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研究生:邱盈霖
研究生(外文):In-Lin, Chiou
論文名稱:以磁振造影技術探討Modic變化與腰椎退化之相關性
論文名稱(外文):The Correlation Investigation of Modic Change and LumbarSpine Degeneration by Magnetic Resonance Imaging
指導教授:莊奇容
指導教授(外文):Chi-Long, Juang
學位類別:碩士
校院名稱:元培科技大學
系所名稱:醫學影像暨放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:102
語文別:中文
論文頁數:83
中文關鍵詞:脊椎退化Modic 變化磁振造影T2 弛豫時間圖像Dixon 方法
外文關鍵詞:Spine DegenerativeModic ChangesMagnetic Resonance ImagingT2 MapsDixon Method
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椎體退化性變化又稱作 Modic 變化,是一種發生在相鄰的椎間盤軟骨終板之退行性變化。這些病灶可使用磁振造影(MRI)加以偵測,MRI 是一種非侵入性及無輻射性又可以精確的偵測脊椎型態的影像診斷技術。此外脊椎周圍肌肉的功用,在於維持脊椎在身體的中心並維持椎體的穩定性;當這些肌肉發生功能變異或萎縮時,就會造成脊椎不穩定並進一步產生下背痛。儘管 Modic 變化和脊椎周圍肌肉的穩定性都與下背痛有關,但它們之間的相關性卻還不清楚。
本研究之志願受試者分別為 29 位下背痛且需要 MRI 掃描者及 30 位健康無下背痛者,年齡為 30 至 85 歲。受試者之椎間盤退化等級參考歐氏下背痛量表及他們的 T2 值進行評估;Modic 變化則由桃園敏盛醫院資深放射科醫師與放射師各一名,獨立進行 T1 及 T2 加權影像的判讀;待周邊肌肉之脂肪/水比值以 Dixon 方法取得之後,所有經過後處理的數據再以 PASW 18.0 統計軟體進行相關性分析。
結果發現無 Modic 變化者 39 位,Modic 變化第 I 型(MC1)者 6 位,Modic 變化第 II 型(MC2)者 11 位及 Modic 變化第 III 型(MC3)者 3 位。統計分析結果,髓核 T2 值與 Modic 變化呈現低相關性(rho = -0.104, P = 0.432),肌肉之脂肪/水的比率則呈現較高相關性(rho = 0.338, P = 0.009)。髓核 T2 值和脂肪/水的比率可以區別有無椎間盤軟骨終板的退化,是腰椎退化發展的重要指標。

Vertebral degenerative bone marrow changes also known as Modic changes, are degenerative changes adjacent to the cartilaginous endplates of the inter-vertebral discs. These lesions are visible in Magnetic Resonance Imaging (MRI), which provides a non-invasive and no radiation precise morphologic evaluation of the lumbar spine. In addition, the function of disc surrounding muscle is to remain the spine at center and keep the stability of inter-body. When dysfunction or atrophy happened in this muscle, the consequential spinal instability will also generate low back pain (LBP). Even though both of them associated with LBP, the correlation between them is still unclear.
In this study, fifty-nine subjects aged from 30 to 85 were divided into two groups, one consist 29 participants with LBP and required spine MRI measurement, and the other one consist 30 healthy volunteers. Degeneration grade of inter-vertebral discs of each subject were evaluated by Oswestry Low-Back-Pain disability questionnaire and their T2 Maps. Modic changes were evaluated by one senior radiologist and one senior radiographer independently by the T1 and T2 weighted images of the subject. After the fat/water ratios were obtained from Dixon method, all the post-processed data were then statistically analyzed by PASW 18.0 software.
The image analysis results showed there were 39 subjects without Modic changes, 6 with Modic changes type I, 11 with Modic changes type II and 3 with Modic changes type III. Statistical analysis results indicated the nucleus T2 value had low correlation (rho = -0.104, P = 0.432) with Modic changes types. However, the fat/water ratio of paraspinal muscle showed a high correlation (rho = 0.338, P = 0.009) with Modic changes. In conclusion, T2 values of the nucleus pulposus and fat/water ratio of paraspinal muscle provided the ability to grade the endplate cartilage degradation, and are the important indicators of the degenerative evolution of lumbar spine.
中文摘要 I
Abstract III
致謝 V
目錄 VI
圖目錄 VIII
表目錄 X
第一章 緒論 1
1.1 研究動機 1
1.2 研究目的 2
第二章 研究背景 3
2.1 脊椎基本構造 3
2.2 下背痛(low back pain) 7
2.3 脊椎周圍肌肉基本構造 8
2.4 Modic 變化 9
2.5 腰椎退化評估方法 10
2.6 磁振原理 13
第三章 材料與方法 23
3.1 研究設計 23
3.2 Dixon 方法之效益評估 24
3.3 受試者主要排除及納入條件 28
3.4 人體試驗程序 29
3.5 儀器 30
3.6 磁振造影掃描參數之設定 31
3.7 資料分析 34
3.8 統計方法 35
3.9 人體試驗流程 35
第四章 結果與討論 36
4.1 不同油水比例之假體的掃描結果 36
4.2 假體之相位校正結果 41
4.3 受試者基本特性 43
4.4 椎間盤髓核 T2 值分析 46
4.5 髓核 T2 值之椎間盤退化等級 50
4.6 腰椎周圍肌肉組織的 F/W 值 52
4.7 髓核 T2 值和腰椎周圍肌肉 F / W 值與 Modic 變化相關性分析 56
第五章 結論 57
參考文獻 58
附件一:下背痛患者 T2 值數據…………………………………………63
附件二:下背痛患者 F/W 值數據………………………………………64
附件三:健康受試者 T2 值數據…………………………………………65
附件四:健康受試者 F/W 值數據………………………………………66
附件五:敏盛綜合醫院人體試驗委員會研究計畫通過函………………67
附件六:受試者同意書……………………………………………………68
附件七:歐式下背痛功能評估量表……………………………………….72

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