注意力缺陷過動症(ADHD)為學齡前的兒童常見的疾病，在許多磁共振造影研究中已顯示，過動症病患於部分腦部區域有組織體積上的差異，且在功能性影像方面的研究也得知該病症在大腦特定區域也有功能性異常的可能性。近十年來，已有研究團隊以擴散磁振造影來偵測中樞神經系統的神經纖維異常之疾病。但在以往研究文獻中所使用的大腦模板影像皆以MNI152標準影像為主，而本研究即是使用自行製作的大腦標準影像整合所有受試者至共同空間中，並利用擴散張量影像偵測ADHD病患與正常人在大腦白質上水分子的擴散非等向性，再進行受試者間的群體比較。
本研究分別透過兩個不同群體比較方法，TBSS與VBM，並使用自製的台灣地區青少年大腦模板進行擴散非等向性的群組比較，兩方法的結果皆顯示，ADHD青少年病患相較於正常受試者之白質區域的FA數值有明顯較小的趨勢，區域包含：下縱束(inferior longitudinal fasciculus)、內囊(internal capsule)、外囊(external capsule)、上縱束(superior longitudinal fasciculus)、視放射(optic radiation)、上額葉(superior frontal)、上放射冠(superior region of corona radiata)、皮質脊髓束(corticospinal tract)、後放射冠/上縱束(posterior region of corona radiata / superior longitudinal fasciculus)、上枕額束(superior fronto-occipital fasciculus)及前放射冠(anterior region of corona radiata)、胼胝體膝部(genu of corpus callosum)等神經纖維。

Attention deficit/hyperactivity disorder (ADHD) is a common disease with a worldwide prevalence of 5% on preschool children. It has been reported that ADHD patients have volume variant in partial brain regions. Futhermore, functional magnetic resonance imaging have also been used to detect function variant possibility in particular brain regions. In the last decade, some researchers used diffusion MR imaging to investigate the abnormality of neural fibers in disease involved with central nervous system. In general, the diffusion anisotropy of white matter in both ADHD patients and healthy subjects can be estimated seperately to undergo inter-subject comparison. While previous studies often used the popular ICBM brain template (MNI152), this study applied a self-made template of Taiwan adolescents as the common space of image normailization.
In this work, group comparison of diffusion fractional anisotropy was performing by using two methods, TBSS and VBM. Both manners found a decreased FA in white matter of ADHD subjects compared with normal control group. However, regions detected by different methods showed low reproducibility. The areas of significant difference include inferior longitudinal fasciculus、internal capsule、external capsule、superior longitudinal fasciculus、optic radiation、superior frontal、superior region of corona radiata、corticospinal tract、posterior region of corona radiata / superior longitudinal fasciculus、superior fronto-occipital fasciculus、anterior region of corona radiata、genu of corpus callosum nerve fibers.

論文審定書 i
致謝 ii
摘要 iii
Abstract iv
圖目錄 vi
表目錄 viii
第一章 簡介 1
1.1 注意力缺陷過動症 (ADHD) 1
1.2 文獻回顧 2
1.3 研究動機 8
第二章 理論 9
2.1 擴散張量影像 (Diffusion Tensor Image) 9
2.2 VBM (Voxel-Based Morphometry) 11
2.2.1 個體對位 (Intra-subject registration) 12
2.2.2 群體對位 (Inter-subject registration) 17
2.3 TBSS (Tract-Based Spatial Statistics) 19
第三章 實驗分析與方法 24
3.1 SPM正規化函式參數選擇 24
3.1.1 來源影像及模板影像平滑化參數 (Source Image Smoothing & Template Image Smoothing) 24
3.1.2 非線性截止頻率 (Nonlinear frequency cutoff) 31
3.1.3 非線性規則化 (Nonlinear Regularisation) 35
3.1.4 仿射規則化 (Affine Regularisation) 38
3.1.5 非線性疊代 (Nonlinear Iteration) 38
3.2 T1 Template 39
3.3 FA Template 56
3.4 群集分析 63
3.4.1 實驗對象與操作環境 63
3.4.2 群集分析方法一：VBM分析 65
3.4.3 群集分析方法二：TBSS分析 67
3.5 統計分析 (Statistical Analysis) 68
第四章 實驗結果與比較 69
第五章 討論 83
參考文獻 93

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