雖然磁振造影用於診斷腦腫瘤已行之多年，但是對於鑑別診斷某些腦瘤仍
然相當困難。此外，傳統定性磁振造影對於預測腦腫瘤的復發十分困難。當
今，磁振造影擴散權重影像已經普遍使用於神經放射學檢查，而表觀擴散係數
則是由磁振造影擴散權重影像所運算出的定量數值。在腦腫瘤中，鑑別診斷多
形性膠質母細胞瘤和原發性大腦淋巴瘤非常重要，因為兩者治療方向差異極
大。然而，傳統磁振造影對於鑑別此兩種腦腫瘤非常困難。另一方面，雖然大
部分顱內腦膜瘤為良性腦腫瘤，但是卻有一部分病人會在手術切除後的幾年內
產生復發。因此，本研究將分析病人手術前的磁振造影擴散權重影像並運用定
量表觀擴散係數來鑑別診斷多形性膠質母細胞瘤和原發性大腦淋巴瘤，以及預
測顱底腦膜瘤在手術切除後復發的可能性。

Although magnetic resonance imaging (MRI) had been used to diagnose brain tumors for a long time, the differentiation of brain tumors is still difficult in some situations. In addition, it is difficult to predict recurrence of brain tumors on conventional qualitative MR imaging. Nowadays, the diffusion-weighted MR imaging (DWI) is already being incorporated into daily clinical practice in neuroradiology, and quantitative apparent diffusion coefficient (ADC) value could be acquired in DWI. Among brain tumors, the differentiation between glioblastoma multiforme (GBM) and primary cerebral lymphoma (PCL) is clinically important because treatment strategies of these two different diseases are substantially different. However, the differentiation of GBM and PCL is difficult on conventional MRI. On the other hand, although most meningiomas are benign brain tumors, a subset of benign skull base meningiomas show early progression/recurrence (P/R) in the first years after surgical resection. In this study, we will investigate the preoperative DWI and ADC values for differentiation between GBM and PCL, and for prediction of P/R in skull base meningiomas.

論文審定書...................................................................................................................i
中文摘要......................................................................................................................ii
Abstract.......................................................................................................................iii
Figure list ....................................................................................................................v
Table list.......................................................................................................................vii
Abbreviations ..............................................................................................................ix
Chapter 1. Diffusion-Weighted MR Imaging (DWI) .....................................................1
1.1 Physics of DWI.......................................................................................................1
1.2 Biomedical Characteristics of DWI ........................................................................6
1.3 DWI in Clinical Practice of Neuroradiology ............................................................9
1.4 DWI in Brain Tumors.............................................................................................10
Chapter 2. Diffusion-Weighted MR Imaging in Differentiation between
Glioblastoma Multiforme and Primary Cerebral Lymphoma........................................15
2.1 Background and Purpose......................................................................................15
2.2 Materials and Methods .........................................................................................17
2.3 Results...................................................................................................................25
2.4 Discussion..............................................................................................................29
Chapter 3. Diffusion-Weighted MR Imaging in Prediction of Progression
in Skull Base Meningiomas .........................................................................................36
3.1 Background and Purpose.......................................................................................36
3.2 Materials and Methods ..........................................................................................38
3.3 Results....................................................................................................................45
3.4 Discussion...............................................................................................................47
Chapter 4. Clinical Impact and Values of Our Studies..................................................53
4.1 DWI in in Differentiation between GBM and PCL ...................................................53
4.2 DWI in Prediction of Progression in Skull Base Meningiomas................................55
4.3 Conclusions.............................................................................................................57
References ...................................................................................................................58
Figures ..........................................................................................................................76
Tables ............................................................................................................................91
Appendix.......................................................................................................................103
1. MRI protocols ...........................................................................................................103
2. CT protocols .............................................................................................................106
Related publications during 2016-2018.........................................................................107
個人簡歷 .......................................................................................................................150

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