional, marked and thus "modified" 3-D volume data set is now using an X-ray device, the while the intervention to record the fluoroscopic images of the vessel together of the vessel section serves, registered. The X-ray device, which captures the images in its own device-specific coordinate system, For example, it is designed as a C-arm X-ray machine can be a monoplane or a biplane. There the 3-D volume data set in its own coordinate system Attachment that was recorded (ie, for example, computed tomography (CT) or magnetic resonance device (MR)), is generated over the Registration created a mapping rule that the two Coordinate systems interconnect so that every point in the Volume of a coordinate system exactly to the corresponding point can be mapped in the volume of the other coordinate system. For registration serves either a 2-D image data set, so at least one with the X-ray device taken 2-D image, or another 3-D volume image data set, for example, with the C-arm X-ray device recorded which can be relatively fast a partial rotation by at least 180 ° (dynamic CT using a C-arm system). In each Case results from this step a mapping rule between the marked 3-D volume data set and the coordinate system of the X-ray device, with the now while the intervention will be recorded continuously fluoroscopy images. Each fluoroscopic image may now be due to the previous registration continuously aligned with orientation and orientation with the marked one 3-D volumetric data superimposed become. This means, to every fluoroscopic image that is a 2-D image from a particular Viewing direction is thus the image plane depending on the position of the X-ray source and the X-ray image detector is, according to the situation and orientation, the corresponding projected View from the 3-D volume dataset used or overlaid. After in the fluoroscopic images the medical instrument, that already introduced is, can be seen, but no vessel or already not at all the stenosed vessel section, this or this, however, can be seen in the 3-D volume data set or concerning the vessel section Even there is marked, due to the superposition inevitably an overlay image in which the exact vessel course including the marked stenosis and lying in the vessel the catheter in his real position. So there is an overlay the 3-D representation of the stenosed vessel section with fluoroscopy. The user can now use this 3-D overlay image display during the Accurately orient wire or catheter thrusts after yourself especially in the area of the vessel closure, which is just not visible in fluoroscopy as described, the actual course of the vessel can be marked and reconstructed three-dimensionally.

In principle, it is possible to take from the pre-interventional data set, for example the CT or MR data set, only the area of the marking, that is to say that of the marked, stenosed vessel section, and to superimpose it with the fluoroscopic images as a 3-D reconstruction partial image. Optionally, of course, the entire reconstructed 3-D image, which also shows the vessel area in front of and behind the marker, are superimposed with the fluoroscopic images. The marking itself must not only concern the vessel section, but rather the marking can also be drawn slightly beyond the section in order to mark the subsequent, healthy vessel wall areas and to mark the overlay marked in the frame. The overlay image itself is displayed from the viewing direction like the recorded fluoroscopic images, and the 3-D volume data set is projected as a 2-D image image corresponding to the fluoroscopic image-taking direction. The mark itself conveniently identifies the vessel edges in the overlay image, this is completely sufficient for the user for orientation, since he is primarily interested in the position of the wire or the catheter relative to the vessel edges. The marking itself can be done simply and very precisely in the area of the vessel edges, since this takes place in the volume, for which the 3-D data set on the screen is reconstructed three-dimensionally is set and the user can therefore accurately recognize the contours.

As described is the pre-interventional 3-D volume data set preferably an MR or a CT angiography dataset that is in high Resolution with very good contrast shows the vessels. By suitable choice of image generation and presentation parameters can be a very good contrast even in the area of the stenosed section be achieved, that is, that the calcified stenosis can also be clearly visualized so that overall the marker can be set very accurately can.

alternative for use with other imaging devices, here so MR or CT devices, recorded 3-D records is It is also possible to pre-interventional 3-D volume data set by means of the designed as a C-arm X-ray device X-ray device, that of fluoroscopic image acquisition serves to record. This means, all image data to be recorded are recorded with the X-ray device, which as a C-arm device drives a fast, dynamic CT, thus So quickly rotated around the table and images from all for a 3-D volume reconstruction necessary viewing directions. Also in this X-ray CT dataset are the vessel as well as the calcified vessel section very recognizable.

A third way the pre-interventional To create a 3-D volume data set consists of a merger of two 3-D subvolume datasets registered with each other, one of which contains the vessel and the vessel section after contrast injection in the region lying distally to the vessel portion and the other the vessel including vessel section after contrast administration in the region lying proximally to the vessel section shows. Also for this one uses preferably the fluoroscopic image recording serving X-ray device, for generating the reconstruction image data set in the case of execution as monoplane device for taking successive shots from different perspectives must be adjusted while at a Biplangerät from home due to the dual provided x-ray equipment Image recordings from two different directions are available. The two subvolume records are after being recorded with the same X-ray device are registered with each other and then fused, so that overall a complete 3-D reconstruction image data set, which follows with the fluoroscopic images after previous marking as initiating described superimposed can be.

The Marking itself can be described by the user on the screen as described above there movable marking element such as a cursor or another Navigation element done. Also conceivable is an automatic Set the marker. For this purpose, the image processing device has suitable Detection algorithms, for example to detect edges, which represent the vessel walls etc. In any case, the image processing device is capable of automatic the vessel section to determine and set the mark.

As already described, it is basically possible to either only the vessel section to mark and in the context of the overlay with the fluoroscopic images only from the 3-D volume data set to overlay. Because this course is as stated in the fluoroscopic images at all not visible, can be seen in the overlay image of However, users are easily recognized. Alternatively, in addition to Vascular section too the course of at least part of the adjoining vessel marked become. It means that at least adjoining Vessel parts in the overlay image also be shown, if not the entire vessel, so far it is contained in the 3-D volume data set, based on the overlay becomes.

The Image mark itself is preferably line-shaped and defines the vessel section edges. The is called, the user receives in the overlay image one Line representation of the vessel section edge relative to the respective image pickup direction in which the overlay image the vessel shows so that it can orient itself exactly as the location of the wire or Catheter tip is relative to the vessel edges.

alternative can the in the overlay image shown picture mark also flat and the projected vessel section volume represent. Received here the user does not mark the edges themselves, only the projected vessel volume. nevertheless he can still effortlessly after the side edges of the image mark the Correspond to vessel section edges and he in this regard can accurately detect the position of the wire or catheter tip.

A further improvement can be achieved by the 3-D representation of the sealed vessel section, so the 3-D overlay image, heart-phase synchronized. For this purpose, according to the invention, a pre-interventional 3-D volume image data set is used, which shows the vessel to different cardiac phases, wherein preferably at each cardiac phase, the marking of at least the vessel portion is carried out, and be preferred also the registration of the serving 2-D image data set or additional 3-D volume data set is recorded at corresponding cardiac phases, and wherein during the fluoroscopy recording detects the cardiac phase and a cardiac phase synchronous Overlay with the marked 3-D volume image data set takes place. The overlay image representation thus always shows the vessel in its real actual position, which can change due to cardiac phase. The marking does not have to take place in all phase volume images, but can be set once in the data set to a cardiac phase and then be automatically followed up by the image processing, and thus set accordingly in the other phase-related volume image data sets. If images of cardiac phases are needed, which lie between two excluded, excellent cardiac phases, then the respective image data set is interpolated, so that an appropriate matching takes place.

In Similarly, a possible respiratory movement, which also in a change of position of the stenosed vessel section to be treated, be recorded. That means, too here are corresponding records taken to different breathing phases and during the Fluoroscopy image capture captures the respiratory phase, leaving a breathable overlay is possible with the marked 3-D volume image data set. The consideration the respiratory movement leads So as well as the consideration the heart phase to a 4D representation.

Farther it is appropriate in the pre-interventional 3-D volumetric data set visible, any in the vessel or in the vessel section existing eye-catching To capture areas and in the overlay image or as part of the automatic marking of the vessel section to take into account. at such conspicuous Areas may be, for example, microcalcifications or contrast-filled Microvolumes act, which are visible in the 3-D reconstruction image. It is now possible to consider such areas as part of the marking, So over it to mark the screen itself or the automatic marking to make these areas then in the context of generating the overlay image to represent in this. The information about any microcalcifications, ie small calcification areas outside the actual occlusion area, can for the Users also represent important information. That is, the doctor receives not just information about the course of the vessel or the vessel wall, but also over any in the vascular area or in the immediate vessel environment conditions. These ranges can be found in any 3-D volume data set, be it a CT or MR dataset, or a separate 2-D x-ray or by means of so-called dual-energy imaging by means of a X-ray equipment 3-D volume dataset created with two X-ray sources offset from each other, be marked.

Farther can use a medical instrument with one preferably on his Tip located element, which has a locating system in its spatial Position can be located, using the coordinate system the locating system with the X-ray device is registered, and wherein upon detection of a predetermined relative position the element to the known position of the vessel wall an optical and / or acoustic warning signal is output. According to this embodiment of the invention So it's going to be over continuously a surveillance system checked, whether the wire or catheter tip is dangerously close to the vessel wall, what for a corresponding locating device is used. On the guidewire or the catheter, a magnetic sensor is preferably arranged at its tip, the over corresponding external locating coils are determined in its spatial position can. This location system is in coordination with the X-ray device registered, so when approaching to the edge of the reconstructed 3-D vessel or vessel section an optical warning signal, such as a flashing on the screen or an audible warning signal such as a warning sound is issued can.

Further Advantages, features and details of the invention will become apparent the embodiment described below and with reference to the Drawing.

In the figure, a scheme is shown, based on which the basic sequence of the method according to the invention is explained. In the method according to the invention is a 3-D volume data set 1 used a vessel 2 with a treatment-requiring, because stenosed vessel section 3 shows. Based on the 3-D volume data set 1 is it possible to have a volumetric image 4 to reconstruct, in which the vessel 2 together with vessel section 3 is shown. The vessel section 3 is stenosed as described, so has calcification, which enforce the vascular lumen, to a complete vascular occlusion (CTO = cronic total occlusion). This occlusion is to be opened as part of a later intervention, which will be discussed below.

The 3-D volume data set may be a pre-interventionally recorded CT or MR angiography data set. Within such data sets, by selecting suitable acquisition parameters and / or suitable image processing parameters, also the area of the chronic stenosis, ie the calcified vascular segment 3 , that is, that in the reconstructed 3-D image output in a manner known per se on a screen, both the healthy portions of the vessel 2 are visible, as well as the stenosed vessel section 3 ,

alternative Also, the 3-D volume data set may be one with a X-ray device, with the patient during the intervention is fluoroscopically monitored will act on recorded record. The X-ray device is in this Case as C-arm X-ray device formed and can by a very fast rotation of the C-arm including radiation source and radiation detector around the patient table, on which the patient is located, similar to a classic CT scan record corresponding image data from all relevant perspectives, to reconstruct the 3-D data set or a complete reconstructable 3-D data set receive. This fast image capture process using a C-arm X-ray device often also referred to as dynamic CT.

Another option, a 3-D volume dataset 1 to generate it is to make it from two registered 3-D subvolume records. These are merged together. Each subvolume record shows the vessel 2 after a contrast agent administration, wherein in a partial volume data set the distal vessel area, ie the area lying behind the vessel narrowing with respect to the flow direction of the blood, is shown after contrast agent administration, while the other partial volume data set shows the proximal area lying before the closure after contrast agent administration. Due to a coordinate registration both volume data sets can be connected to each other. The area of the vessel closure is also visible after the partial volume data records are recorded with an X-ray device, so that both the healthy vessel areas and the occluded vessel area can be recognized in the overall 3D volume data set obtained. Either a biplane X-ray device can be used to accommodate the partial volume data sets, that is to say those on which two separate image recording systems (that is to say each X-ray tube and detector) are provided. Also, a monoplanes C-arm X-ray machine can be used, in which case the C-arm for reconstruction must be moved in at least two defined positions.

Basically, the possibilities described are the 3-D volume data set 1 to obtain well-known and need not be described in detail. However, it is central that such a 3-D volume data set is used as a starting point for the method according to the invention.

As shown, it is possible to record the 3-D volume data set in a heart-phase-synchronized manner, for which purpose only an exemplary ECG curve is shown in the example shown 5 is shown. That is, the volume data set 1 or several separate such volume data sets are recorded or reconstructed to defined cardiac phases. After it is at the vessel 2 is very often a coronary vessel, which moves with the heartbeat, it is particularly useful for a good image presentation, if always the current vessel position can be displayed, which can change depending on the cardiac phase. In the example, the starting point for the further method is a heart-phase-resolved or heart-phase-synchronized 3-D volume data set 1 or a plurality of such data records associated with corresponding phases, wherein subsequently the corresponding volume data record is selected depending on the applied cardiac phase.

In a corresponding manner, a respiratory motion can also be detected. In the figure is with the curve 6 a basic course of a respiratory curve shown, which leads to a raising and lowering of the chest and thus also to a possible movement of the vessel to be treated. The breathing can be detected, for example, via a chest belt or the like. The 3-D volume data set 1 Thus, alternatively or additionally, it can also be taken with respiration resolution, that is, a corresponding volume data record is present for each respiration phase, or the volume data set used is resolved and synchronized. This therefore makes it possible to capture such movements by image technology.

As described, in the 3-D volume data set 1 reconstructable volume image 4 in which the vessel 2 is shown, the vessel section 3 be well recognized. The next step will now be in the volume image displayed on a screen 4 by means of a marking agent 7 , For example, a screen cursor, the boundary region of the vessel portion 3 with a marker 8th , here a line. This marking can be carried out as described by the user himself by using the marking agent 7 moved across the screen and the control mouse or the like, the mark in the 3-D volume data set 1 performs. Alternatively, there is the possibility of marking 8th Also to set automatically, what the image processing means, via which the reconstruction and representation of the volume data set or volume image is carried out, have appropriate algorithms to the grave excellent area of the vessel section 3 to detect and determine, for example via an edge detection, the vessel boundary. The mark 8th is then automatically in the 3-D volume data set 1 set. The setting of the marking causes the area of the occlusion, ie the vessel section 3 , in the 3-D volume data set 1 is excellent.

The setting of the mark can be like this be that only the area of the vessel section 3 is marked, or even anschießende sections of the healthy vessel. This depends on the type of subsequent processing. Either can from the 3-D volume dataset 1 only the area of the set marking, that is to say only this defined vessel area, can be used and represented in the way of the image fusion described below, or the entire vessel area including the marking. In the former case, it is better information about the subsequent course of the vessel relative to the occluded vessel section 3 to have, expediently, the marking 8th also to draw something into the area of healthy vascular areas.

The pre-interventionally recorded 3-D volume data set, for example as a CT or MR angiography data set, is recorded before the actual intervention, including the actual treatment of the vascular occlusion, ie the vascular segment 3 to understand. If it is an MR or CT angiography data set, then this is necessarily recorded with an image recording device, with which the subsequent fluoroscopic monitoring is not performed. If the 3-D volume data set is recorded with just this X-ray device, then the patient is necessarily already on the examination table, on which the actual intervention takes place.

In any case, prior to the actual intervention, a registration must be made in such a way that it is ensured that the pre-interventional 3-D volume data set can subsequently be overlaid with the subsequently recorded fluoroscopic images in accordance with the position and angulations. For this purpose, in the example shown, if the patient is on the patient table immediately before the intervention, then another 3-D volume data set 9 recorded here as a fast recorded X-ray CT data set, in which also the vessel 2 shown, but in a slightly different position. That is, create a coordinate transformation that uses each pixel of the 3-D volume dataset 1 in the correct position a corresponding pixel of the further 3-D volume data set 9 can be assigned. In the figure, here are the different coordinates x, y and z with respect to the 3-D volume data set 1 and the coordinates x ', y' and z 'relative to the further 3-D volume data set 9 specified. This registration also takes place via a suitable image processing device, which has both data records. On the basis of the imaging or transformation rule determined in this case, it is now possible with the X-ray device to refer to anything 9 in the context of the subsequent fluoroscopic image recording fluoroscopic image, which is taken from a particular line of sight, thus a certain position of the image pickup relative to the examination area, exactly the correct image plane or projection plane from the now modified, because marked and registered 3-D volume data set 1 selected and used for later fusion.

This is shown in the following step. The intervention started here, it became in the example shown a wire or catheter 10 into the vessel 2 introduced. With the X-ray device, preferably a C-arm X-ray device, who now the continuous fluoroscopy images 11 recorded, so there is a continuous fluoroscopy. Within these fluoroscopic images 11 is only the guidewire or catheter 10 but very little image information regarding the vessel 2 , The vessel section 3 is in the fluoroscopic images 11 not recognizable.

However, now to the user, the wire or catheter 10 in the vessel 2 moved, exact optical information regarding the position of the catheter tip 12 relative to the vessel wall is now, starting from the known position of the X-ray image recording means of the fluoroscopy X-ray device, that is the position or recording direction of the fluoroscopic image 11 , in the 3-D volume data set 1 exactly the image plane or projection direction selected, which corresponds to the transformation or mapping rule due to the previous registration of the fluoroscopic image plane. In other words, the 3-D volume data set now becomes positional and angulation-compliant with the fluoroscopic image 11 superimposed. From the 3-D volume data set 1 is now the mark 8th and the adjoining areas of the healthy vessel 2 visible, from the fluoroscopic image 11 is the exact location of the catheter 10 to recognize. If both are now superimposed, the result is an overlay image 13 in which the user exactly the position of the catheter 10 can recognize in the vessel and relative to the stenosis. Also the stenosed vessel section 3 is over the mark here 8th holding a screen marker 14 which shows this area visually highlighted (eg in the form of a line or a flat, colored screen mark 14 ), very visible to the user. He can see exactly how the relative position of the tip 12 of the catheter to the respective vessel wall. Thus he can also recognize any impermissible approach or the catheter 10 immediately withdraw if it touches the vessel wall. Any perforations are prevented. He can also see very well how he moves through the hardened occlusion material in the area of vasoconstriction, for which purpose the catheter is to be pushed under pressure against the calcified material. The information about the course of the vessel wall in the region of the vessel section 3 receives he here exclusively due to the superposition of the invention 3-D volume data 1 with the currently recorded fluoroscopic images 11 ,

Unless in the area of the catheter tip 12 an element like a magnetic sensor 15 is provided, which can be determined in its spatial position and with respect to the coordinate system of the fluoroscopy X-ray device, there is the possibility of the exact position of the catheter tip 12 relative to the vessel wall, to then give a possible audible and / or visual warning signal if an improper approach is given.

As further shown, the recording of the fluoroscopic images may also be preferred 12 heart phase synchronized and / or breath synchronized done. Shown again are a heart curve 16 , so an ECG, as well as a respiratory curve 17 , If the fluoroscopy image acquisition heart-phase and / or breath-synchronized, so the respective cardiac phase or respiratory phase is therefore known at any time. This, in turn, allows the corresponding 3-D volume image data set, heart-phase or breath-synchronized 1 or to select the corresponding phase-related data part in order to then base it on the image overlay. That is, the generation and presentation of the overlay image is then Herzphasen- and breath synchronized and shows the actual geometric conditions and relative positions of the individual elements, namely catheter 10 and vessel 2 , to each other. After all calculations are done in real time, the image representation of the real conditions can be done in this way.

Claims (13)

Process for image presentation of a person in need of treatment Section of a vessel, in particular a stenosed vessel section, with one in the vessel, leading in this medical instrument, on a screen, with the following steps: - Use a pre-interventional recorded 3-D volume data set of the vessel, - Marking the course at least of the vessel section in a 3-D representation of the 3-D volume data set, - Registration of the pre-interventional marked 3-D volume data set with one with an X-ray device, the while the intervention for taking fluoroscopic images of the vessel including the vessel section serves, recorded 2-D image data set or another 3-D volume image data set, - continuous Recording of interventional fluoroscopic images with the X-ray device and continuous position and orientation-appropriate overlay the individual, at least the medical instrument showing fluoroscopic images with the marked 3-D volume data set registered with the fluoroscopic images at least in the region of the marked vessel section such that in the overlay image the course of the vessel section as Picture mark is visible. Method according to claim 1, characterized in that that the pre-interventional 3-D volumetric data set an MR or a CT angiography dataset is. Method according to claim 1, characterized in that that the pre-interventional 3-D volume data set by means of the designed as a C-arm X-ray device X-ray equipment is recorded. Method according to claim 1, characterized in that that the pre-interventional 3-D volume data set by merging two registered with each other 3-D sub-volume data sets, one of which is the vessel and the vessel section after contrast administration in the area lying distally to the vessel section and the other the vessel with vessel section after contrast administration in the region lying proximally to the vessel section shows is obtained. Method according to one of the preceding claims, characterized characterized in that the marking is automatic or by means of a on the screen movable marking element takes place. Method according to one of the preceding claims, characterized characterized in that in addition to vessel section also marks the course of at least part of the adjoining vessel becomes. Method according to one of the preceding claims, characterized characterized in that the image mark is linear and represents the vessel section edges. Method according to one of claims 1 to 6, characterized that the picture mark is flat is and the projected vessel section volume represents. Method according to claim 7 or 8, characterized that the image marker compared to the adjacent image area is different in color. Method according to one of the preceding claims, characterized in that a pre-interventional 3-D volume data set is used, which the vessel to different heart phases, and that the heart phase is detected during the fluoroscopy recording and a cardiac phase-synchronous superimposition takes place with the marked 3-D volume data set. Method according to one of the preceding claims, characterized that is a pre-interventional 3-D volumetric data set is used, which the vessel to different respiratory phases shows, and that while The fluoroscopy recording records the respiratory phase and a respiratory phase-synchronous overlay with the marked 3-D volume data set. Method according to one of the preceding claims, characterized characterized in that in pre-interventional 3-D volumetric data set Any areas present in or on the vessel or vessel section, conspicuous areas captured and displayed in the overlay image or as part of the automatic marking of the vessel section considered become. Method according to one of the preceding claims, characterized characterized in that a medical instrument having a preferably element located at its tip, which has a location system in its spatial Position can be located, using the coordinate system the locating system with the X-ray device is registered, and wherein upon detection of a predetermined relative position the element to the known position of the vessel wall an optical and / or acoustic warning signal is output.