一氧化碳中毒對於大腦會造成缺氧性的損傷，在有些案例的磁共振影像上可以發現到大腦組織有萎縮的現象，也有些案例於白質或深層灰質，如：蒼白球(globus pallidus)，可以觀察到亮度的異常。本研究藉由FreeSurfer軟體使用voxel-based morphometry的演算法來量測多個大腦組織的體積，比較一氧化碳中毒後一個月與九個月不同組織的體積變化，並且使用paired t-test評估兩個時間點的差異性，另外由於蒼白球富含鐵離子，也利用磁化率權重影像對於鐵離子的累積有高度敏感這個特性，觀察蒼白球在不同時間追蹤影像中的改變。
研究結果發現在白質區域九個月的體積相較於一個月的體積有顯著性的減少(P=0.016)，將有沒有發生遲發性腦神經精神症候群(delayed neuropsychiatric syndrome, DNS)的患者分開，可以發現發生DNS患者白質體積有極顯著性的減少(P=0.001)，沒有發生DNS的患者則無明顯改變，另外在磁化率權重影像上，在有些案例中可以於蒼白球上觀察到有區域性高信號(regional hyperintensity)與點狀低訊號(dotted hypointensity)的出現，區域性高信號出現時會伴隨著點狀低訊號，但與DNS的發生沒有關聯性。

Carbon monoxide poisoning may cause brain hypoxic injury. According to previous magnetic resonance imaging report, brain atrophy could happen on surviving patients. In addition, abnormal signal intensity is possible in white matter and deep gray matter, such as globus pallidus. In this longitudinal study, voxel-based morphometry is performed by using FreeSurfer to investigate the volumetric change of brain tissues. Data collected at one and nine months after carbon monoxide poisoning, respectively, are compared by using the paired t-test. In addition, susceptibility weighted imaging, which is sensitive for the accumulation of paramagnetic substances, is also applied to monitor the appearance of the ion-rich global pallidus at several follow-up experiments.

Compared to one-month follow-up, white matter volume is found to decrease significantly at nine month (P=0.016). The decrease of white matter volume is more apparent on those patients with delayed neuropsychiatric syndrome (P=0.001). On the contrary, no significant difference is found on patients without DNS. In susceptibility weighted imaging, regional hyperintensity and dotted hypointensity can be observed on globus pallidus in some cases. However, according to the limited sample size of this study, regional hyperintensity will be accompanied by dotted hypointensity appears, but both of them are not related to the occurrence of DNS.

論文審定書 i
致謝 ii
摘要 iii
Abstract iv
圖目錄 vii
表目錄 ix
第一章 介紹 1
1.1 背景 1
1.2 文獻探討 6
1.2.1 灰、白質體積變化 6
1.2.2 SWI特性 9
1.3 研究動機 10
第二章 影像資料與方法 11
2.1 受試者影像資料收集 11
2.2 體積變化處理方法 13
2.2.1 FreeSurfer處理原理與流程 13
2.2.2 體積比較方法與統計 16
2.3 SWI處理方法 17
2.3.1 處理流程 17
2.3.2 Phase unwrapping 18
2.3.3 高通濾波器 20
2.3.4 SWI組成 21
第三章 結果 22
3.1 體積變化結果 22
3.1.1 影像分割結果 22
3.1.2 體積變化結果 23
3.2 SWI結果 29
3.2.1 不同的半高全寬 29
3.1.2 不同時間追蹤之SWI 31
第四章 討論與結論 36
4.1 灰、白質體積討論 36
4.2 SWI特徵討論 41
4.3 結論 43
References 44

1. Ernst, A. and Zibrak, J.D., Carbon monoxide poisoning. N Engl J Med, 1998. 339(22): p. 1603-8.
2. Prockop, L.D. and Chichkova, R.I., Carbon monoxide intoxication: an updated review. J Neurol Sci, 2007. 262(1-2): p. 122-30.
3. Beppu, T., The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol, 2014. 35(4): p. 625-31.
4. Choi, I.S., Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol, 1983. 40(7): p. 433-5.
5. Inagaki, T., et al., A long-term follow-up study of serial magnetic resonance images in patients with delayed encephalopathy after acute carbon monoxide poisoning. Psychiatry Clin Neurosci, 1997. 51(6): p. 421-3.
6. Durak, A.C., et al., Magnetic resonance imaging findings in chronic carbon monoxide intoxication. Acta Radiol, 2005. 46(3): p. 322-7.
7. Kinoshita, T., et al., Pallidoreticular damage in acute carbon monoxide poisoning: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol, 2005. 26(7): p. 1845-8.
8. Lapresle, J. and Fardeau, M., The central nervous system and carbon monoxide poisoning. II. Anatomical study of brain lesions following intoxication with carbon monixide (22 cases). Prog Brain Res, 1967. 24: p. 31-74.
9. Sener, R.N., Acute carbon monoxide poisoning: diffusion MR imaging findings. AJNR Am J Neuroradiol, 2003. 24(7): p. 1475-7.
10. Teksam, M., et al., Diffusion-weighted MR imaging findings in carbon monoxide poisoning. Neuroradiology, 2002. 44(2): p. 109-13.
11. Kim, J.H., et al., Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. AJNR Am J Neuroradiol, 2003. 24(8): p. 1592-7.
12. Lo, C.P., et al., Diffusion-tensor MR imaging for evaluation of the efficacy of hyperbaric oxygen therapy in patients with delayed neuropsychiatric syndrome caused by carbon monoxide inhalation. Eur J Neurol, 2007. 14(7): p. 777-82.
13. Beppu, T., et al., Assessment of damage to cerebral white matter fiber in the subacute phase after carbon monoxide poisoning using fractional anisotropy in diffusion tensor imaging. Neuroradiology, 2010. 52(8): p. 735-43.
14. Chang, K.H., et al., Delayed encephalopathy after acute carbon monoxide intoxication: MR imaging features and distribution of cerebral white matter lesions. Radiology, 1992. 184(1): p. 117-22.
15. Uchino, A., et al., MRI of the brain in chronic carbon monoxide poisoning. Neuroradiology, 1994. 36(5): p. 399-401.
16. Kesler, S.R., et al., Verbal memory deficits associated with fornix atrophy in carbon monoxide poisoning. J Int Neuropsychol Soc, 2001. 7(5): p. 640-6.
17. Porter, S.S., et al., Corpus callosum atrophy and neuropsychological outcome following carbon monoxide poisoning. Arch Clin Neuropsychol, 2002. 17(2): p. 195-204.
18. Pulsipher, D.T., Hopkins, R.O., and Weaver, L.K., Basal ganglia volumes following CO poisoning: A prospective longitudinal study. Undersea Hyperb Med, 2006. 33(4): p. 245-56.
19. Chen, H.L., et al., Structural and cognitive deficits in chronic carbon monoxide intoxication: a voxel-based morphometry study. BMC Neurol, 2013. 13: p. 129.
20. Haacke, E.M., et al., Susceptibility weighted imaging (SWI). Magn Reson Med, 2004. 52(3): p. 612-8.
21. Bae, J.W., et al., Susceptibility-weighted imaging findings of subacute delayed carbon monoxide intoxication: a report of five cases. J Neurol Sci, 2012. 312(1-2): p. 13-7.
22. 內政部消防署 - 統計年報. 2013; Available from: http://www.nfa.gov.tw/main/Content.aspx?ID=&MenuID=232.
23. Fischl, B., et al., Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron, 2002. 33(3): p. 341-55.
24. FreeSurfer Analysis Pipeline Overview. Available from: http://freesurfer.net/fswiki/FreeSurferAnalysisPipelineOverview.
25. Cusack, R. and Papadakis, N., New robust 3-D phase unwrapping algorithms: application to magnetic field mapping and undistorting echoplanar images. Neuroimage, 2002. 16(3 Pt 1): p. 754-64.
26. Haacke, E.M., et al., Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol, 2009. 30(1): p. 19-30.
27. 陳彥霖, 定量病灶內磁化率信號方法應用於星狀細胞瘤、腦部轉移腫瘤、與腦膿瘍之分析. 2015, 國立中山大學電機工程學系.
28. Miura, T., et al., CT of the brain in acute carbon monoxide intoxication: characteristic features and prognosis. AJNR Am J Neuroradiol, 1985. 6(5): p. 739-42.
29. Tom, T., et al., Neuroimaging characteristics in carbon monoxide toxicity. J Neuroimaging, 1996. 6(3): p. 161-6.