臺灣博碩士論文加值系統

本研究的目的是顯示擴散加權磁振造影技術 (DW-MRI)對骨盆腔膿瘍患者的診斷運用。我們研究了11例患者（年齡 37-78歲, 平均 42歲），這些病人都經確定診斷為骨盆腔膿瘍 ( pelvis abscess) 並且在高雄榮總接受了骨盆腔磁振造影 (pelvis MRI)檢查。除了常規 MRI掃瞄序列外，我們加入擴散加權磁振造影及使用兩個不同的b值（b= 0 and 1000 s/mm2）下的影像。所有患者經手術或穿刺抽吸來證實骨盆腔膿瘍的診斷。其中6例病人中的病原體已被培養出來，病原體包括大腸桿菌，鏈球菌和放線菌病。骨盆腔膿瘍呈現明顯高信號的擴散加權磁振造影和低擴散運動（限制水分子擴散運動）的表觀彌散係數（ADC）的影像。在11例骨盆腔膿瘍中平均表觀彌散係數值為0.76 ×10 -3 mm2/s （範圍在 0.53 -0.97 × 10 -3 mm2 /s）。骨盆腔膿瘍在病菌培養呈陰性或陽性的病人的表觀彌散係數值分別為0.70 × 10−3 mm 2/s 和0.81× 10−3 mm 2/s 。此結果顯示: 在病菌培養呈陰性及陽性的兩組病人，其表觀彌散係數值並無統計上差異 (p=0.144)。另外，我們同時分析了7位骨盆腔囊泡性腫瘤的病人，測量囊泡腫瘤在擴散加權磁振造影特性並測量其平均表觀彌散係數值。7位骨盆腔囊泡性腫瘤病人的平均表觀彌散係數值平均為2.15 × 10 -3 mm2/s (範圍1.51 -2.61 × 10 -3 mm 2/s) 。囊泡腫瘤的表觀彌散係數值統計上 顯著地高於骨盆腔膿瘍的表觀彌散係數值 (p<0.001)。擴散加權磁振造影技術對不確定的骨盆腔囊泡腫瘤的判讀提供了有用的資訊，尤其是在分辨骨盆腔膿瘍
或是骨盆腔囊泡性腫瘤的病人。

The purpose of this study was to demonstrate the clinical applications of diffusion-weighted MRI techniques for patients with pelvic abscesses. Eleven patients (age 37-78 years, average 42 years) with a final diagnosis of pelvic abscess in Kaohsiung Veterans General Hospital underwent pelvic MRI examinations, which included diffusion-weighted sequences at the two different b values (b=0 and1000 s/mm2) in addition to conventional MRI sequences. Pelvic abscesses were confirmed in all patients by surgery or needle aspiration. In six patients, pathogens, including Escherichia coli, Streptococcus and Actinomycosis have been identified. Pelvic abscesses were markedly homogeneously hyperintense on diffusion-weighted MRI and hypointense (restricted water diffusion) on apparent diffusion coefficient (ADC) map. The average of the mean ADC values at the pelvic abscesses of these eleven patients was 0.76 × 10 -3 mm2/s (range 0.53 -0.97 × 10 -3 mm 2/s). The average of mean ADC values of pelvic abscesses with negative or positive microorganisms in culture were 0.70 × 10−3 and 0.81× 10−3 mm2/s, respectively. This data showed that there was no significant difference in ADC values between positive and negative bacterial cultures (p=0.144). In addition, we also reviewed seven patients with pelvic cystic tumors and measured the mean ADC values of cystic tumors on MRI. The average of the mean ADC values at pelvic cystic component of masses in seven patients was 2.15 × 10 -3 mm2/s (range 1.51 -2.61 × 10 -3 mm2/s). The ADC values of pelvic cystic tumors were significantly higher than those of pelvic abscesses (p&lt;0.001). DW-MRI provides the helpful information for interpreting pelvic equivocal cystic masses, especially differentiating pelvic abscess from cystic tumor.

五、目錄
一、封面....................................................................................i
二、論文電子檔著作權授權書..............................................................ii
三、論文審定同意書...........................................................................iii
四、誌謝..............................................................................................iv
五、目錄...............................................................................................v
六、English Abstract............................................................................1
七、Chinese Abstract 中文摘要..........................................................3
八、List of Abbreviation........................................................................5
九、Introduction....................................................................................6
9.1 Diffusion-weighted imaging and “Brownian motion” …….............6
9.2 Measurements of “Brownian motion” ...........................................6
9.3 Applications of Diffusion-weighted MRI........................................7
9.4 Diffusion-weighted MRI for infection.............................................7
9.5 Diffusion-weighted MRI for pelvic diseases...................................8
十、Materials and Methods....................................................................9
10.1 Patient enrollments....................................................................9
10.1.1 Patients with pelvic abscesses............................................9
10.1.2 Patients with pelvic cystic tumors........................................9
10.1.3 Ex vivo imaging of pelvic abscess......................................10
10.2 MRI protocols...........................................................................11
10.2.1 Conventional MRI sequences...........................................11
10.2.2 DW-MRI sequences for patients with pelvic abscesses
and cystic tumors.................................................................11
10.2.3 DW-MRI sequences for ex vivo image of abscess..............12
10.3 Post scanning process...............................................................13
10.3.1 Calculation of ADC values...................................................13
10.3.2 Placement of ROI for pelvic lesions....................................13
10.3.3 ROI measurement for ex vivo images.................................14
10.4 Statistical analysis
十一、 Results..........................................................................................15
11.1 DW-MRI of pelvic abscess........................................................15
11.2 Conventional MRI of pelvic abscess.........................................15
11.3 Diagnostic accuracy of images for pelvic abscess....................15
11.4 Surgical and pathogens results of pelvic abscess....................16
11.5 Ex vivo images of pelvic abscess.............................................17
11.6 DW-MRI and ADC maps of cystic pelvic masses.....................17
十二、Discussion.......................................................................................18
12.1 DW-MRI and water diffusion....................................................18
12.2 Conventional imaging for pelvic abscess..................................18
12.3 Alternative imaging studies for pelvic abscess.........................19
12.4 Current studies of DW-MRI for brain abscess..........................19
12.5 Studies of DW-MRI for abdominal abscesses...........................20
12.6 Mechanism of restricted water motion in abscess.....................20
12.7 Differential diagnosis between pelvic abscess and pelvic
cystic tumor................................................................................21
12.8 EPI sequences for current DW-MRI..........................................21
12.9 Limitations of this study.............................................................22
十三、Conclusion.......................................................................................24
十四、Perspectives....................................................................................25
十五、References.........................................................................................26
十六、Figures.................................................................................................28
Fig.1. Speed difference of water diffusion in normal tissue, cystic necrosis, solid tumor and abscess...................................................................................28
Fig. 2. A 40-year-old woman presenting with a palpable mass in the lower abdomen and hematuria. ................................................................................................29
Fig. 3. A 37-year-old women with tubo-ovarian abscess. .....................................31
Fig. 4. Comparison of the measured ADC values in the abscess with positive and negative bacterial culture results.........................................................................33
Fig. 5. Ex vivo ADC map of abdominal abscess and diluted abscess (abscess: distilled water=1:10) in separated syringe tubes. .................................................34
Fig. 6. A 30-year-old woman with high grade serous adenocarcinoma of ovary....35
Fig. 7. Comparison of the measured ADC values in the pelvic abscess and pelvic cystic tumor.......................................................................................................36
Table 1. Patients’ data and imaging characteristics of pelvic abscesses on MRI.....37
Table 2. Summary of published studies and ADC values of infection and cystic malignancy .......................................................................................................38
十七、 Appendix................................................................................................40
十八、 Publications..................................................................................

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