穿顱磁刺激檢查(TMS)是藉由快速改變的磁場對大腦皮質進行刺激產生運動誘發電位，進而獲得腦部到周邊肢體整體的神經功能狀態。目前臨床上使用標準流程定位方式與醫師的經驗法則來尋找蜜合點，由於此方法不能精確提供醫師蜜合點的位置，且每位患者蜜合點對磁刺激強度的反應不大相似，導致醫師在尋找蜜合點位置相當的耗時且困難。本研究以患者的電腦斷層或核磁共振影像，透過對比度調整與特徵值擷取等，將大腦的二維影像轉成三維影像。利用布林函數、擠出與偏移曲面等三維影像處理，將蜜合點對應於輔助頭罩的位置加以標示，並且於輔助頭罩表面標示出TMS線圈擺放角度，以達到讓臨床醫師方便使用之目的。本研究同時也於高雄榮民總醫院進行38名缺血性腦中風患者之人體試驗，在患者發病10天內、第30天以及第90天進行TMS，並比較輔助頭罩與臨床方式標示出蜜合點的精確度，記錄患者的運動閥值、運動誘發電位振幅與中樞運動傳導時間等參數。假體實驗結果顯示，本研究之輔助頭罩的定位次數與時間與標準流程方法的定位次數與時間有顯著差異(p<0.001)，而透過標準流程方法定位出來的蜜合點與主運動皮質區的平均差距0.33±2.05mm，與本研究的定位準確度有顯著差異(p<0.001)。臨床試驗結果顯示，有MEP響應的群組中，中樞傳導時間比運動誘發電位振幅和運動閥值更能成為患者運動功能恢復的預後因子。由此得知，本研究可以提供臨床醫師一個定位準確度高，有效降低定位次數與時間，且使用方便的輔助頭罩。本研究也證實了透過TMS誘發的運動誘發電位，可做為缺血性腦中風患者運動功能恢復的預後因子之一。

Transcranial magnetic stimulation (TMS) is defined as a kind of electrophysiological examination that could stimulate cerebral cortex by rapidly changing magnetic field to gain a whole the state of neurological function from the brain to the surrounding limb.A method for positioning the sweet-point (SP) is still clinically targeting standard procedure and rule of thumb.The beginning of method could not accurately provide the positioning of SP which had different response by TMS. It was time-consuming and difficult to find SP for doctor.This study used contrast, feature extraction and other methods converted two-dimensional image to three-dimensional image of brain through computed tomography (CT) imaging or magnetic resonance imaging (MRI) of patients. The positioning of SP and the angle of TMS coil were marked on the surface of the headgear by Boolean function, extrusion, offset surface and other three-dimensional image processing to clinicians objectives. In this study, 38 patients with ischemic stroke participated in the clinical trial at Kaohsiung Veterans General Hospital. The physician performed TMS on the onset of the disease within 10 days, the 30th day and the 90th day to record the patient's motion threshold, motion evoked potentials (MEP) amplitude and central motion conduction time (CMCT) and so on. Furthermore, they compared the accuracy of positioning the SP from headgear and standard process. The results of the phantom study showed thatthe number of times and time in positioning of headgear were significantly different from the standard process (p<0.001). The average distance were between SP and motor cortex was 0.33±2.05mm which was significantly different from this study (p<0.001). In the clinical trial results show CMCT could be used as a prognostic factor more than MEP Amplitude and MT in MEP response group. Therefore, this study could provide a high accuracy of positioning for clinicians to effectively reduce the number of times and time in positioning and easily use it.In addition, this study was also confirmed that the value of MEP induced by TMS which could indeed be a prognostic factor of patients with ischemic stroke.