臺灣博碩士論文加值系統

現今量測骨質密度主要使用雙能量X光吸收術（dual-energy x-ray absorptiometry, DEXA），掃描後獲得平面骨質密度（areal bone mineral density, aBMD），但DEXA會受到病人體厚、腹部脂肪含量與骨骼結構的影響，使結果有誤差的存在；而三維的骨質密度分析是藉由定量式電腦斷層掃描（Quantitative Computed Tomography, QCT），還有微型電腦斷層掃描（Micro-Computed Tomography, Micro-CT），兩種檢查的方法都需先經過一般CT掃描，去分析獲得骨骼的三維參數立體骨質密度（volumetric bone mineral density, vBMD）。本研究利用CT影像分析骨骼內結構，並計算aBMD、vBMD及骨小樑分數（trabecular bone score, TBS），找出參數間之關聯性，並且希望可以利用TBS參數進而預測骨骼的vBMD。本研究使用了53例女性及男性之腹部電腦斷層影像，於影像中定出腰椎有興趣區域後，接著以灰階平方差計算TBS，並分析其與aBMD、vBMD間的趨勢性。根據實驗的結果顯示，TBS、aBMD及vBMD皆會隨著年齡增加呈現下降的趨勢，而各參數間也獲得了顯著的差異。因此我們認為，TBS對人體骨骼強度的評估是有幫助的，而且對於的vBMD預測是一個有效的指標。

Bone mineral density (BMD) is critical to the bone strength of patients. Dual-energy x-ray absorptiometry (DEXA) is a common method for measuring the BMD of patients. However, the BMD values from DEXA are strongly influenced by body thickness, abdominal fat content, and bone structure. Therefore, volume bone mineral density (vBMD) is proposed and evaluated using quantitative computed tomography (QCT) and micro-computed tomography (micro-CT). In this study, the relationships between areal bone mineral density (aBMD), vBMD, and trabecular bone score (TBS) were evaluated using computed tomography (CT) images. Abdominal CT images were collected from 53 patients who have been confirmed free from bone diseases. The aBMD, vBMD, and TBS from the variogram were calculated from each lumbar spine. According to the results of the regression analysis, TBS, aBMD, and vBMD are inversely proportional to age. The TBS is proportional to the aBMD and vBMD values. Therefore, the TBS calculated from projection images is a useful index for evaluating bone quality and can be used for estimating the vBMD of patients further.

目 錄
中文摘要 ................................................................................................................ I
Abstract ................................................................................................................ II
目 錄 ............................................................................................................... III
圖 目 錄 ......................................................................................................... VI
表 目 錄 ......................................................................................................... IX
第一章 前言 ......................................................................................................... 1
1.1 研究背景 ...................................................................................................... 1
1.2 研究目的 ...................................................................................................... 5
1.3 論文架構 ...................................................................................................... 6
第二章 文獻回顧 ................................................................................................. 7
2.1 骨骼解剖 ...................................................................................................... 7
2.2 骨質疏鬆 ...................................................................................................... 8
2.3 雙能量Ｘ光吸收術 ................................................................................... 11
2.4 骨小樑骨質分數 ........................................................................................ 14
2.5 骨體積分率及體積骨質密度計算........................................................... 16
第三章 材料與方法 ........................................................................................... 20
3.1 電腦斷層影像前處理 ............................................................................... 20
3.2 骨小樑骨質分數 ........................................................................................ 22
3.3 定量式立體骨質密度分析 ....................................................................... 24
3.3.1 K2HPO4 假體製備 ............................................................................... 25
3.3.2 CaHA 假體製備 .................................................................................. 25
3.4 雙組合模型 ............................................................................................... 26
3.5 平面骨質密度 ............................................................................................ 29
3.6 腹部CT 影像 ............................................................................................ 29
3.7 脊椎網格模型建立 .................................................................................... 30
3.8 統計分析 .................................................................................................... 32
第四章 結果 ....................................................................................................... 33
4.1 骨小樑骨質分數 ....................................................................................... 33
4.2 定量式電腦斷層掃描 ................................................................................ 39
4.3 立體骨質密度 ............................................................................................ 41
4.4 平面骨質密度 ............................................................................................ 43
4.5 統計分析 .................................................................................................... 49
第五章 討論 ....................................................................................................... 51
第六章 結論 ....................................................................................................... 56
第七章 未來展望 ............................................................................................... 57
參考文獻 ............................................................................................................. 58

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