基於靜息態功能性磁振造影之分率低頻振幅波 動和區域同質性於缺血性腦中風之研究

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楊欣諭(Shin-Yu Yang) 查詢紙本館藏

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論文名稱

基於靜息態功能性磁振造影之分率低頻振幅波動和區域同質性於缺血性腦中風之研究
(Study on Fractional Amplitude of Low-frequency Fluctuations and Regional Homogeneity Based on Resting State Functional Magnetic Resonance Imaging in Ischemic Stroke)

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摘要(中)

本研究目的是利用區域同質性（Regional homogeneity, ReHo）和分率低頻振幅波動（Fractional amplitude of low-frequency fluctuations, fALFF）來探究神經影像上缺血性腦中風後各腦區的自發性活動狀況與中風後恢復狀況之間的關聯。
通常，大腦梗塞後六個月內是復健治療的黃金期，尤其是前三個月恢復效果最為明顯。因此，我們募集缺血性大腦中風患者於中風後7天內、1個月、3個月之靜息態功能性磁振造影，探究其在典型頻帶（0.01–0.08 Hz）範圍的ReHo和fALFF，將之與復健量表進行相關性分析，及相對於年紀、性別匹配正常對照組進行統計分析。參與本研究的包括14位腦梗塞位於腦幹（Brain stem），以及17位腦梗塞位於皮質及/或皮質下層（Cortical–subcortical）的患者。
以下這兩項是本研究的主要的結果。第一，基於體素分析（Voxel-based analysis），腦梗塞病人與正常對照組的全腦ReHo或fALFF之雙樣本t檢定結果在許多腦區有顯著差異，這現象可能是病側或對側的神經網路遭到腦梗塞所破壞，或者在恢復過程中出現腦功能網路的重組和重新佈線整合。第二，基於感興趣區的分析（ROI-based analysis），經由斯皮爾曼相關分析（Spearman correlation analysis）發現，在有些感興趣腦區其ReHo或fALFF之腦梗塞後一個月時相對於中風後七天內的變化與復健量表中風後三個月時相對於腦梗塞後一個月時的變化兩者之間有顯著相關，此結果表示在這些腦區有可能藉由在腦梗塞後7天內和1個月時的ReHo或fALFF推估腦梗塞後3個月時復健量表所表徵的康復狀況。
本研究的結果可望輔助神經內科醫師在臨床預後上更準確的預後腦梗塞中風病人的恢復狀況，因而有助於診療決策之提出。

摘要(英)

The purpose of this study is to use regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF) methods to explore the relationship between the spontaneous brain activity and recovery status after acute ischemic stroke.
Usually, the golden period of rehabilitation treatment after cerebral infarction is within the first six months, especially in the first three months. Therefore, we collected the functional MRI scans of patients with ischemic cerebral stroke within 7 days, 1 month, and 3 months after stroke, and measured the ReHo and the fALFF in the typical frequency band within 0.01–0.08 Hz. We compared the stroke patients’ ReHo or fALFF with the rehabilitation scale; The ReHo and fALFF of the patients and those of the control group are also compared. Patients in this study included 14 with the lesion in the brain stem and 17 with the lesion in the cortical–subcortical region.
The following two are the main results of this research. First, in terms of voxel-based analysis, there are significant differences in the two-sample t test results of the whole-brain ReHo or fALFF between stroke patients and normal people in several brain regions. This phenomenon may be due to that the ipsilateral or contralateral neural network of the lesion was damaged by cerebral infarction, or the reorganization and rewiring of the brain function network occurred during the recovery process. Second, in terms of ROI-based (region of interestbased) analysis, Spearman correlation analysis found that, in some brain ROIs, the changes of the ReHo or the fALFF measured 1 month after stroke relative to that measured within 7 days after stroke have a significant correlation with the changes in the rehabilitation scale at 3 months after stroke and at 1 month after stroke. This result indicates that these brain ROI’s ReHo or fALFF measured within 7 days and in 1 month after stroke may be used to predict the rehabilitation status represented by the rehabilitation scale at 3 months after stroke.
The results of this study are expected to assist neurologists in predicting the patient’s recovery status after stroke more accurately in terms of clinical prognosis, thus contributing to diagnosis and treatment decisions.

關鍵字(中)

★ 缺血性腦中風
★ 靜息態功能性磁振造影
★ 區域同質性
★ 分率低頻振幅波動

關鍵字(英)

★ Ischemic Stroke
★ Resting State Functional Magnetic Resonance Imaging
★ Regional Homogeneity
★ fractional Amplitude of Low-Frequency Fluctuation

論文目次

摘要 i
Abstract iii
誌謝 v
目錄 vi
圖目錄 ix
表目錄 xii
第一章導論 1
1.1 前言 1
1.2 研究背景 4
1.3 功能連接 5
1.3.1 區域同質性 5
1.3.2 分率低頻振幅波動 7
1.4 中風復健評估量表 8
1.4.1 傅格－梅爾評估量表 8
1.4.2 雷氏修正量表 9
1.4.3 巴氏量表 10
1.4.5 功能性由口進食量表 11
1.5 論文研究架構 12
第二章材料與方法 13
2.1 篩選條件 13
2.2 fMRI數據採集 17
2.3 fMRI數據預處理 18
2.4 ReHo測量和 fALFF測量 19
2.5 雙樣本檢定 20
2.6 相關性分析 21
第三章結果 23
3.1 參與者特徵 23
3.2 感興趣區域之雙樣本檢定 31
3.3 斯皮爾曼相關性分析 43
3.3.1 所有大腦中風之區域同質性相關性分析 49
（一）與傅格－梅爾評估量表之區域同質性的相關性分析 49
（二）與雷氏修正量表之區域同質性的相關性分析 50
（三）與巴氏量表之區域同質性的相關性分析 51
（四）與伯格平衡量表之區域同質性的相關性分析 54
3.3.2 左側大腦中風之區域同質性的相關性分析 58
（一）與傅格－梅爾評估量表之區域同質性的相關性分析 58
（二）與巴氏量表之區域同質性的相關性分析 59
（三）與伯格平衡量表之區域同質性的相關性分析 62
3.3.3 所有大腦中風之分率低頻振幅波動相關性分析 64
（一）與傅格－梅爾評估量表之分率低頻振幅波動的相關性分析 64
（二）與巴氏量表之分率低頻振幅波動的相關性分析 71
（三）與伯格平衡量表之分率低頻振幅波動的迴歸分析 75
3.3.4 左側大腦中風之分率低頻振幅波動相關性分析 80
（一）與傅格－梅爾評估量表之分率低頻振幅波動的相關性分析 80
（二）與巴氏修量表之分率低頻振幅波動的相關性分析 86
（三）與伯格平衡量表之分率低頻振幅波動的相關性分析 88
3.4 區域同質性的雙樣本t檢定 91
3.4.1 翻轉影像使左腦為病灶側區域同質性的雙樣本t檢定 91
3.4.2 左側中風之區域同質性的雙樣本t檢定 99
3.4.3 右側大腦中風之區域同質性的雙樣本檢定 104
3.5 分率低頻振幅波動的雙樣本t檢定 110
3.5.1 翻轉影像使左腦為病灶側分率低頻振幅波動的雙樣本t檢定 110
3.5.2 左側中風之分率低頻振幅波動的雙樣本t檢定 115
3.5.3 右側大腦中風之分率低頻振幅波動的雙樣本t檢定分析 120
3.6 區域同質性和傅格－梅爾評估量表的相關性 125
3.6.1 翻轉影像使左腦為病灶側之區域同質性的相關性 125
3.6.2 左側大腦中風之區域同質性的相關性 129
3.7 分率低頻振幅波動和傅格－梅爾評估量表間的相關性 132
3.7.1 翻轉影像使左腦為病灶側之分率低頻振幅波動的相關性 132
3.7.2 左側大腦中風之分率低頻振幅波動的相關性 136
第四章討論 140
4.1 相關文獻討論 141
4.2 感興趣區域之雙樣本檢定 161
4.3 感興趣區域之相關性 166
4.4 基於體素之雙樣本檢定 168
4.5 中風患者與傅格－梅爾評估量表的相關性 175
第五章結論與未來展望 179
參考文獻 182
附錄 193
附錄一、神經影像應用於缺血性中風復健評估量表 193
附錄二、大腦中風部位位於腦幹患者 208
附錄三、大腦中風部位位於皮質及/或皮質下層患者 209

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指導教授

蔡章仁(Jang-Zern Tsai)

審核日期

2020-8-18

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