磁振影像（Magnetic Resonance Imaging，簡稱MRI ）是近幾年越來越熱門的新醫學影像技術。在醫學臨床上，法洛氏四重症患者的心臟本身就有先天性的不良與缺損，導致流入肺動脈的血液不足，因此臨床上會針對此問題對法洛氏四重症患者做適當的矯正。即使是經過矯正的法洛氏四重症患者，他的肺動脈血流仍然不能與一般正常人一樣。因此，矯正過之法洛氏四重症患者的肺動脈血流成為一個臨床上很值得研究的課題。

本文主要使用磁振造影的相位對比影像，對於已矯正之法洛氏四重症的患者做更深入的左右肺動脈血流的量化分析與比較。使用參數「coefficient of variance (CV)」與「regurgitant fraction」將血流的亂流與紊流作定量化的分析，並且觀察已矯正之法洛氏四重症的患者與正常人血流正向流之向量圖的差異性。而結果發現血流中亂流與紊流的CV與regurgitant fraction兩參數值有著正向的相關性。因此，我們可推論使用CV與regurgitant fraction參數以及向量圖的觀察可幫助臨床上針對血流狀態的分析與診斷。

Recently magnetic resonance imaging has become more and more popular in clinical applications. In clinical studies, the heart of the TOF patient has some congenital defects. These defects lead to insufficient blood flowing into the pulmonary arteries, rendering the necessary of repair for TOF patients. However, even after repair, the blood in pulmonary arteries still cannot flow in the same way with those of normal people. For this reason, studies on the flow behavior of pulmonary arteries in TOF patients would be valuable in clinical applications.

In this study, we focus on the quantitative analysis of in-plane flow in branch pulmonary arteries (left and right pulmonary arteries) after repair of tetralogy of Fallot (TOF) by means of phase-contrast MR imaging. The regurgitation and turbulence were evaluated by coefficient of variance (CV) and regurgitant fraction. Vector map of in-plane flow was also included in order to facilitate the observation of flow patterns. Our result shows a positive correlation of CV and regurgitant fraction in terms of turbulence and regurgitation. Therefore, we conclude that CV and regurgitant fraction as well as vector maps may be helpful to quantitate in-plane flow for after repair of TOF patients, providing a more accurate analysis in clinical diagnosis.

摘要
Abstract
1. 序論 7
1.1. 磁振造影（Magnetic Resonance Imaging, MRI） 7
1.1.1. 原理 7
1.2. 相位對比（Phase contrast）影像 8
1.3. 法洛氏四重症 (Tetralogy of Fallot, 簡稱TOF) 10
1.3.1. 正常心臟 10
1.3.2. TOF患者的心臟 10
1.3.3. 心臟的矯正 11
1.4. 組織架構 11
2. 文獻、動機與分析方法 16
2.1. 醫學影像檔案 16
2.1.1. 識別字 16
2.1.2. 欄位規則 16
2.1.3. 重點標籤 17
2.1.4. 例外狀況 17
2.2. phase contrast檔案排列 18
2.3. 使用向量圖的多方向性血流方向分析 18
2.4. Fontan的定量分析 19
2.5. 湧昇流分析 20
2.6. 研究動機 20
2.7. 本文分析方法 21
2.7.1. Region of Interest（ROI） 21
2.7.2. 投影 21
2.7.3. CV 22
2.7.4. Net Flow 22
2.7.5. Regurgitant fraction 22
3. 結果與討論 30
3.1. 資料來源 30
3.2. 資料統計 31
3.3. 血流趨勢與向量圖 （Vector map） 31
3.4. 數據 32
3.4.1. CV部分 32
3.4.2. Regurgitant fraction部分 33
3.4.3. CV & Rf的比較 34
3.4.4. Net Flow & CV的比較 34
3.5. 討論 35
4. 結論 48
5. 參考文獻 49

[1] STEWART C. BUSHONG, ScD, et al, Magnetic Resonance Imaging Physical and Biological Principles Mosby

[2] Paul J. Keller, PHD, Basic Principles of Magnetic Resonance Imaging
Dept. of Magnetic Resonance Research, Barrow Neurological Institute, St. Joseph’s Hopital and Medical Center, Phoenix, AZ,85013

[3] I-Seok Kang, MD, Andrew N. Redington, MD, et al. Differential Regurgitation in Branch Pulmonary Arteries After Repair of Tetralogy of Fallot -- A Phase-Contrast Cine Magnetic Resonance Study Circulation. 2003;107:2938-2943.

[4] Joachim Lotz, MD, Christian Meier, PhD, et al. Cardiovascular Flow Measurement with Phase-Contrast MR Imaging: Basic Facts and Implementation RadioGraphics 2002; 22:651–671

[5] 彭旭霞, 利用相位對比影像估計肺動脈管壁上之壓力波傳遞速度 碩士論文, 2003/06

[6] McKesson Health Solution LLC. http://www.fairview.org/healthlibrary/content/ca_tetralog_art.htm

[7] Heart Center Online http://heart.healthcentersonline.com/

[8] 台北榮總兒童醫學部網站 http://www.vghtpe.gov.tw/~ped/index.htm

[9] 台灣醫學會網站 – 台灣的先天性心臟 http://www.fma.org.tw/medicial_data/taiwan08.htm

[10] Wikipedia, The Free Encyclopedia http://en.wikipedia.org/wiki/Main_Page

[11] Peter Armstrong, Martin L. Wastie, Diagnostic Imaging Blackwell Science Ltd.
鄭慶明編譯，醫學影像診斷學，第四版，合記圖書出版社

[12] Philip J. Kilner*, Guang-Zhong Yang*, et al. Asymmetric redirection of flow through the heart NATURE, VOL 404, 13 APRIL 2000

[13] The Report of the Manitoba Pediatric Cardiac Surgery Inquest http://www.pediatriccardiacinquest.mb.ca/ch02/tetralogy.html

[14] MAYO CLINIC http://www.mayoclinic.org/

[15] Atallah-Yunes NH, Kavey RW, et al., Postoperative assessment of a modified surgical approach to repair of tetralogy of Fallot: Long term follow up. Circulation 1996;94[suppl II]:II-22-II-26.

[16] Bove EL, Lupinetti FL, Tetralogy of Fallot. In Pediatric Cardiac Surgery,
Ed C. Mavroudis and C. Backer, Mosby, 276-291.

[17] National Electrical Manufacturers Association, Digital Imaging and Communications in Medicine (DICOM) Part 5: Data Structures and Encoding PS 3.5-2004,

[18] 高銘儀, 應用3D區域成長法於腦部磁共振影像之分割 碩士論文, 2003/07

[19] 何斌、金永傑 , DICOM 醫學圖像檔格式 中國科技論文在線 www.paper.edu.cn

[20] GE Medical Systems, HISPEED ADVENTAGE CT/i 4.1 & 5.3 CONFORMANCE STATEMENT Appendix A-D

[21] GE Medical System, SIGNA Application Guild, Vascular Magnetic Resonance Imaging Volume Three, Five

[22] Reed H. Mohiaddin, Guang Z. Yang, et al. Visualization of Flow by Vector Analysis of Multidirectional Cine MR Velocity Mapping Computer Assisted Tomography. 18(3):383-392, May/June

[23] Eliezer Be’eri, MD, Stephan E. Maier, MD, PhD, et al. In Vivo Evaluation of Fontan Pathway Flow Dynamics by Multidimensional Phase-Velocity Magnetic Resonance Imaging Circulation. 1998;98:2873-2882.

[24] 高雄榮民總醫院 http://www.vghks.gov.tw/

[25] Reed H. Mohiaddin, et al., Visualization of Flow by Vector Analysis of Multidirectional Cine MR Velocity Mapping Computer Assisted Tomography 18(3):383-392 May/June

[26] Yang GZ. et al., Vortical Flow Feature Recognition: A Topological Study of In Vivo Flow Patterns Using MR Velocity Mapping Computer Assisted Tomography, 22(4):577-586, 1998