臺灣博碩士論文加值系統

背景與目的:
過去的研究會在核磁共振(MRI)影像上，使用手動圈選肌肉面積來評估肌肉質量的減少，然而此手動圈選的方式容易有主觀判斷的誤差。本研究目的是利用雙能量X光吸收儀(DXA)在成人所測得的骨質密度值(BMD)，與MRI在腰椎上所掃瞄出的核心肌群，再利用半自動的影像分割方法獲得核心肌群的肌肉面積，並且評估BMD與肌肉面肌的相關性。
材料與方法:
本研究回顧了85例接受過DXA與MRI檢查的停經後婦女，這兩種檢查時間不得超過3個月，患者分為50例的非骨質疏鬆患者，以及35例的骨質疏鬆患者。其年齡都要在50歲以上，且剔除有壓迫性骨折、骨刺、嚴重的脊椎側彎、開過刀、放過金屬植入物或是洗腎患者。本研究使用高斯混和模型進行半自動影像分割，在5張MRI橫切面上(L1-L2, L2-L3, L3-L4, L4-L5, L5-S1)分別測量豎脊肌的淨肌肉面積，接者使用皮爾森相關係數探討患者的BMD與淨肌肉面積及其他參數間的相關性。
結果:
相關分析結果顯示，BMD與肌肉面積、體重、BMI、年齡、停經年齡均呈顯著相關，而且在肌肉面積與BMD的分析中，L1-L2切面的淨肌肉面積與BMD有較高的顯著性。在非骨鬆族群中，僅L1-L2豎脊肌橫截面淨肌肉面積與L-spine的BMD呈現正相關性。然而，在骨鬆族群中，豎脊肌在不同切面上的淨肌肉面積幾乎都與L-spine的BMD值呈現正相關，其中L1-L2淨肌肉面積與BMD有最高的相關性。
討論與結論:
本研究顯示半自動的影像分割方法有助於準確地測量核心肌群的肌肉面積，透過核心肌群之橫截面淨肌肉面積之量測，可以評估停經婦女之骨質疏鬆的嚴重程度，此外，結果也顯示L1-L2比其他切面的淨肌肉面積與BMD有較高的顯著性，可能是因為上層切面與豎脊肌較其他切面垂直。因此，L1-L2豎脊肌橫截面淨肌肉面積是適合用來探討停經婦女的骨質疏鬆程度，除了與BMD有較高的相關性外，亦可降低所需影像分割時間。

關鍵詞:骨質密度、雙能量X光吸收儀、磁振造影、肌少症、停經婦女、骨質疏鬆、核心肌群

Background and Objective:
Magnetic Resonance Imaging (MRI) has been previously utilized to evaluate the extent of muscle mass loss by manual drawing of muscle area which however is prone to subjective errors. The purpose of this study was to investigate the correlation between the bone mineral density (BMD) obtained from dual-energy X-ray absorptiometry (DXA) and the muscle area obtained from MRI using semi-automatic segmentation.
Materials and Methods:
This study reviewed 85 postmenopausal women who were older than 50 years old and had undergone both DXA and MRI examinations in 3 months. Of 85, 50 patients were without osteoporosis and 35 patients were with osteoporosis. None of them had compression fracture, osteophyte, severe scoliosis, bone surgery, metal implant, and dialysis. This study performed a semi-automatic Gaussian mixture segmentation method to obtain lean muscle area of erector spinae from five axial spine MRIs (L1-L2, L2-L3, L3-L4, L4-L5, L5-S1), and used Pearson’s correlational analysis to investigate the correlations between BMD, lean muscle area, and other parameters.
Results:
Correlational analysis showed that in 85 patients, the BMD was significantly correlated with muscle area, body weight, BMI, age, and duration of amenorrhea, and the L1-L2 muscle area was found to have higher correlation with BMD than those of lower slices. In non-osteoporotic group, the muscle area was significantly correlated with BMD only at L1-L2 slice. However, in osteoporotic group, the muscle areas of most slices were significantly correlated with BMD, and the muscle area at L1-L2 level had higher correlation than other levels.
Discussion and Conclusion:
This study demonstrated that the semi-automatic segmentation method is helpful to accurately measure the core muscle area which can be used to assess the severity of osteoporosis in postmenopausal women. The results also showed that the muscle area at L1-L2 level had higher significant correlation with BMD than other slices, suggesting that upper slice is more perpendicular to the erector spinae than lower slices and the obtained muscle cross-sectional area is more accurate. Therefore, we concluded that L1-L2 muscle area is suitable for investigating the severity of osteoporosis in postmenopausal women, not only because it has higher correlation with BMD but also because it takes less image analyzing time.


Keywords: BMD, DXA, MRI, Sarcopenia, Postmenopausal Women, Osteoporosis, Core muscles

致謝 I
中文摘要 II
英文摘要 IV
目錄 VI
圖目錄 VIII
表目錄 IX
第一章　研究背景與目的 1-1
1.1 骨骼疏鬆之成因與現況 1-1
1.2 探討骨鬆之測量方法 1-4
1.2.1 雙能量X光吸收測量儀(Dual energy X-ray Absorptiometry) 1-4
1.2.2 定量式電腦斷層掃描(Quantitative computed tomography) 1-7
1.2.3 定量式超音波檢查(Bone quantitative ultrasonography，QUS) 1-10
1.2.4 磁振造影(Magnetic resonance imaging，MRI) 1-12
1.3 肌少症與評估方法 1-15
1.3.1 肌少症的介紹 1-15
1.3.2 評估骨骼肌質量以及肌肉的成像方法 1-15
表 1 3、評估骨骼肌質量以及肌肉的成像方法 1-17
1.4 過去測量肌肉方法之缺點 1-20
1.5 本研究目的 1-22
第二章　材料與方法 2-1
2.1 病人收集方法 2-1
2.1.1 研究族群 2-2
2.2 影像收集方法 2-5
2.2.1 研究肌群分析 2-5
2.2.2 研究儀器 2-5
2.2.3 影像收集方法 2-6
2.3 半自動影像分割方法-高斯混合理論 2-11
2.3.1 高斯雜訊 2-11
2.3.2 高斯混合模型(Gaussian Mixture Model，GMM) 2-13
2.4 影像分割方法 2-14
2.5 計算條件與統計方法 2-20
2.5.1 肌肉面積的測量值 2-20
2.5.2 統計分析 2-21
第三章　實驗結果 3-1
3.1 病人資料分析結果 3-1
3.2 影像資料分析結果 3-3
3.3 相關性分析結果 3-6
3.3.1 BMD值與各參數之相關性分析 3-6
3.3.2 肌肉總面積與各參數之相關性分析 3-22
3.3.3 BMD值與各層肌肉之相關性分析 3-24
3.4 面積測量的穩定性分析 3-28
第四章　討論 4-1
4.1 病人資料結果 4-1
4.2 影像分割結果 4-3
4.3 統計分析結果 4-6
4.4 該研究之優缺點 4-15
第五章　結論 5-1
參考文獻
附錄　附錄一 人體試驗委員會審查證明書

圖目錄
圖 1 1、骨質疏鬆症示意圖[4] 1-3
圖 1 2、在L-spine MRI影像下手動描繪的肌肉面積[37] 1-21
圖 2 1、豎脊肌在L-spine中的相對位置 2-7
圖 2 2、MRI中的互激假影(cross-talk artifacts) 2-8
圖 2 3、L-spine MRI矢狀面 2-9
圖 2 4、高斯雜訊模型 2-12
圖 2 5、在MRI的軸向影像中顯示腰椎旁肌肉不同等級的脂肪浸潤 2-16
圖 2 6、手動圈選肌肉的感興趣區域(ROI)(以圖 2 5的1為例) 2-17
圖 2 7、高斯混合模型 2-18
圖 2 8、高斯混合模型影像分割後的肌肉及脂肪分布 2-19
圖 3 1、非骨鬆族群肌肉面積直方圖 3-5
圖 3 2、骨鬆族群肌肉面積直方圖 3-5
圖 3 3、全部群體L-spine BMD值與絕對總面積散佈圖 3-9
圖 3 4、全部群體Hips BMD值與絕對總面積散佈圖 3-9
圖 3 5、全部群體L-spine BMD值與機率總面積散佈圖 3-10
圖 3 6、全部群體Hips BMD值與機率總面積散佈圖 3-10
圖 3 7、全部群體L-spine BMD值與年齡散佈圖 3-11
圖 3 8、全部群體Hips BMD值與年齡散佈圖 3-11
圖 3 9、全部群體L-spine BMD值與停經期間散佈圖 3-12
圖 3 10、全部群體Hips BMD值與停經期間散佈圖 3-12
圖 3 11、全部群體L-spine BMD值與體重散佈圖 3-13
圖 3 12、全部群體Hips BMD值與體重散佈圖 3-13
圖 3 13、全部群體L-spine BMD值與BMI散佈圖 3-14
圖 3 14、全部群體Hips BMD值與BMI散佈圖 3-14
圖 3 15、非骨鬆族群L-spine BMD值與體重散佈圖 3-16
圖 3 16、非骨鬆族群Hips BMD值與體重散佈圖 3-16
圖 3 17、非骨鬆族群L-spine BMD值與BMI值散佈圖 3-17
圖 3 18、非骨鬆族群Hips BMD值與BMI值散佈圖 3-17
圖 3 19、骨鬆族群L-spine BMD值與絕對總面積散佈圖 3-19
圖 3 20、骨鬆族群Hips BMD值與絕對總面積散佈圖 3-19
圖 3 21、骨鬆族群L-spine BMD值與機率總面積散佈圖 3-20
圖 3 22、骨鬆族群Hips BMD值與機率總面積散佈圖 3-20
圖 3 23、骨鬆族群Hips BMD值與體重散佈圖 3-21
圖 3 24、骨鬆族群Hips BMD值與BMI值散佈圖 3-21

表目錄
表 1 1、世界衛生組織基於骨質密度的骨質疏鬆症定義[9] 1-6
表 1 2、骨質密度測量儀的測量部位以及優缺點 1-13
表 1 3、評估骨骼肌質量以及肌肉的成像方法 1-17
表 2 1、骨鬆族群 2-3
表 2 2、非骨鬆族群 2-4
表 2 3、影像收集流程圖 2-10
表 3 1、骨鬆與非骨鬆族群比較表 3-2
表 3 2、在MRI下的豎脊肌面積 3-4
表 3 3、全部群體BMD值與各參數之間的皮爾森相關係數 3-8
表 3 4、非骨鬆族群BMD值與各參數之間的皮爾森相關係數 3-15
表 3 5、骨鬆族群BMD值與各參數之間的皮爾森相關係數 3-18
表 3 6、全部群體肌肉總面積與各參數之間的皮爾森相關係數 3-23
表 3 7、非骨鬆族群肌肉總面積與各參數之間的皮爾森相關係數 3-23
表 3 8、骨鬆族群肌肉總面積與各參數之間的皮爾森相關係數 3-23
表 3 9、全部群體的BMD值與肌肉機率面積之皮爾森相關係數 3-25
表 3 10、全部群體的BMD值與肌肉絕對面積之皮爾森相關係數 3-25
表 3 11、非骨鬆族群的BMD值與肌肉絕對面積之皮爾森相關係數 3-26
表 3 12、非骨鬆族群的BMD值與肌肉機率面積之皮爾森相關係數 3-26
表 3 13、骨鬆族群的BMD值與肌肉絕對面積之皮爾森相關係數 3-27
表 3 14、骨鬆族群的BMD值與肌肉機率面積之皮爾森相關係數 3-27
表 3 15、非骨鬆與骨鬆族群之變異係數 3-29
表 4 1、非骨鬆與骨鬆族群比較表 4-2
表 4 2、非骨鬆與骨鬆族群肌肉面積比較表 4-5
表 4 3、BMD值與其他參數相關性 4-9
表 4 4、豎脊肌肌肉總面積與其他參數相關性 4-11
表 4 5、BMD值與豎脊肌肌肉面積相關性 4-14

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