利用相位對比磁振造影技術評估馬凡氏症患者主動脈血流之螺旋現象

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研究生：	陳品蓁 Chen, Pin-Chen
論文名稱：	利用相位對比磁振造影技術評估馬凡氏症患者主動脈血流之螺旋現象 Evaluation of Helix in the Aortic Flow For Marfan Syndrome Patients by Phase-contrast Magnetic Resonance Imaging
指導教授：	焦傳金 Chiao, Chuan-Chin 彭旭霞 Peng, Hsu-Hsia
口試委員:	曾文毅 Tseng, Wei-Yih 邱馨慧 Chiou, Hsin-Hui
學位類別：	碩士 Master
系所名稱：	生命科學暨醫學院 - 系統神經科學研究所 Institute of Systems Neuroscience
論文出版年：	2017
畢業學年度：	105
語文別：	英文
論文頁數：	60
中文關鍵詞：	馬凡氏症、核磁共振、主動脈
外文關鍵詞：	Marfan Syndrome, Magnetic Resonance Imaging, Aorta
相關次數：	點閱：2 下載：0
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馬凡氏症是一種因FBN1基因突變造成的結締組織病變，發生在主動脈的主動脈根部擴張、主動脈瘤、以及接著造成的主動脈剝離被認為是病人猝死的危險因子。主動脈中過多的螺旋流將會導致心臟功能異常。本篇研究的目的是透過視覺化及定量化的分析，了解有症狀的馬凡氏症患者與正常人在主動脈血流的螺旋流現象。針對十八位馬凡氏症患者 (年齡：25.0 ± 7.1 歲)及十五位年齡相當的正常受試者 (年齡：29.0 ± 10.6歲)，其螺旋流現象及血流動力學參數主要是透過四維的相位對比核磁共振造影的影像達到視覺化及定量化的研究。在主動脈根的直徑及臨床評估參數(Z score)上，馬凡氏症患者 (38.9 ± 8.9毫公分; 3.4 ± 3.1)都顯著大於正常受試者(25.9 ± 4.5毫公分; -0.9 ± 1.2) ，P值小於0.001。主動脈血流的視覺化是利用商業化軟體做分析。主動脈血流的分級及馬凡氏症患者在升主動脈和主動脈弓有較大的旋轉角度都顯示出，馬凡氏症患者的血流流速較低，且有較少往前推進的血流特性。血流動力學參數，包括血流流速、旋度密度、相對旋度和縱向血管壁剪力，都顯示可以有效區分馬凡氏症患者以及健康受試者，尤其在升主動脈的部分。相對旋度在時間上及位置上的分布情形可以清楚的表示出馬凡氏症患者及健康受試者在核中心的差異，這種方式提供了未來在病人分類上一個更具前瞻性的應用。

Marfan syndrome (MFS) is a disorder of connective tissue structure caused by a mutation in the fibrillin 1 (FBN1) gene. Aortic root dilatation, aneurysms and subsequent dissection occurring in the aorta are considered to be the risk of sudden death for patients. Increased helical flow in the aorta will result in abnormal cardiac functions. The aim of this study were to visualize and quantify helical flow in aortic flow for MFS patients compared with normal subjects. Flow patterns and hemodynamic parameters in the thoracic aorta were visualized and quantified based on time-resolved 3D phase contrast MRI with three-directional velocity encoding (4D flow MRI, temporal resolution ~40 ms, spatial resolution ~1.17 mm) in 18 patients with confirmed MFS (age = 25.0 ± 7.1 years) and in 15 age-matched normal subjects (age = 29.0 ± 10.6 years). Aortic root diameter and Z score for MFS patients (38.9 ± 8.9 mm; 3.4 ± 3.1) were significant larger than that for normal subjects (25.9 ± 4.5 mm; -0.9 ± 1.2). Visualization of aortic flow were evaluated in commercial software. The grading of aortic flow and larger rotational angles in ascending aorta and aortic arch showed that MFS patients had smaller velocity and less bifurcation characteristics for blood flow propagation. The hemodynamic parameters, including velocity, helicity density, relative helicity and axial wall shear stress, had distinguished MFS patients to normal subjects mostly in ascending aorta. Spatiotemporal distribution of relative helicity clearly showed the difference of core center between MFS patients and normal subjects, which provided promising approaches for patient managements in the future.

   Chapter 1 Introduction    1
1    Marfan syndrome (MFS)    1
1.1    Clinical diagnosis    1
1.2    Clinical treatments    2
2    Helix and helicity    4
2.1    Definition    4
2.2    Applications    4
3    Motivation and purposes    6
   Chapter 2 Theory    7
1    Phase-contrast magnetic resonance image (PC-MRI)    7
2    4D flow MRI    9
   Chapter 3 Materials and methods    11
1    Study cohort    11
2    Image acquisition and post-processing    12
3    Helix visualization    14
3.1    Vector field and rotational ratio    14
3.2    Streamline and rotational angle    15
4    Quantification of helix-related parameters    16
4.1    Velocity, helicity density, relative helicity and axial WSS    16
4.2    Individual helicityAED mapping and AED classification    18
5    Statistical analysis    21
   Chapter 4 Results    22
1    Demographics of study cohorts    22
2    Helix visualization    22
2.1    Vector field and rotational ratio    22
2.2    Streamline and rotational angle    27
3    Quantification of helix-related parameters    29
3.1    Velocity, helicity density and relative helicity    29
3.2    Axial WSS    34
3.3    Individual helicityAED mapping and AED classification    37
3.4    Correlation analysis    41
   Chapter 5 Discussion    43
1    Helix visualization    43
2    Quantification of helix-related parameters    45
2.1    Physiologically features of aortic flow    45
2.2    Relative helicity    45
2.3    Axial WSS    46
2.4    HelicityAED mapping    47
2.5    Correlation analysis    49
3    Limitations    51
   Chapter 6 Conclusion    53
   Chapter 7 Questions and answers    54
   Chapter 8 References    58

                                

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