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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 施庭芳(Tiffany Ting-Fang Shih) | |
| dc.contributor.author | Chih-Horng Wu | en |
| dc.contributor.author | 吳志宏 | zh_TW |
| dc.date.accessioned | 2021-06-16T13:40:07Z | - |
| dc.date.available | 2015-09-24 | |
| dc.date.copyright | 2013-09-24 | |
| dc.date.issued | 2013 | |
| dc.date.submitted | 2013-07-15 | |
| dc.identifier.citation | 1. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Hepatology. 2004 Dec;40(6):1387–95.
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Nonalcoholic Fatty Liver Disease: Predictors of Nonalcoholic Steatohepatitis and Liver Fibrosis in the Severely Obese. Gastroenterology. 2001 Jul;121(1):91–100. 8. Todo S, Demetris AJ, Makowka L, Teperman L, Podesta L, Shaver T, et al. Primary nonfunction of hepatic allografts with preexisting fatty infiltration. Transplantation. 1989;47(5):903. 9. Zamboni F, Franchello A, David E, Rocca G, Ricchiuti A, Lavezzo B, et al. Effect of macrovescicular steatosis and other donor and recipient characteristics on the outcome of liver transplantation. Clin. Transplant. 2001;15(1):53–7. 10. Fan ST, Lo CM, Liu CL, Yong BH, Chan JKF, Ng IOL. Safety of donors in live donor liver transplantation using right lobe grafts. Arch. Surg. 2000;135(3):336. 11. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N. Engl. J. Med. 2001;344(7):495–500. 12. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005 Jun;128(7):1898–906. 13. Lee SS, Park SH, Kim HJ, Kim SY, Kim MY, Kim DY, et al. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J. Hepatol. 2010;52(4):579–85. 14. Mehta SR, Thomas EL, Bell JD, Johnston DG, Taylor-Robinson SD. Non-invasive means of measuring hepatic fat content. World J. Gastroenterol. Wjg. 2008;14(22):3476. 15. Van Werven JR, Marsman HA, Nederveen AJ, Smits NJ, Fiebo J, van Gulik TM, et al. Assessment of Hepatic Steatosis in Patients Undergoing Liver Resection: Comparison of US, CT, T1-weighted Dual-Echo MR Imaging, and Point-resolved 1H MR Spectroscopy1. Radiology. 2010;256(1):159–68. 16. Kim H, Taksali SE, Dufour S, Befroy D, Goodman TR, Petersen KF, et al. Comparative MR study of hepatic fat quantification using single-voxel proton spectroscopy, two-point dixon and three-point IDEAL. Magn. Reson. Med. 2008 Mar;59(3):521–7. 17. Guiu B, Loffroy R, Petit J-M, Aho S, Ben Salem D, Masson D, et al. Mapping of liver fat with triple-echo gradient echo imaging: validation against 3.0-T proton MR spectroscopy. Eur. Radiol. 2009 Feb 27;19(7):1786–93. 18. Guiu B, Petit JM, Loffroy R, Ben Salem D, Aho S, Masson D, et al. Quantification of Liver Fat Content: Comparison of Triple-Echo Chemical Shift Gradient-Echo Imaging and in Vivo Proton MR Spectroscopy1. Radiology. 2009;250(1):95. 19. Pineda N, Sharma P, Xu Q, Hu X, Vos M, Martin DR. Measurement of Hepatic Lipid: High-Speed T2-Corrected Multiecho Acquisition at 1H MR Spectroscopy—A Rapid and Accurate Technique1. Radiology. 2009;252(2):568–76. 20. Friedrich-Rust M, Wunder K, Kriener S, Sotoudeh F, Richter S, Bojunga J, et al. Liver Fibrosis in Viral Hepatitis: Noninvasive Assessment with Acoustic Radiation Force Impulse Imaging versus Transient Elastography1. Radiology. 2009;252(2):595–604. 21. Chen B-B, Hsu C-Y, Yu C-W, Wei S-Y, Kao J-H, Lee H-S, et al. Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients. Eur. Radiol. 2011 Aug 31;22(1):171–80. 22. Lewin M, Poujol-Robert A, Boelle P-Y, Wendum D, Lasnier E, Viallon M, et al. Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology. 2007 Sep;46(3):658–65. 23. Huwart L, Sempoux C, Salameh N, Jamart J, Annet L, Sinkus R, et al. Liver fibrosis: noninvasive assessment with MR elastography versus aspartate aminotransferase–to-platelet ratio index1. Radiology. 2007;245(2):458–66. 24. Ryan CK, Johnson LA, Germin BI, Marcos A. One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl. 2002;8(12):1114–22. 25. Trotter JF. Selection of donors for living donor liver transplantation. Liver Transpl. 2003 Oct;9(10C):S2–S7. 26. Kim SH, Lee JM, Han JK, Lee JY, Lee KH, Han CJ, et al. Hepatic Macrosteatosis: Predicting Appropriateness of Liver Donation by Using MR Imaging—Correlation with Histopathologic Findings1. Radiology. 2006;240(1):116–29. 27. Qayyum A, Goh JS, Kakar S, Yeh BM, Merriman RB, Coakley FV. Accuracy of Liver Fat Quantification at MR Imaging: Comparison of Out-of-Phase Gradient-Echo and Fat-saturated Fast Spin-Echo Techniques—Initial Experience1. Radiology. 2005;237(2):507. 28. Guiu B, Petit J-M, Loffroy R, Aho S, Ben Salem D, Masson D, et al. Liver methylene fraction by dual- and triple-echo gradient-echo imaging at 3.0T: Correlation with proton MR spectroscopy and estimation of robustness after SPIO administration. J. Magn. Reson. Imaging. 2011 Jan;33(1):119–27. 29. Lee SS, Lee Y, Kim N, Kim SW, Byun JH, Park SH, et al. Hepatic fat quantification using chemical shift MR imaging and MR spectroscopy in the presence of hepatic iron deposition: Validation in phantoms and in patients with chronic liver disease. J. Magn. Reson. 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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/62308 | - |
| dc.description.abstract | 脂肪肝是指可逆性的脂肪堆積在肝臟細胞內，是已開發國家常見的肝臟疾病。飲酒、肥胖、糖尿病及代謝症候群是造成脂肪肝最常見的原因。肝臟切片是脂肪肝診斷的黃金標準但它屬於一種侵襲性的檢查。過去的研究顯示磁振造影及磁共振波譜相較於超音波及電腦斷層有較好的診斷力。但不同的磁振造影方法及磁共振波譜之間精確度的比較仍然不明瞭。本研究是要比較不同的磁振技術與組織切片下脂肪肝的程度及實驗室內肝細胞脂肪油滴萃取的相關性。
我們收集六十位預備接受肝切除手術的病人進行二迴波磁振造影(double-echo magnetic resonance imaging)、三迴波磁振造影(triple-echo magnetic resonance imaging)及磁共振波譜(magnetic resonance spectroscopy)的檢查。病人脂肪肝的程度以外科檢體內組織脂肪肝的百分比(histologic steatosis percentage)及肝細胞內三酸甘油酯密度(intrahepatocellular triglyceride density)當作黃金標準並以皮爾森相關係數(Pearson correlation coefficient)來作為相關性的指標。此外，以林氏一致性相關係數(Lin’s concordance coefficient)，Bland-Altman 95%一致性界限來評估三種磁振技術估計肝細胞內三酸甘油酯密度的準確性。診斷的表現則是以ROC (receiver operating characteristic)曲線來比較及分析。 三種影像方法所測的脂肪訊號與脂肪肝程度都有顯著相關，但三迴波磁振造影及磁共振波譜相較於二迴波磁振造影與組織脂肪肝的百分比及肝細胞內三酸甘油酯密度具有較強的相關性。此外，三迴波磁振造影有最高的林氏一致性相關係數(ρ = 0.881)及最高比例在Bland-Altman 95%一致性界限內(93.3%, 56/60)。最後，以ROC曲線分析大於5%組織脂肪肝，三迴波磁振造影的曲線下面積(0.9783)相較於二迴波磁振造影達到統計上的顯著(P = .0121)。 在三種磁振技術中，三迴波磁振造影是非侵犯性評估脂肪肝較好的方法。 | zh_TW |
| dc.description.abstract | Hepatic steatosis is reversible presence of fat deposits in hepatocytes. It is a common liver disease in developed country. Alcoholism, obesity, insulin-resistant diabetes mellitus, and metabolic syndrome are the most common causes of fatty liver. Liver biopsy has been the gold standard for hepatic steatosis diagnosis. Previous study shows magnetic resonance imaging and magnetic resonance spectroscopy are better diagnostic tools than ultrasound and computed tomography but their relative accuracy remains uncertain. This study was conducted to compare different magnetic resonance techniques and correlate the techniques with the histological findings and measurement of intracellular lipid density.
Sixty patients scheduled for elective liver resection were included in this study. Liver fat fraction was preoperatively counted from non-tumor liver parenchyma with double-echo, triple-echo magnetic resonance imaging, and magnetic resonance spectroscopy. The hepatic steatosis was defined by histologic steatosis percentage and intrahepatocellular triglyceride density from the surgical specimen as the reference standard. Imaging quantification results were evaluated by using Pearson correlation. Lin’s concordance coefficient and Bland-Altman 95% limits of agreement were used to evaluate the concordance among the 3 magnetic resonance techniques in estimating intrahepatocellular triglyceride density. The diagnostic performance was compared by using receiver operating characteristic curve analysis. All 3 imaging methods were significantly correlated with the degree of hepatic steatosis. However, triple-echo magnetic resonance imaging, and magnetic resonance spectroscopy measurements of hepatic steatosis had a stronger relationship with histologic steatosis percentage and intrahepatocellular triglyceride density than did double-echo magnetic resonance imaging. The triple-echo magnetic resonance imaging had the highest concordance correlation coefficients (ρ = 0.881) and percentage (93.3%, 56/60) within the Bland-Altman 95% limits of agreement. For receiver operating characteristic curve analysis with diagnosing >5% histologic steatosis percentage, the triple-echo magnetic resonance imaging had larger area under curve (0.9783) than double-echo magnetic resonance imaging with statistical significance (P = .0121). Among 3 magnetic resonance techniques, triple-echo magnetic resonance imaging may be the preferred imaging examination method for a noninvasive assessment of hepatic steatosis. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T13:40:07Z (GMT). No. of bitstreams: 1 ntu-102-P00421007-1.pdf: 2292507 bytes, checksum: 8a884fa22fbb365e58ae1fd8a6a110c9 (MD5) Previous issue date: 2013 | en |
| dc.description.tableofcontents | 口試委員會審定書 i
誌 謝 ii 中文摘要 iii 英文摘要 iv 目 錄 vi 一、 緒論 1 二、 研究方法與材料 4 二.1 受試者選擇標準 4 二.2 試驗設計與流程 4 二.3 試驗期限與進度 6 二.4 所需藥品或醫療器材名稱及數量 6 二.4.1 二迴波磁振造影 6 二.4.2 三迴波磁振造影 7 二.4.3 高速T2校正多迴波磁共振波譜 7 二.4.4 細胞內脂肪的萃取 7 二.4.5 擴散權重影像 8 二.5 資料之蒐集處理評估及統計分析方法 8 二.6 臨床上不良反應及處理方法 11 二.7 身心上可能產生之危險性與獲得之利益 11 三、 結果 12 三.1 病理組織的結果 12 三.2 研究群體的臨床及實驗室數據 12 三.3 影像結果與檢體資料的相關性 12 三.4 影像結果與肝細胞內脂肪萃取的一致性 13 三.5 診斷精確度 13 三.6 影像結果的相關性與肝纖維化的關係 14 三.7 超音波脈衝壓力影像及擴散權重影像診斷力的比較 14 四、 討論 16 五、 臨床的應用 18 六、 未來的展望 19 七、 圖表 20 表 1 研究群體的臨床及組織學上的特性 20 表 2 三種磁振技術與組織脂肪肝的百分比及肝細胞內三酸甘油酯密度的皮爾森相關係數；三種磁振技術估計肝細胞內三酸甘油酯密度的林式一致性相關係數、Bland及Altmann的 95%一致性界限及多少點落在模型內 21 表 3 以大於5%組織脂肪肝來診斷脂肪肝及大於20%組織脂肪肝做為診斷脂肪肝不適合進行活體肝臟移植的ROC曲線分析 23 表 4 比較二迴波磁振造影、三迴波磁振造影及磁共振波譜診斷大於5%組織脂肪肝的表現 24 表 5 二迴波磁振造影、三迴波磁振造影及磁共振波譜與組織脂肪肝的百分比的相關係數在不同肝纖維化的分組分析 25 表 6 超音波脈衝壓力影像及擴散權重影像診斷力的比較 26 圖 1 超音波影像的脂肪肝(#)，相較於腎臟(*)具有較高的迴音性。 27 圖 2 電腦斷層影像的脂肪肝，肝實質部分相較於肝內血管密度降低。 28 圖 3 磁振造影影像的脂肪肝，反相影像(B)相較於正相影像(A)肝實質部分訊號降低。 29 圖 4 二迴波磁振造影在正相及反相的影像上選取一塊正方形區域並紀錄其訊號強度，進而計算脂肪訊號分數。 30 圖 5 三迴波磁振造影先獲得第一正相(A)、反相(B)及第二正相(C)的影像，再計算出T2*分佈圖(D)、水分影像(E)、脂肪影像(F)，最後得出脂肪分數分布圖(G)，選取一塊正方形區域並紀錄其訊號強度。 31 圖 6 在定位影像上選取一塊大小為20公釐的正方體，藉由使用自動校正及後處理，可得磁共振波譜所計算的脂肪訊號分數。 32 圖 7 三個b值(b=0, 600, 1000)的擴散權重影像及所計算出的表觀擴散係數(ADC)。 33 圖 8 十六個b值的擴散權重影像及所計算出的慢擴散係數(Dslow, b≥200)、快擴散係數(Dfast, b<200)及灌流分率(perfusiob fraction, PF)。 34 圖 9 散佈圖及線性迴歸顯示身體質量指數與與肝細胞內三酸甘油酯密度成些許相關。 35 圖 10 散佈圖及線性迴歸顯示血清中三酸甘油酯與肝細胞內三酸甘油酯密度成些許相關。 35 圖 11 散佈圖及線性迴歸顯示血清中總膽固醇與肝細胞內三酸甘油酯密度的相關性則為差。 36 圖 12 散佈圖及線性迴歸顯示肝脾密度比率與肝細胞內三酸甘油酯密度成中度相關。 36 圖 13 散佈圖及線性迴歸顯示二迴波磁振造影與組織脂肪肝的百分比成中度相關。 37 圖 14 散佈圖及線性迴歸顯示三迴波磁振造影與組織脂肪肝的百分比成高度相關。 37 圖 15 散佈圖及線性迴歸顯示磁共振波譜與組織脂肪肝的百分比成高度相關。 38 圖 16 散佈圖及線性迴歸顯示二迴波磁振造影與肝細胞內三酸甘油酯密度成中度相關。 39 圖 17 散佈圖及線性迴歸顯示三迴波磁振造影與肝細胞內三酸甘油酯密度成高度相關。 39 圖 18 散佈圖及線性迴歸顯示磁共振波譜與肝細胞內三酸甘油酯密度成高度相關。 40 圖 19 散佈圖及線性迴歸顯示組織脂肪肝的百分比與肝細胞內三酸甘油酯密度成高度相關。 40 圖 20 二迴波型梯度影像估計肝細胞內三酸甘油酯一致性。有55個點(91.6%)落於Bland及Altmann95%同意閾值內。 41 圖 21 三迴波型梯度影像估計肝細胞內三酸甘油酯一致性。有57個點(95.0%)落於Bland及Altmann95%同意閾值內。 42 圖 22 磁共振波譜估計肝細胞內三酸甘油酯一致性。有56個點(93.3%)落於Bland及Altmann95%同意閾值內。 43 圖 23 組織脂肪肝的百分比估計肝細胞內三酸甘油酯一致性。有58個點(96.7%)落於Bland及Altmann95%同意閾值內。 44 圖 24 ROC曲線比較二迴波磁振造影、三迴波磁振造影及磁共振波譜診斷大於5%組織脂肪肝。 45 圖 25 線性迴歸顯示二迴波磁振造影與組織脂肪肝的百分比的相關性在F0-F2組成中度相關在F3-F4組則成些許相關。 46 圖 26 線性迴歸顯示三迴波磁振造影與組織脂肪肝的百分比的相關性在F0-F2組成高度相關在F3-F4組也成高度相關。 47 圖 27 線性迴歸顯示磁共振波譜與組織脂肪肝的百分比的相關性在F0-F2組成高度相關在F3-F4組降成中度相關。 48 圖 28 預備進行肝移植的捐贈者進行術前評估，包含分別進行左右肝體積的測量及要進行捐贈的那一葉測量脂肪肝的程度。此捐贈者有約30%的脂肪肝，不適合做為捐贈者。 49 圖 29 同圖 19那一位預備進行肝移植的捐贈者，此捐贈者原有約30%的脂肪肝，三個月飲食控制及運動後再做一次脂肪肝測量為0%，適合做為捐贈者。 50 八、 參考文獻 51 | |
| dc.language.iso | zh-TW | |
| dc.subject | 脂肪肝 | zh_TW |
| dc.subject | 非酒精性脂肪肝病 | zh_TW |
| dc.subject | 肝硬化 | zh_TW |
| dc.subject | 磁振造影 | zh_TW |
| dc.subject | 磁共振波譜 | zh_TW |
| dc.subject | Fatty liver | en |
| dc.subject | Non-alcoholic fatty liver disease | en |
| dc.subject | Liver cirrhosis | en |
| dc.subject | Magnetic resonance imaging | en |
| dc.subject | Magnetic resonance spectroscopy | en |
| dc.title | 比較不同磁振造影及磁共振波譜技術定量肝組織脂肪堆積之研究 | zh_TW |
| dc.title | Quantification of Hepatic Steatosis: A Comparison of the Accuracy among Multiple Magnetic Resonance Techniques | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 101-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 胡瑞恒(Ray-Heng Hu),劉俊人(Chun-Jen Liu) | |
| dc.subject.keyword | 脂肪肝,非酒精性脂肪肝病,肝硬化,磁振造影,磁共振波譜, | zh_TW |
| dc.subject.keyword | Fatty liver,Non-alcoholic fatty liver disease,Liver cirrhosis,Magnetic resonance imaging,Magnetic resonance spectroscopy, | en |
| dc.relation.page | 53 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2013-07-15 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
| 顯示於系所單位： | 臨床醫學研究所 | |
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