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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 李百祺 | zh_TW |
| dc.contributor.advisor | Pai-Chi Li | en |
| dc.contributor.author | 賴國隆 | zh_TW |
| dc.contributor.author | Kuo-Lung Lai | en |
| dc.date.accessioned | 2025-07-18T16:07:56Z | - |
| dc.date.available | 2025-07-19 | - |
| dc.date.copyright | 2025-07-18 | - |
| dc.date.issued | 2025 | - |
| dc.date.submitted | 2025-07-04 | - |
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Nat Rev Rheumatol 2017;13(12):731-741. | - |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/97840 | - |
| dc.description.abstract | 傳統能量都卜勒在檢測早期類風濕性關節炎(RA)時對於微弱與緩慢血流的靈敏度有限，可能導致誤診。超快能量都卜勒(Ultrafast power Doppler, ufPD)是一種新穎影像技術，具備更高的血流檢測靈敏度，可作為RA診斷與疾病活動度監測的重要工具。本論文整合三項研究。第一項研究納入33名RA患者(含19名確診與14名早期)及15名健康者，比較ufPD與傳統能量都卜勒於腕關節掃描的表現。ufPD檢測到較大的滑膜血流面積，其風濕病學結果測量評分的敏感度達0.985、準確度為0.719，明顯優於傳統能量都卜勒(敏感度0.424、準確度0.604)。ufPD顯示更高的滑膜血流性、擴張的血管和更亮的都卜勒訊號，其峰值滑膜都卜勒亮度的接收者操作特徵曲線下面積為0.802(敏感度0.909、準確度0.813)，為最具診斷價值的變數。尤其在早期RA，ufPD大幅提升診斷敏感度與準確度(各增加0.561和0.209)。第二項研究評估ufPD灌流影像參數與疾病活動度指標的關聯性。ufPD影像參數與臨床指標呈現弱至中度相關（r = 0.221–0.374, p < 0.05），其中滑膜都卜勒亮度相關性最高。達到深度臨床緩解的患者中，此相關性更為顯著（r = 0.578–0.641, p < 0.001），顯示ufPD可作為疾病活動評估工具。第三項研究評估超音波(US)介導微氣泡(MB)敷料合併匹洛西卡凝膠於手部關節炎的治療效果。30名患者的症狀性關節分配到MB/US組、US組與對照組。結果顯示MB/US組在疼痛緩解、滑膜肥大與血管性改善方面均優於其他組，整體治療反應率達66.7%，且無不良反應，顯示此技術有助於增強藥物傳輸與治療效果。未來計畫將結合自適應解調技術進一步提升ufPD影像品質，並透過磁振造影作為黃金標準，評估其對RA與早期乾癬性關節炎的診斷能力。 | zh_TW |
| dc.description.abstract | Conventional power Doppler (cPD) has a limited sensitivity in detection of slow blood flow in early-stage rheumatoid arthritis (RA), potentially leading to misdiagnosis. Ultrafast power Doppler (ufPD) is an innovative imaging technique with enhanced sensitivity for slow-flow detection, making it a valuable tool for RA diagnosis and disease activity monitoring. This dissertation integrates findings from three studies. The first study included 33 RA patients (19 established and 14 early-stage) and 15 healthy controls to compare ufPD with cPD in wrist joint scanning. ufPD detected significantly larger synovial blood flow areas. Using the OMERACT scoring system, ufPD yielded a sensitivity of 0.985 and an accuracy of 0.719, outperforming cPD (sensitivity 0.424, accuracy 0.604). Among the ufPD image features, peak synovial PD brightness showed the highest diagnostic value (Area Under ROC Curve 0.802, sensitivity 0.909, accuracy 0.813). Notably, ufPD significantly improved diagnostic sensitivity and accuracy in early RA (an increment of 0.561 and 0.209 respectively). The second study explored the correlation between ufPD perfusion imaging variables and clinical disease activity indices. ufPD variables showed weak-to-moderate correlations with clinical indices (r = 0.221–0.374, p <0.05), with synovial PD brightness being the most strongly correlated. Among patients in deep clinical remission, these correlations strengthened (r = 0.578–0.641, p <0.001), supporting the utility of ufPD in disease activity assessment. The third study assessed the therapeutic efficacy of ultrasound (US)-mediated microbubbles (MB) dressing combined with piroxicam gel in hand arthritis. The symptomatic joints of 30 patients were assigned to MB/US, US, or control groups. The MB/US group showed superior pain relief and greater improvement in synovial hypertrophy (76.7%) and vascularity (66.7%), with an overall treatment response rate of 66.7%, and no side effects reported. Future studies aim to enhance ufPD perfusion imaging using adaptive demodulation of tissue signals and to validate its diagnostic performance against MRI as a gold standard, with potential application in early psoriatic arthritis detection. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2025-07-18T16:07:56Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2025-07-18T16:07:56Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | Acknowledgements i
Chinese abstract ii Abstract iii Contents v Figure viii Table x Chapter 1. Introduction 1 1.1 Background 1 1.2 Novel ultrasound technology for early detection of synovitis 2 1.3 Correlation with clinical disease activity 5 1.4 Novel ultrasound technology for treating arthritis 5 1.5 Motivations and Aims 9 Chapter 2. Technical Foundations of Ultrafast Doppler 11 2.1 Principle of ultrafast acquisition 11 2.2 Principle of spatial SVD filtering 12 2.2.1 SVD matrix decomposition 12 2.2.2 Blood/Tissue/Noise signal separation 12 2.2.3 Perfusion imaging concept 15 2.3 Phantom experiment design and results 17 2.3.1 Flow rate estimation 17 2.3.2 System design 18 2.3.3 Experimental procedures 19 2.3.4 Results 20 2.3.4.1 Ultrafast Doppler imaging 20 2.3.4.2 Conventional Doppler imaging 21 Chapter 3. Diagnostic Capability of Ultrafast Doppler for RA 22 3.1 Methods 22 3.1.1 Patient selection 22 3.1.2 Clinical assessment 25 3.1.3 Ultrasound assessment 25 3.1.4 Image analysis 26 3.1.5 Statistical analysis 30 3.2 Results 32 3.2.1 Ultrafast PD has higher sensitivity and accuracy 32 3.2.2 Diagnostic performance of ultrafast PD in conventional PD-negative wrist joints 35 3.2.3 Diagnostic performance of ultrafast PD in early-stage RA 36 3.2.4 Optimal diagnostic indicators and thresholds 37 Chapter 4. Correlation of Ultrafast Doppler Variables with Disease Activity 43 4.1 Methods 43 4.1.1 Patient selection 43 4.1.2 Clinical assessment 43 4.1.3 Ultrasound assessment 44 4.1.4 Image analysis 44 4.1.5 Statistical analysis 46 4.2 Results 47 4.2.1 Imaging capability at different disease activity levels 47 4.2.2 Ultrafast PD variables are positively correlated with disease activity 51 4.2.3 Ultrafast PD variables have higher clinical correlation in the dCR population 51 4.2.4 Ultrafast PD variables correlate to clinical indices RA patients with bilateral conventional PD-negative wrists 52 Chapter 5. Ultrasonication with Microbubbles Dressing for Arthritis 56 5.1 Motivation 56 5.2 Methods 56 5.2.1 Number of subjects, inclusion and exclusion criteria 56 5.2.2 Study design 56 5.2.2.1 Preparation of microbubble solution 56 5.2.2.2 Ultrasonic implanter settings 57 5.2.2.3 Treatment procedure 57 5.2.2.4 Outcome evaluation 58 5.2.2.5 Image analysis 58 5.2.3 Definition of therapeutic responses 60 5.2.4 Statistical analysis 61 5.3 Results 61 Chapter 6. Discussion 69 6.1 Diagnostic capacity of ultrafast power Doppler 69 6.1.1 Diagnostic capacity and clinical utility 69 6.1.2 Limitations 71 6.2 Correlation between ultrafast Doppler and disease activity 73 6.2.1 Disease activity correlation and Clinical benefits 73 6.2.2 Limitations 75 6.3 Ultrasonication with microbubbles for hand arthritis 76 6.3.1 Efficacy of ultrasonication-mediated microbubbles dressing 76 6.3.2 Limitations 78 Chapter 7. Conclusions and Future work 79 7.1 Conclusions 79 7.2 Future work 80 7.2.1 Improve ultrafast PD perfusion imaging by adaptive demodulation of tissue signals 80 7.2.2 MRI as the gold standard for assessing the diagnostic capacity of ultrafast PD for rheumatoid arthritis 81 7.2.3 Application of ultrafast PD for early detection of psoriatic arthritis 82 7.2.4 Extend case numbers of the ultrasonication with microbubbles trial 83 References 84 | - |
| dc.language.iso | en | - |
| dc.subject | 超快都卜勒 | zh_TW |
| dc.subject | 微氣泡 | zh_TW |
| dc.subject | 灌流 | zh_TW |
| dc.subject | 診斷 | zh_TW |
| dc.subject | 類風濕性關節炎 | zh_TW |
| dc.subject | 超快都卜勒 | zh_TW |
| dc.subject | 微氣泡 | zh_TW |
| dc.subject | 灌流 | zh_TW |
| dc.subject | 診斷 | zh_TW |
| dc.subject | 類風濕性關節炎 | zh_TW |
| dc.subject | ultrafast Doppler | en |
| dc.subject | microbubble | en |
| dc.subject | ultrafast Doppler | en |
| dc.subject | rheumatoid arthritis | en |
| dc.subject | diagnosis | en |
| dc.subject | perfusion | en |
| dc.subject | microbubble | en |
| dc.subject | perfusion | en |
| dc.subject | diagnosis | en |
| dc.subject | rheumatoid arthritis | en |
| dc.title | 先進的超音波技術應用於類風濕性關節炎:早期檢測、臨床疾病活動度相關性和治療效果 | zh_TW |
| dc.title | Advanced Ultrasound Technologies for Rheumatoid Arthritis: Early Detection, Clinical Disease Activity Correlation, and Therapeutic Efficacy | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 113-2 | - |
| dc.description.degree | 博士 | - |
| dc.contributor.oralexamcommittee | 劉浩澧;許秉寧;郭柏齡;廖愛禾;謝寶育 | zh_TW |
| dc.contributor.oralexamcommittee | Hao-Li Liu;Ping-Ning Hsu;Po-Ling Kuo;Ai-Ho Liao;Bao-Yu Hsieh | en |
| dc.subject.keyword | 超快都卜勒,類風濕性關節炎,診斷,灌流,微氣泡, | zh_TW |
| dc.subject.keyword | ultrafast Doppler,rheumatoid arthritis,diagnosis,perfusion,microbubble, | en |
| dc.relation.page | 91 | - |
| dc.identifier.doi | 10.6342/NTU202501393 | - |
| dc.rights.note | 同意授權(全球公開) | - |
| dc.date.accepted | 2025-07-07 | - |
| dc.contributor.author-college | 電機資訊學院 | - |
| dc.contributor.author-dept | 生醫電子與資訊學研究所 | - |
| dc.date.embargo-lift | 2025-07-19 | - |
| 顯示於系所單位： | 生醫電子與資訊學研究所 | |
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