探究大腦運動皮質厚度變化於缺血性腦中風之預後

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黃肜菘(Jung-Sung Huang) 查詢紙本館藏

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論文名稱

探究大腦運動皮質厚度變化於缺血性腦中風之預後
(Prognosis of Ischemic Stroke Based on Changes in Thickness of Cerebral Motor Cortex)

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摘要(中)

本研究將急性缺血性中風患者的三個時期與正常健康志願者之磁振造影(Magnetic Resonance Imaging，MRI)進行影像前處理後，使用以表面為基礎的型態計量學(Surface-based Morphometry，SBM)計算出大腦之腦脊髓液(Cerebrospinal Fluid，CSF)、灰質(Gray Matter，GM)及白質(White Matter，WM)機率圖譜及腦皮質平均厚度。然後，基於感興趣區域(Region of Interest，ROI)方法將大腦分割成360個區域，選取其中的大腦運動皮質區進行皮質厚度的統計、相關性及回歸分析。
本研究在不同條件下使用各種適合的統計方法，例如以曼-惠特尼U檢定分析中風患者與正常受試者間大腦皮質厚度是否具有顯著差異、以魏克森符號排序檢定分析中風患者三個時期之腦皮質厚度是否具有顯著差異。本研究對腦皮質或腦皮質下層中風群(Cortical-subcortical stroke)及腦幹中風群(Brain stem stroke)進行分析，所分析的大腦運動皮質區主要包含以下三個大腦區：體感與運動皮質區(Somatosensory and Motor Cortex)、中央旁小葉及中扣帶皮質區(Paracentral Lobular and Mid Cingulate Cortex)、與前運動皮質區(Premotor Cortex)。斯皮爾曼等級相關係數被用以分析在不同患部之皮質厚度與中風評估量表之間是否有正、負相關性。本研究在回歸分析中使用多元線性回歸及順序邏輯回歸，利用MRI影像所算出的皮質厚度預測中風評估量表分數。期望本研究發展的方法能在臨床醫學上對於醫師判斷病情有所幫助。

摘要(英)

This study aimed to analyze the changes of the motor cortex in acute ischemic stroke patients after stroke onset. The Magnetic Resonance Imaging (MRI) data were collected from the recruited patients at three stages：one week, one month, and three months poststroke. MRI data of normal healthy volunteers were also collected. After image preprocessing, the surface-based morphometry (SBM) was used to calculate the probability map of Cerebrospinal Fluid (CSF), Gray Matter (GM) and White Matter (WM) of the brain and the average thickness of the cerebral cortex. The Region of Interest (ROI) Method segments the brain into 360 regions, on which statistical, correlation and regression analysis of the motor cortical thickness were conducted.
A variety of statistical methods appropriate to different conditions were used in the study. The Mann-Whitney U test was used to analyze whether there is a significant difference in cerebral cortical thickness between stroke patients and healthy volunteers. The Wilcoxon signed rank test was used to analyze whether there is significant difference in the cerebral cortical thickness in the three stages at the stroke affected parts in the cortical-subcortical stroke group and the brain stem stroke group. Analysis of the cerebral motor cortex focused in three brain areas, i.e., the Somatosensory and Motor Cortex, the Paracentral Lobular and the Mid Cingulate Cortex, and the Premotor Cortex. Spearman′s correlation analysis was used to reveal possible positive or negative correlations between the change of cortical thickness and the changes of motor assessment scores at various brain regions. The predictability of motor assessment scores based on the MRI-acquired cortical thickness was investigated with multiple linear regression and ordinal logistic regression. The results of this research may be clinically valuable for stroke prognosis.

關鍵字(中)

★ 缺血性中風
★ 磁振造影
★ 大腦皮質厚度
★ 感興趣區域
★ 回歸分析

關鍵字(英)

★ ischemic stroke
★ magnetic resonance imaging
★ cerebral cortex thickness
★ region of interest
★ regression analysis

論文目次

摘要 i
Abstract ii
誌謝 iv
目錄 v
圖目錄 ix
表目錄 x
第1章緒論 1
1.1 背景介紹 1
1.2 研究動機 2
1.3 文獻回顧 3
第2章資料與研究方法 4
2.1 病人數據採集 4
2.2 計算腦皮質厚度方法 6
2.3 腦皮質分區圖譜 8
2.3.1 圖譜介紹 8
2.3.2 圖譜分析與選擇 10
2.4 中風評估量表 12
2.4.1 雷氏修正量表 12
2.4.2 傅格－梅爾評估量表 13
2.4.3 巴氏量表 14
2.4.4 柏格氏平衡量表 15
2.5 實驗步驟與方法 16
第3章實驗結果與討論 18
3.1 統計分析 18
3.1.1 卡方檢定 18
3.1.2 獨立樣本t檢定 19
3.1.3 曼-惠特尼U檢定 20
3.1.4 魏克森符號排序檢定 26
3.2 斯皮爾曼等級相關係數 30
3.3 回歸分析 34
3.3.1 多元線性回歸 34
3.3.2 順序邏輯回歸 47
3.4 討論 67
第4章結論與未來展望 70
4.1 結論 70
4.2 未來展望 72
參考文獻 73
附錄一、雷氏修正量表 77
附錄二、傅格－梅爾評估量表 78
附錄三、巴氏量表 83
附錄四、柏格氏平衡量表 85
附錄五、患部為腦幹之皮質厚度與柏格氏平衡量表分數之斯皮爾曼相關性 88
附錄六、患部為腦幹之皮質厚度與巴氏量表分數之斯皮爾曼相關性 90
附錄七、患部為腦幹之皮質厚度與傅格－梅爾評估量表分數之斯皮爾曼相關性 91
附錄八、患部為腦幹之皮質厚度與雷氏修正量表分數之斯皮爾曼相關性 92
附錄九、患部為腦皮質或腦皮質下層之皮質厚度與柏格氏平衡量表分數之斯皮爾曼相關性 94
附錄十、患部為腦皮質或腦皮質下層之皮質厚度與巴氏量表分數之斯皮爾曼相關性 95
附錄十一、患部為腦皮質或腦皮質下層之皮質厚度與傅格－梅爾評估量表分數之斯皮爾曼相關性 96
附錄十二、患部為腦皮質或腦皮質下層之皮質厚度與雷氏修正量表分數之斯皮爾曼相關性 97
附錄十三、患部為腦幹之皮質厚度與柏格氏平衡量表分數之多元線性回歸預測關係圖 99
附錄十四、患部為腦幹之皮質厚度與巴氏量表分數之多元線性回歸預測關係圖 100
附錄十五、患部為腦幹之皮質厚度與雷氏修正量表分數之多元線性回歸預測關係圖 102
附錄十六、患部為腦皮質或腦皮質下層之皮質厚度與巴氏量表分數之多元線性回歸預測關係圖 103
附錄十七、患部為腦皮質或腦皮質下層之皮質厚度與雷氏修正量表分數之多元線性回歸預測關係圖 104

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指導教授

蔡章仁(Jang-Zern Tsai)

審核日期

2021-1-22

推文