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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鍾孝文(Hsiao-Wen Chung) | |
dc.contributor.author | Chao-Ying Wang | en |
dc.contributor.author | 王昭穎 | zh_TW |
dc.date.accessioned | 2021-06-15T04:58:45Z | - |
dc.date.available | 2015-07-30 | |
dc.date.copyright | 2010-07-30 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-07-28 | |
dc.identifier.citation | References
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The pathologenesis of postpartum necrosis of the anterior lobe of the pituitary gland. Acta Endocrinology 1961;37:479-510. 16. Argyropoulou M, Perignon E, Brunelle F, Brauner R, Rappaport R. Height of normal pituitary gland as a function of age evaluated by magnetic resonance imaging in children. Pediatric Radiology 1991;21:247-249. 17. Kuroiwa T, Okabe Y, Hasuo K, Yasumori K, Mizushima A, Masuda K. MR imaging of pituitary dwarfism. AJNR Am J Neuroradiol 1991;12:161-164. 18. Tillmann V, Tang VW, Price DA, Hughes DG, Wright NB, Clayton PE. Magnetic resonance imaging of the hypothalamic-pituitary axis in the diagnosis of growth hormone deficiency. J Pediatr Endocrinol Metab 2000;13:1577-1583. 19. Blethen SL, Allen DB, Graves D, August G, Moshang T, Rosenfeld R. Safety of recombinant deoxyribonucleic acid-derived growth hormone: The national cooperative growth study experience. J Clin Endocrinol Metab 1996;81:1704-1710. 20. Taback SP, Dean HJ. Mortality in Canadian children with growth hormone (GH) deficiency receiving GH therapy 1967-1992. The Canadian Growth Hormone Advisory Committee. J Clin Endocrinol Metab 1996;81:1693-1696. 21. Nishi Y, Tanaka T, Takano K, Fujieda K, Igarashi Y, Hanew K, Hirano T, Yokoya S, Tachibana K, Saito T, Watanabe S. Recent status in the occurrence of leukemia in growth hormone-treated patients in Japan. J Clin Endocrinol Metab 1999;84:1961-1965. 22. Kornreich L, Horev G, Lazar L, Schwarz M, Sulkes J, Pertzelan A. MR findings in growth hormone deficiency: correlation with severity of hypopituitarism. AJNR Am J Neuroradiol 1998;19:1495-1499. 23. Horvath E, Kovacs K. Fine structural cytology of the adenohypophysis in rat and man. J Electro Microsc Tech 1988:8:401-432. 24. Scheithauer BW, Horvath E, Kovacs K, et al. Pleurihormonal pituitary adenomas. Semin Diagn Pathol 1986;3:69-82. 25. Catherine Garel, Juliane Leger. Contribution of magnetic resonance imaging in non-tumoral hypopituitarism in children. Horm Res 2007;67:194-202. 26. Luba M, Bossowski A, Kulikowska J, Urban M, Szarras-Czapnik M, Rutkowski R, Parol T, Gasiorek T, Sawicka B, Skrzydło M. Precocious puberty due to hypothalamic hamartoma. Pediatr Endocrinol Diabetes Metab. 2008;14(4):257-61. 27. Lee CT, Tung YC, Tsai WY. Etiology and clinical features of isosexual precocious puberty in Taiwanese girls: twenty-three years' experience in National Taiwan University Hospital. J Pediatr Endocrinol Metab. 2009;Oct;22(10):947-53. 28. Zucchini S, di Natale B, Ambrosetto P, De Angelis R, Cacciari E, Chiumello G. Role of magnetic resonance imaging in hypothalamic-pituitary disorders. Horm Res. 1995;44 Suppl 3:8-14. 29. Sharafuddin MJA, Luisiri A, Garibaldi LR, FuIk’ DL, Klein JB, Gillespie KN, Graviss ER. MR Imaging diagnosis of central precocious puberty: importance of changes in the shape and size of the pituitary gland. AJR 1994;162:1167-1173. 30. Robben SG, Oostdijk W, Drop SL, Tanghe HL, Vielvoye GJ, Meradji M. Idiopathic isosexual central precocious puberty: magnetic resonance findings in 30 patients. Br J Radiol. 1995;68(805):34-8. 31. Elster AD. Modern Imaging of the pituitary. Radiology 1993;187:1-14. 32. Antoniazzi F, Zamboni G. Central precocious puberty: current treatment options. Paediatr Drugs. 2004;6(4):211-31. 33. Ducharme JR, Collu R. Pubertal development: normal, precocious and delayed. Clin Endocrinol Metab. 1982;Mar;11(1):57-87. 34. Sato N, Sze G, Endo K. Hypophysitis: endocrinologic and dynamic MR findings AJNR Am J Neuroradiol 1998;19:439-444. 35. Manfré L, Midiri M, Rosato F, Janni A, Lagalla R. Perfusion MRI in normal and abnormal pituitary gland. a preliminary study. Clin Imaging 1997;21:311-318. 36. Sakamoto Y, Takahashi M, Korogi Y, Bussaka H, Ushio Y. Normal and abnormal pituitary glands: gadopentetate dimeglumine-enhanced MR images. Radiology 1991;178:441-445. 37. Stadnik T, Stevenaert A, Beckers A, Luypaert R, Buisseret T, Osteaux M. Pituitary microadenomas: diagnosis with two- and three-dimensional MR imaging at 1.5T before and after injection of gadolinium. Radiology 1990;176:419-428. 38. Maier C, Riedl M, Clodi M, Bieglmayer C, Mlynarik V, Trattnig S, Luger A. Dynamic contrast-enhanced MR imaging of the stimulated pituitary gland. NeuroImage 2004;22:347-352. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46223 | - |
dc.description.abstract | 本研究的主題為透過T1動態顯影之磁振造影,觀察腦下垂體區域性血液微灌流動力學的現象,與小兒內分泌疾病之間是否具有關連性。再深入探討微小之腦下垂體腺體中,其血液微灌流的現象變化與腺體荷爾蒙分泌細胞的分佈,在不同小兒內分泌疾病間有無空間對應關係。另外,疾病的嚴重程度與血液灌流改變間有無關連性。我們希望在除了骨骼素片、內分泌學的抽血檢定數據外,能找出另一個可提供臨床診斷及後續臨床治療之影像評估指標,作為針對小兒腦下垂體引發之生長疾病診斷及治療的監測工具,達到垂體磁振造影血液動力學研究模型的建立與標準。
小兒的腦下垂體的影像研究,過去幾年一直侷限於形態學上的判讀與研究,而對於垂體血流的動態的研究,常因為空間解析度與時間解析度的限制,或是分析方法不夠客觀,造成各個研究發表在針對於腦下垂體的應用結果上有很大的差異性,應用的範圍往往只能針對單一個切面或局部區域,使得在臨床應用廣泛性上有所限制。臨床上,對於許多內分泌數值已經反映出異常的病童,在傳統磁振造影檢查中,有些確能找出中樞神經系統的病因,但是仍然有大部分的案例發現結構完全正常。在這樣情形下,如何找出病因與診斷,對於小兒科醫師的治療與後續追蹤有著很大的影響。本研究為達成區域性的T1動態顯影磁振造影檢查之腦下垂體微灌流影像,利用動態注射順磁性的磁振造影顯影劑配合多切面動態連續的快速自旋迴波取像,並以數學模型分析得到每個區域微灌流之相關數據,觀察是否這些腦下垂體結構完全正常的病童在血流之區域微灌流上有無特殊的意義及其與內分泌的指標有無相關性,另外利用數學模型的分析與誤差值的模擬評估,使得實驗的誤差可量化並獲得可以接受的定量微灌流血流數據。 論文中納入小兒內分泌專科醫師評估為獨立性生長激素缺損與中樞性性早熟兩類病童,採用相關骨骼素片及內分泌學評估數值,臨床身高、生理發育表徵評估均達到小兒科確定診斷者納入,作為觀察病例。採用動態顯影之磁振造影影像經由模型化的分析所推導出之生理微灌流量化參數(A, slope, TTP, Cmax, k21, Kel),分別針對族群間(中樞性性早熟、獨立性生長激素缺損兩個群組與正常受試者比較)所呈現之數值差異性作統計分析比較,並使用ROI (region of interest)方式針對腦下垂體的十個區域(後切面、中切面、前切面兩側及中央、垂體莖突)所得到之各區域性的量化指標來系統性比較三個群組的差異性。其群組之間的平均值統計差異則用獨立樣本t檢定的統計方法,並觀察對應之內分泌賀爾蒙的數值與本研究的結果間有無關連性,關連性的檢測以Pearson 檢定的統計方法,當p值小於0.05則認為兩個群組之間的影像表現有顯著差異。 本研究結果發現在腦下垂體血液微灌流的參數中,TTP (Time To Peak)在獨立性生長激素缺損的群組中相較於正常的小孩有統計上顯著的延長(P小於0.005),而此延長TTP的現象經由區域性的比對後,並無發現空間上與生長激素分泌細胞間有關連意義。而生長激素的缺損程度與顯影強度(peak enhancement)及微灌流流入斜率(wash-in slope)之間發現存在著負相關連性並且有統計上的意義(P<0.05),顯示病童於腦下垂體有補償性的腦血流體積增加的生理意義。而此負關連性的現象經由區域性的比對後,發現在腦下垂體前葉之後切面與中切面具有顯著性的意義(PR,PM,PL and MR, P小於0.05)。而另一個族群的研究結果發現,顯影強度參數在中樞性性早熟的群組中相較於正常的小孩有統計上顯著的降低(P小於0.05),而此降低顯影強度的現象經由區域性的比對後,也無發現空間上與黃體激素分泌細胞間有關連意義。而黃體激素的增加程度與微灌流流入斜率(wash-in slope)之間發現存在著負相關連性並且有統計上的意義(P<0.05),顯示病童於腦下垂體有較低的低灌流效率的生理意義。而此負關連性的現象經由區域性的比對後,發現在腦下垂體前葉之中切面具有顯著性的意義(MR, P小於0.05),推測此類病人垂體門脈血流存在異常之可能性。 我們的結論是,區域性的T1動態顯影之磁振造影檢查配合數學模型的分析與誤差的評估與模擬,確實可以觀察腦下垂體門脈系統之局部血液微灌流動力學的現象,與瞭解小兒內分泌疾病之間是否具有關連性。在合理的影像訊雜比資料下,此一研究的模型可能可以提供小兒內分泌醫師在疾病診斷與後續追蹤治療的判斷上一個可行的工具。 | zh_TW |
dc.description.abstract | We sought to investigate quantitatively the topographical perfusion characteristics of the adenohypophysis using dynamic contrast-enhanced (DCE) MR imaging in idiopathic growth hormone deficiency (IGHD) and idiopathic central precocious puberty (ICPP) patients. Another aim of this study is to investigate the relation of the hormone levels in IGHD and ICPP with respect to the regional perfusion parameter alternations. We hypothesize that endocrine disease is topographically dependent and pituitary blood perfusion might play a role. Our study try to address these regional perfusion impairments by T1 dynamic contrast enhanced MR imaging combined with the pharmacokinetic model.
Dynamic contrast enhanced T1-weighted MR imaging has the capability of exploiting tissue perfusion properties via quantitative analysis using appropriate tracer kinetic model. But, the structure surrounding the pituitary gland such as air and bone may deteriorate the field homogeneity, making DCE MR imaging difficult to implement with satisfactory proper image quality. Therefore, past studies with only single-slice acquisition limit the scope to evaluate the pituitary perfusion properties. We attempt to conquer the technical limitation of regional pituitary perfusion through the combination of fast spin echo T1 dynamic contrast enhanced MR imaging with pharmacokinetic model analysis. The perfusion parameters can further be derived quantitatively and data analysis can be extended to topographical perfusion characteristics of the adenohypophysis. The study found that time to peak (TTP) for the IGHD group was significantly prolonged than normal control (p<0.005). The prolonged TTP in IGHD was found to be diffuse and lack of lateralization. The levels of growth hormone deficiency were negatively correlated with the peak enhancement and slope of wash-in phase, suggesting increased blood volume in IGHD within the pituitary gland. Another group study in ICPP showed that peak enhancement was significantly decreased than normal control (p<0.005) and the abnormality was found to be diffuse and lack of posteriority. The increasing levels of luteinizing hormone were negatively correlated with the slope of wash-in phase, suggesting decreased perfusion efficiency in ICPP within the pituitary gland. In conclusion, dynamic contrast-enhanced fast spin echo T1-weighted MR imaging and Brix model analysis allow multi-slice and multi-regional quantitative evaluation of the anterior pituitary gland in endocrine disease such as IGHD and ICPP. This technique may help to approach the clinical question when the morphological imaging feature alone does not explain the clinical findings. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T04:58:45Z (GMT). No. of bitstreams: 1 ntu-99-Q89921018-1.pdf: 646236 bytes, checksum: fb83a2c48b0254d2aa873245eb167590 (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 目 錄
口試委員會審定書 誌謝……………………………………………………………………….. i 中文摘要……………………………………………………………….… ii 英文摘要……………………………………………………………….….iv Chapter 1 Introduction……..…………………………………………..1-1 References………………….……………………………………1-3 Chapter 2 Methods 2.1 Background…………………………………………….…….2-1 2.2 Dynamic contrast enhanced MR image acquisition…….………2-3 2.3 Pharmacokinetic model in pituitary gland……………….….… 2-5 References…………………………………………..…………2-10 Chapter 3 Error estimate and simulation 3.1 Error assessment and Monte Carlo simulation………………3-1 3.2 Results…………………………………………………………..3-3 3.3 Discussion and conclusion……………………………………...3-4 Chapter 4 Clinical application 4.1 Idiopathic growth hormone deficiency 4.1.1 Introduction……….……………………………………… .4-1 4.1.2 Patients enrolled and data analysis…………………… …4-3 4.1.3 Results…………………………………………………….4-5 4.1.4 Discussion and conclusion………………………………..4-7 4.2 Idiopathic central precocious puberty 4.2.1 Introduction……..………………………………………..4-17 4.2.2 Patients enrolled and data analysis……….………………4-19 4.2.3 Results…………………………………………………….4-20 4.2.4 Discussion and conclusion………………………………..4-22 Chapter 5 Discussion and Conclusion…………………….…………...5-1 References……………………….………………………………5-4 | |
dc.language.iso | zh-TW | |
dc.title | 腦下垂體的區域微灌流定量分析及研究 | zh_TW |
dc.title | Quantitative Analysis of Regional Pituitary Perfusion by Dynamic Contrast Enhanced T1 MR Imaging | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 博士 | |
dc.contributor.coadvisor | 陳震宇(Cheng-Yu Chen) | |
dc.contributor.oralexamcommittee | 郭萬祐(Wan-Yuo Guo),吳文超(Wen-Chau Wu),柯正雯(Cheng-Wen Ko),阮春榮(Chun-Jung Juan),莊子肇(Tzu-Chao Chuang) | |
dc.subject.keyword | 腦下垂體,區域性動態顯影磁振造影,數學模型分析,獨立性生長激素缺損,中樞性性早熟, | zh_TW |
dc.subject.keyword | pituitary gland,dynamic contrast-enhanced MR imaging,Brix model,idiopathic growth hormone deficiency,idiopathic central precocious puberty, | en |
dc.relation.page | 61 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-07-29 | |
dc.contributor.author-college | 電機資訊學院 | zh_TW |
dc.contributor.author-dept | 電機工程學研究所 | zh_TW |
顯示於系所單位: | 電機工程學系 |
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