臺灣博碩士論文加值系統

目標：
利用影像強度擾動分析法(image strength fluctuation, ISF)與統計參數圖譜法(statistical parametric mapping, SPM)分析阿茲海默(Alzheimer’s disease, AD)在單光子電腦斷層攝影(SPECT)之腦血流變化。
材料與方法：
本研究為回溯性研究，30位99mTc-HMPAO SPECT影像經核醫科醫師判讀正常並排除電腦斷層(CT)或磁振造影(MRI)有異常者為正常組，包括17位男性與13位女性，平均年齡為41.2 ± 22.9歲，30位SPECT腦血流影像經核醫科醫師判讀為典型阿茲海默症(AD)為疾病組，包括16位男性與14位女性，平均年齡為76.5 ±9.4歲。利用SPM軟體內建之SPECT模版，將受試者的影像資料作正規化(normalization)和平滑化(smoothing)後，分別以SPM和ISF來分析正常組與疾病組腦血流變化。ISF方法主要利用Z分數(score)方法，找到有異常擾動的組距區間，並比對正常與不正常切片的影像。從比對中，作影像的補集運算，尋找冷熱區，然後查閱原始影像的灰階值，確定冷熱特徵點，且藉此特徵點來連結腦部功能區。
結果:
SPM分析結果顯示疾病組在兩側下頂小葉區(inferior parietal lobule)、左顳葉區的內上腦迴(middle or superior temporal gyrus)、右顳葉區的上腦迴(superior temporal gyrus)及右顳葉區的次葉腦島(sub-lobar insula)等區域比正常組的大腦血流有顯著減少。ISF結果與SPM的座標軸，高達83.3%的區域是吻合的。
結論: 利用ISF，可以分析核醫鎝-99m六甲基丙烯胺肟(99mTc-HMPAO)腦血流影像異常的區域，其結果與SPM一致。

Objectives:
To compare the effectiveness of both image strength fluctuation (ISF) and statistical parametric mapping (SPM) for analyzing cerebral blood flow traced by single photon emission computed tomography (SPECT) in patients with Alzheimer’s disease (AD).
Materials and methods:
This retrospective study included the comtrol group having 30 healthy subjects (17 men and 13 women; mean age, 41.2 ± 22.9 years) with normal cerebral blood flow, as revealed by computed tomography, magnetic resonance imaging, and 99m technetium hexamethyl propylene-amine-oxime (99mTc-HMPAO) SPECT. Images were interpreted by nuclear medicine physicians. The experimental group comprised 30 patients (16 men and 14 women; mean age, 76.5 ± 9.4 years) with clinically diagnosed AD. After normalization and smoothing data by the SPECT template of the SPM software, I analyzed the differences in the cerebral blood flow between two groups. The ISF method also revealed unusual fluctuation of the image strength range by using Z score analysis. The hot and cold areas were obtained as the difference appeared between normal and abnormal images. Analysis of the gray intensities of cold and hot areas was used to show cold and hot characteristic points and correlated with brain functional areas.
Results:
The results of SPM analysis revealed significantly reduced blood flow in bilateral inferior parietal lobule, the middle or superior gyrus of the left temporal lobe, and the superior gyrus as well as the sublobar insula of the right temporal lobe. The results from SPM were similar to those obtained with ISF showing same regions (83.3%).
Conclusion:
For analyzing the cerebral blood flow of AD patients traced by 99mTc HMPAO brain SPECT, the results obtained by the ISF method based on the Z-score method were almost the same as those by SPM.

中文摘要………………………………………………………………3
英文摘要………………………………………………………………4
第一章 緒論………………………………………………..............12
1.1 研究動機與目的………………………………………………..19
1.2 實驗設計………………………………………………………..22
1.3腦圖像統計參數圖譜法簡介…..……………………………….23
1.4影像強度擾動分析法介紹……………………..……………….31
1.4.1 隨機數列與常態分佈概念……………………………….32
1.4.2 正常人的平均腦之資料庫建立………………………….34
1.4.3 影像灰階強度分佈(Contour Plot)………………………..35
1.4.4 擾動(Fluctuation)的定義………………………………....36
第二章 研究材料與方法…………………………………..……….37
2.1受試者…………………………………………………..……….37
2.2核醫腦血流灌注(99mTc-HMPAO brain SPECT)程序…………..37
2.2.1單光子電腦斷層攝影條件設定(Data Acqusition)……….38
2.2.2影像匯出(Data processing)………………………….........40
2.3 用影像強度擾動分析法比較正常人與AD平均體素差異…....48
2.4 影像強度擾動分析法之資料處理與影像判讀…………..........48
第三章 結果…………………………………………………...........50
3.1 以SPM分析正常人與AD其99mTc HMPAO腦血流影像之差異.50
3.2 以SPM顯著性差異結果找出與ISF相對應點…………………51
3.3 以影像強度擾動分析法比較結果……………………………..51
3.4 以ISF色階圖像顯示正常人與AD差異…………………..........55
3.5 以ISF呈現缺血區域圖像……………………………………....55
3.6 與SPM相接軌的樞紐--冷熱區上的特徵點……...……………56
3.7 以Brodmann Map呈現SPM與ISF結果.………………………..59
第四章 討論及結論………………………………………...............60
第五章 參考文獻…………………………………………...............71
附件一………………………………………………………...93
附件二………………………………………………………...95
附件三………………………………………………………...96

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