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研究生： 劉議璘
Liu, Yi-lin
論文名稱： 心臟內超音波之心臟影像切割與三維重建以輔助心房中膈缺損關閉術
Three-Dimensional Reconstruction of Intracardiac Echocardiography to guide device closure of Atrial Septal Defect
指導教授： 陳天送
Chen, Tain-song
謝凱生
Hsieh, Kai-hsien
學位類別： 碩士
Master
系所名稱： 工學院 - 醫學工程研究所
Institute of Biomedical Engineering
論文出版年： 2007
畢業學年度： 95
語文別： 中文
論文頁數： 63
中文關鍵詞： 心房中膈缺損關閉術 、心房中膈缺損 、心臟內超音波
外文關鍵詞： intracardiac echocardiography, secundum atrial septal decect, Atrial Septal Defect
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    • 經由心導管方式以閉合器來把第二型心房中隔缺損關閉已經是治療心房中隔缺損首選方式。但不同於外科手術，心導管手術方式無法直接看到心房中隔缺損情況，如破洞大小、個數與破洞邊緣；以往做此閉合術時，必須藉由X光螢光幕看到閉合器的位置以及藉由氣球測量導管以量得破洞有多大，或是利用食道超音波來觀察，但是前兩種方法無法得知破洞邊緣資訊與破洞個數，而食道超音波則需全身麻醉並具有臨床危險。心臟內超音波可以彌補上述方法之不足，不但可以清楚觀察心房結構，更能藉此評估閉合器卡在心房中隔缺損的位置是否恰當。
    本研究將於心導管手術時併用心臟內超音波來觀察心房結構，如此不但不需全身麻醉且能降低臨床危險性。但由於心臟為一個立體結構，使用二維心臟內超音波時常需以想像的方式，來評估心房的立體結構與心房中隔缺損情況，如此既不客觀也無一定的準則。所以本研究發展三維心臟內超音波影像重建系統，讓心房中隔關閉術操作人員可以清楚地瞭解三維心房中隔缺損的空間位置與相關人體解剖位置，如此能更清楚監測心導管手術的進行以及術後關閉器位置，對於促進心房中隔關閉術安全操作極為重要。

    It is the best way to treat the secundum type of Atrial Septal Defect (ASD) using the cardiac catheterization & interventional procedure. In the past years, the clinicians detected the location of the catheter through angiography images and measure the size of the ASD by balloon catheter test. However, the cardiac catheterization can not display the whole view of the ASD, such as the location, size, and rim of the ASD. Therefore, we utilize the transesophageal echocardiography (TEE) to observe the ASD. However, TEE needs general anesthesia with clinical risk. Intra-cardiac echocardiography (ICE) not only allows us to observe the atrium structure in the heart, but also to evaluate the device closure of ASD for guidance during the operation.
    This research utilized the ICE to observe the atrium structure during cardiac catheterization procedures & interventional closure of ASD. Since the heart is a three-dimensional anatomical structure and two-dimensional ICE images often needed to reconstruct to assess the three-dimensional structure of the atrium and ASD. In this study, we develop a real-time ICE converting to three-dimensional reconstruction system. The operator of transcatheter closure of ASD can realize the three-dimensional ASD and the relevance to cardiac anatomy in 3D feature. The transcatheter of ASD will be safer and easier with this new 3D Image Reconstruction of Cardio-anatomy using Intracardiac Echocardiography.

    中文摘要.................................................I 英文摘要.................................................Ⅱ 誌謝.................................................... Ⅲ 目錄.....................................................IV 圖目錄...................................................VI 第一章 緒論...............................................1 第1-1節 先天性小兒心房中膈缺損(ASD........................2 第1-2節 ASD診斷的方法.....................................4 第1-2-1節 安普拉茲閉合器..................................4 第1-2-2節 雙極X光攝影術...................................5 第1-3節 心臟內超音波......................................7 第1-4節 文獻回顧..........................................9 第二章 心臟內超音波影像的處理及分析......................11 第2-1節 心臟內超音波影像之取得...........................11 第2-2節 主動輪廓模型.....................................14 第2-2-1節 內在能量.......................................15 第2-2-2節 外在能量.......................................16 第2-2-3節 氣球輪廓模型...................................19 第2-3節 醫師手動判斷ASD..................................22 第三章 實驗材料與方法....................................23 第3-1節 影像分割........................................ 24 第3-2節 邊界平滑方程式...................................24 第3-3節 三次方雲形曲線...................................25 第3-3-1節 分段線性近似函數.............................. 25 第3-3-2節 Cubic spline 應用於Z軸之平滑化.................31 第3-4節 心臟內超音波影像對位(Image Registration).........36 第四章 結果與討論........................................41 第4-1節 影像前處理...................................... 41 第4-2節 Active Contour Model快速搜尋影像邊界法...........43 第4-3節 影像對位.........................................46 第4-4節 影像分割及三維重建...............................49 第4-5節 三維影像重建與手動圈選ASD重建....................51 第4-6節 模擬心房假體實驗.................................53 第五章 結論與未來展望...................................60 第5-1節 結論.............................................60 第5-2節 未來展望.........................................60 參考文獻.................................................62 圖目錄 圖 1-1 心房中膈缺損示意圖.................................3 圖 1-2 安普拉茲閉合器.....................................4 圖 1-3 雙極X光機器及病人在機器上的位置....................6 圖 1- 4心房中隔修復術中X光攝影術所拍攝的處理程序..........6 圖 1- 5心臟內超音波影像示出心導管手術過程.................8 圖 1- 6 三維重建心臟影像..................................9 圖 2 -1 超音波影像序列擷取路徑............................12 圖 2 -2 心臟內超音波系統架構圖............................13 圖 2 -3 Sobel運算子.......................................18 圖 2 -4 值對balloon force的影響..........................19 圖 2 -5 Active contour model 解決邊界不連續的問題.........20 圖 2 -6 Active contour model 演算法之流程圖...............21 圖 2 -7手動圈選邊界示意圖.................................22 圖 3 -1基本架構流程圖.....................................23 圖 3 -2 B型雲形線座標標準式0~3階之繪圖及方程式............31 圖 3 -3標準化之B型雲形線..................................31 圖 3 -4 open curve利用cubic spline的曲線擬合..............34 圖 3 -5 close curve利用periodic cubic spline的曲線擬合....35 圖 3 -6心臟內超音波影像導管內探頭偏移的情形...............36 圖 3 -7影像金字塔模型.....................................38 圖 3 -8影像對位流程圖.....................................40 圖 4 -1影像前處理之處理步驟: 探頭濾除、二值化、中值濾波...42 圖 4 -2影像前處理之處理步驟: 形態學上的處理...............42 圖 4 -3初步邊界檢測的結果.................................44 圖 4 -4 Active Contour Model序列影像邊界快速搜尋法........45 圖 4 -5 兩影像之相異面積值計算............................46 圖 4 -6影像邊界二值化取面積...............................47 圖 4 -7 影像對位後之結果..................................48 圖 4 -8右心房影像分割及重建之結果.........................49 圖 4 -9心臟超音波影像經過線性插補後之結果.................50 圖 4 -10三維影像重建和ASD手動圈選重建.....................51 圖 4 -11心房收縮影像重建後之結果..........................52 圖 4 -12聚丙烯材質心房假體.................................53 圖 4 -13假體置於水箱內....................................53 圖 4 -14心房假體X光影像...................................54 圖 4 -15超音波心房假體影像................................54 圖 4 -16假體影像分割結果…................................55 圖 4 -17假體三維重建結果..................................56 圖 4 -18假體三維重建分析圖................................58 圖 4 -19有缺口假體影像切面及圈選出之邊界圖................59 圖 4 -20有缺口假體影像三維重建…..........................59 圖 5 -1 磁性探頭軌跡架構圖................................61

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