以健檢正子造影檢視年齡與性別對腦內葡萄糖代謝之影響; Age and Gender Influences 18F-deoxyglucose (FDG) metabolism in normal Healthy Examination Study --A PET study
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(2) 中文摘要: 在過去我們要作腦部半定量分析時，常常需要人工手動圈選感興 趣區(ROI, region of interest)，然後測量其計數值。之後使用 統計軟體處理實驗數據，例如SAS、SPSS、或使用Microsoft Excel 做資料統計，比較差異性。但是常常因不同人圈選之位置、大小 不同，極易造成人為誤差，以及只能得到資料數據上的變化，比 較沒有整體性(Hall et al., 1991; Hibbard et al., 1987; Zhao et al., 1995, 1996)，因此SPM軟體便孕育而生。 在以SPECT / PET 及 fMRI 等功能性腦造影儀器,獲取大腦影像空 間訊息的統計及資料分析的軟體中，SPM（Statistical Parametric Mapping , Friston 1991 ,The Wellcome Department of Imaging Neuroscience 的 Functional Imaging Laboratory）是最為全世 界的認知神經科學家在科學期刊中被引用次數最多的一套分析軟 體(http://www.fil.ion.ucl.ac.uk/spm/)。 SPM (Friston et al., 1991,1994; Poline et al., 1995; Worsley et al., 1992),是結合受試者影像和統計方法的軟體，是把影像 體素(Voxel)和體素之間差異值的統計比較，一般可以應用於核醫 造影PET/SPECT或是磁振功能造影(fMRI)腦神經功能研究。 在過去的論文經驗之中,我們看到了利用腦部功能性核磁共振 (fMRI),單光子放射電腦斷層掃描(SPECT)來檢視腦部局部血流量 1.
(3) 藉以探討不同腦部區域所代表的功能定位(brain mapping) 葡萄糖是腦部代謝最重要的物質.正子斷層掃描(PET)是利用帶有 放射線的葡萄糖,藉由其在腦部的吸收狀況,用以代表其局部區域 的代謝功能.藉以認定其所代表的功能性定位。 我們由中國醫藥大學附設醫院,接受健檢正子造影的正常人之中, 排除了有全身性系統疾病的病人之後。將其分為男性小於 60 歲, 男性大於 60 歲,女性小於 60 歲,以及女性大於 60 歲共四組,各 25 人,作交叉比對。分析其腦部代謝是否有基本上的差異。 在經過排除有系統性疾病的病人之後,進行正子造影.再來我們利 用 SPM 軟體先將受試者的影像資料作前處理的動作，如重新定位， 均勻化所有影像，並使所有影像平滑化。 之後選擇我們要統計的方式，作 Two-sample T-Test 模式，選擇 此實驗目的主題之受試者影像，設定 P 值<0.05 為有統計學意義。 當有差異的部分(實驗 P 值小於設定值時)出現時,則會顯示在 Talairach space 解剖座標圖上(黑點區塊)，我們就可以知道在腦 部區域出了什麼問題。 由結果可以看出, 綜合以上的研究結果結論出，健康成人的腦部 葡萄糖代謝,在不同性別及年齡有基本上的不同。 就男性而言,年輕男性在理解力(BA24)及情緒反應(BA47)較為激 烈。就女性而言,年輕女性在情緒反應(BA38,47)較為激烈。而年 2.
(4) 輕男性較年輕女性於視覺動作（BA19）及記憶語言(BA37)有較佳 表現。. 3.
(5) Abstract. In the passes, when we make the brain semi-quantity analysis, We frequently needs to circle the interest area (ROI, region of interest), then surveys it to count the value. Then uses the statistical software processing empirical datum afterwards, for example SAS, SPSS, or use Microsoft Excel to make the material statistics, compared with difference. But frequently because of the different person circle the different position and size , is extremely easy to create the personal error, as well as only can obtain the change in the material data, compared with does not have the integrity (Hall et al., 1991; Hibbard et al., 1987; Zhaoet al., 1995, 1996).Therefore the SPM software then breeds lives.. In functional brain image instrument and so on SPECT/PET and fMRI, to gains the cerebrum space image and the material analysis software, SPM (Statistical Parametric Mapping, Friston 1991, The Wellcome Department of Imaging Neuroscience Functional Imaging Laboratory) is the most world cognition department of neurology scientist is. 4.
(6) quoted a number of times most set of analyses software in the scientific periodical (http://www.fil.ion.ucl.ac.uk/spm/).. SPM (Friston et al., 1991,1994 ; Poline et al., 1995; Worsley et al., 1992), is the union the trying image and the statistical method software. It is comparison the difference statistical value in the image between the voxel and voxel, It generally may be supposed to use in nuclear medical radiography PET/SPECT perhaps the function radiography (fMRI) the brain function research.. During the past paper experience, we saw the use of brain function nuclear magnetic resonance (fMRI), the single photon emission computer scan (SPECT) .It inspect the regional brain blood current capacity so as to discuss the functional localization which the different brain region represents (brain mapping). We set up cases who accept the PET (Positron Emission Tomography) in healthy exam in the hospital by the Chinese medicine university, after excluded the patient which has the whole body system disease. Divides cases into the male it to be smaller than 60 years old, the male 5.
(7) is bigger than 60 years old, the female is smaller than 60 years old, as well as the female is bigger than 60 years old of altogether four groups, each 25 people, processing intersect analyzes of his/her brain metabolism whether has basic difference.. Glucose is the most important material in brain metabolism .The Positron Emission Tomography (PET) use has the radioactive glucose, the affiliation by it in the brain absorption condition, with represents its partial region metabolism function .So as to recognized its functional localization.. After excluded the patient which has the systematic disease, carries on the Positron Emission Tomography .Then use the SPM software pre-process of image material as segmentation ,normalization and smoothing.. Chooses the way afterwards which we must count, makes Two-sample the T-Test pattern, chooses this experimental goal subject in the trying image, establishes the P value to be smaller than 0.05 as statistics result . Then demonstrate in Talairach space (dark spot), We may 6.
(8) know had any problem in the brain region.. May see by the result, above the synthesis findings conclusion leaves, the healthy adult's brain glucose metabolism, has basic different in the sex and the age.. Speaking of the male, the young male is intense in the comprehension faculty (BA24) and the mood response (BA47). Speaking of the female, the young female is intense in the mood response (BA38,47). But a young male has a better performance to the visual movement (BA19) and the memory, language (BA37) then younger female.. 7.
(9) 誌. 謝. 辭. 感謝高嘉鴻副教授在學業上指導及指正，使學生論文得以順 利完成，學生由衷的感謝並於此致上最高的敬意及謝忱。 感謝彰基醫院,南基醫院,大里仁愛醫院院方的支持與協助，讓 我在臨床工作之餘能順利完成學業及論文的寫作。 同時也感謝中國醫藥大學附設醫院核醫科顏國振先生的參與 並協助指導正子造影操作及資料蒐集與分析，在此致上無限的謝 意。. 魏銘政 謹誌於台中 中華民國 九十五年 七月. 8.
(10) 目. 錄. 第一章 前言 第一節 研究背景--------------------------------------------- 13 第二節 研究目的----------------------------------------------16 第二章 研究方法 第一節 研究材料----------------------------------------------17 第二節 研究設計----------------------------------------------18 第三節 統計方法----------------------------------------------19 第三章 研究結果 第一節 描述性統計分析-------------------------------------20 第二節 推論性統計分析-------------------------------------21 第四章 討論 第一節 結果討論----------------------------------------------49 第二節 研究限制----------------------------------------------52 第五章 結論與建議 第一節 結論----------------------------------------------------53 第二節 建議----------------------------------------------------54. 參考文獻……………………………………………………………55. 9.
(11) 附錄 誌謝辭………………………………………………………………8 表目錄………………………………………………………………11 圖目錄………………………………………………………………12 授權書聲明…………………………………………………………61. 10.
(12) 表目錄 (表一) 病歷基本資料,年齡,性別 (表二) 各分組平均年齡. 11.
(13) 圖目錄 圖一: 腦部葡萄糖吸收,小於六十歲,男大於女.統計表格 圖二: 腦部葡萄糖吸收,小於六十歲,男大於女.二維座標 圖三: 腦部葡萄糖吸收,小於六十歲,男大於女.3D 立體圖示 圖四: 腦部葡萄糖吸收,小於六十歲,男小於女.統計表格 圖五: 腦部葡萄糖吸收,大於六十歲,男大於女.統計表格 圖六: 腦部葡萄糖吸收,大於六十歲,男小於女.統計表格 圖七: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).統計表格 圖八: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).二維座標 圖九: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).三維圖示 圖十: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).統計表格 圖十一: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).二維座標 圖十二: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).三維圖示 圖十三: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).統計表格 圖十四: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).二維座標 圖十五: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).三維圖示 圖十六: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).統計表格 圖十七: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).二維座標 圖十八: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).三維圖示. 12.
(14) 第一章 前言 第一節 研究背景 人類對於自身的了解,一向是解剖先於生理. 大腦約有一百五十億個神經細胞,即使分為同種作用群,也可 能需要分為一萬種以上.大腦每天能記錄生活中八千六百萬條訊 息,每一秒之中,大腦中就要進行者十萬種不同的化學反應.這些 細胞代表的功能,雖然部分已被研究確認.但是細胞與細胞之間以 及細胞團塊及細胞團塊之間的關係與聯絡,卻一直未被科學家確 認.(The dark side of brain , Nature 2005). 1981 年,美國科學家斯佩里對”腦裂人”的研究,證實了大腦 的不對稱性,並提出了<左右腦分工理論>,因此榮獲了諾貝爾生理 學醫學獎.. 所以我們提出在同性別不同年齡,或是不同性別相同年齡,在 大腦的代謝功能上是否有基本的差異這項假設.. 近年來藉由腦部功能性影像的發展,硬體及軟體的快速發展, 將統計分析進化到更加簡化的過程.藉由軟體的運作及硬體的加 速,結果的取得更加迅速及方便. 13.
(15) 而影像取的方面,從剛開始的結構性分析之超音波,電腦斷 層(CT),核磁共振(MRI),到近來發展的功能性分析之單光子斷層 掃描核(SPECT,1960), 正子射出電腦斷層攝影(PET,1973),甚至最 新的結合功能性及結構性的 PETCT,陸續提供了我們對大腦功能及 結構性的分析.. 隨著電腦數位科技的不斷進步,運算程式的成熟演化,進一 步藉由統計學,可以進一步的確認大腦區域性的功能 (即大腦定 位的方式) .. 在過去的論文經驗之中,我們看到了利用腦部功能性核磁共 振(fMRI),單光子放射電腦斷層掃描(SPECT)來檢視腦部局部血流 量藉以探討不同腦部區域所代表的功能定位(brain mapping) (例 如 Andreas R. Luft 的 Comparing Motion- and Imagery-Related Activation in the Human Cerebellum:A Functional MRI Study Germany Hum. Brain Mapping 6:105–113, 1998.或是 Nan-Tsing Chiu 的 Educational Level Influences Regional Cerebral Blood Flow in Patients with Alzheimer’s Disease THE JOURNAL OF NUCLEAR MEDICINE • Vol. 45 • No. 11 • November 2004) . 14.
(16) 葡萄糖是腦部代謝最重要的物質.. 正子射出電腦斷層攝影(positron emission tomography, PET)是 項非侵襲性的核子醫學造影技術。藉由正子放射藥物經由吸入,吞 食或注射進入體內，再以 PET 偵測此放射性物質(如 FDG)在體內的 分佈及隨著時間而改變的情形，即可用來作為全身器官組織的功 能性造影檢查。亦可藉以認定其所代表的功能性定位.. PET 的原理是葡萄糖會放出正電子，而正電子會跟負電子結合在一 起，然後會放出兩個γ射線，其方向會幾乎成一直線 180 度，PET 的偵測器會用成環形的，然後γ射線會打在偵測器上，我們就知 道病灶在這條直線上，而多條直線就會構成一個點，我們就可之 病灶的確切位置。. 故我們結合兩者的優點,進行資料的收集及統計分析.. 15.
(17) 第二節 研究目的 我們藉由中國醫藥大學附設醫院,接受健檢正子造影的正常人之 中,分析性別及年齡對其腦部葡萄糖代謝是否有基本上的差異.. 16.
(18) 第二章 研究方法 第一節 研究材料 我們由 2002 年 7 月到 2003 年 12 月,在中國醫藥大學附設醫院,接 受健檢正子造影的正常人之中, 排除了有全身性系統疾病的病人 之後.取樣 100 人. (表一) 病歷基本資料,年齡,性別. 17.
(19) 第二節 研究設計. 我們由中國醫藥大學附設醫院,接受健檢正子造影的正常人之中, 排除了有全身性系統疾病的病人之後. 將其分為男性小於 60 歲,男性大於 60 歲,女性小於 60 歲,以及女 性大於 60 歲共四組,各 25 人,作交叉比對,分析其腦部代謝是否有 基本上的差異.. 在經過排除有系統性疾病的病人之後,進行正子造影.再來我們利 用 SPM 軟體先將受試者的影像資料作前處理的動作，如重新定位， 均勻化所有影像，並使所有影像平滑化。. 之後選擇我們要統計的方式，作 Two-sample T-Test 模式，選擇 此實驗目的主題之受試者影像，設定 P 值<0.05 為有統計學意義。. 當有差異的部分(實驗 P 值小於設定值時)出現時,則會顯示在 Talairach space 解剖座標圖上(黑點區塊)，我們就可以知道在腦 部區域出了什麼問題。. 18.
(20) 第三節 統計方法 SPM 99 , 2000 年 1 月 25 日釋出版本 （Statistical Parametric Mapping , Friston 1991 ,The Wellcome Department of Imaging Neuroscience 的 Functional Imaging Laboratory）. 19.
(21) 第三章 研究結果 第一節 描述性統計分析 本臨床研究,總共收集有中國醫藥大學附設醫院 2002 年 7 月至 2003 年 12 月.接受健檢正子照影者共 100 名(表一)， 其年紀平均,小於六十歲者為 48.56 歲，大於六十歲者為 67.64 歲，(表二)男女比為 1：1。. (表二) 各分組平均年齡 Male. Female. <60 y/o. 48.36 (25). 48.76 (25). ≥ 60 y/o. 68.92 (25). 66.36 (25). 20.
(22) 第二節 推論性統計分析. 一. 男 (<60y, 25 Healthy Examination Studies) vs. 女 (<60y, 25 Healthy Examination Studies) PET Model：Compare-populations: 1 scan/subject (two sample t-test). 男＞女： Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.050 (215 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=5.09) & extent size threshold was set at P = 0.063 (0.003 corrected，50 voxels), with correction for multiple comparisons.. 21.
(23) 圖一: 腦部葡萄糖吸收,小於六十歲,男大於女.統計表格. 22.
(24) 圖二: 腦部葡萄糖吸收,小於六十歲,男大於女.二維座標. 23.
(25) 圖三: 腦部葡萄糖吸收,小於六十歲,男大於女.3D 立體圖示. 24.
(26) 男＜女：No significant difference. Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.050 (215 voxels), without correction for multiple comparisons.. 25.
(27) 圖四: 腦部葡萄糖吸收,小於六十歲,男小於女.統計表格. 26.
(28) 二. 男 (>60y, 25 Healthy Examination Studies) vs. 女 (>60y, 25 Healthy Examination Studies) PET Model：Compare-populations: 1 scan/subject (two sample t-test). 男＞女： No significant difference Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (285 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=4.99) & extent size threshold was set at P = 1.000 (0.050 corrected，0 voxels), with correction for multiple comparisons.. 27.
(29) 圖五: 腦部葡萄糖吸收,大於六十歲,男大於女.統計表格. 28.
(30) 男＜女：No significant difference. Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (285 voxels), without correction for multiple comparisons.. 29.
(31) 圖六: 腦部葡萄糖吸收,大於六十歲,男小於女.統計表格. 30.
(32) 三. 男 (<60y, 25 Healthy Examination Studies) vs. (≧ 60y, 25 Healthy Examination Studies). 男(＜60y) ＞ 男(≧60y)： Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (235 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=5.05) & extent size threshold was set at P = 0.074 (0.004 corrected，50 voxels), with correction for multiple comparisons.. 31.
(33) 圖七: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).統計表格. 32.
(34) 圖八: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).二維座標. 33.
(35) 圖九: 腦部葡萄糖吸收,男,(小於六十歲)大於(大於六十歲).三維立體圖示. 34.
(36) 男(＜60y) ＜ 男(≧60y)： No significant difference Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (235 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=5.05) & extent size threshold was set at P = 1.000 (0.050 corrected，0 voxels), with correction for multiple comparisons.. 35.
(37) 圖十: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).統計表格. 36.
(38) 圖十一: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).二維座標. 37.
(39) 圖十二: 腦部葡萄糖吸收,男,(小於六十歲)小於(大於六十歲).三維圖示. 38.
(40) 四. 女 (<60y, 25 Healthy Examination Studies) vs. (≧ 60y, 25 Healthy Examination Studies). 女(＜60y) ＞ 女(≧60y)： Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (270 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=5.01) & extent size threshold was set at P = 1.000 (0.050 corrected，0 voxels), with correction for multiple comparisons.. 39.
(41) 圖十三: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).統計表格. 40.
(42) 圖十四: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).二維座標. 41.
(43) 圖十五: 腦部葡萄糖吸收,女,(小於六十歲)大於(大於六十歲).三維圖示. 42.
(44) 女(＜60y) ＜ 女(≧60y)： Uncorrected：The voxel height threshold was set at P = 0.001 (height threshold T=3.27) & extent size threshold was set at P = 0.049 (270 voxels), without correction for multiple comparisons. Corrected：The voxel height threshold was set at P = 0.000 (0.050 corrected，height threshold T=5.01) & extent size threshold was set at P = 0.096 (0.005 corrected，50 voxels), with correction for multiple comparisons.. 43.
(45) 圖十六: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).統計表格. 44.
(46) 圖十七: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).二維座標. 45.
(47) 圖十八: 腦部葡萄糖吸收,女,(小於六十歲)小於(大於六十歲).三維圖示. 46.
(48) 由上述之結果,我們將有意義的三維座標,輸入下列之程式. 可以得到下述之表格. 47.
(49) <60 y. ≧ 60y. (<60 y) VS (≧ 60y). M>F. Right cerebellum ,posterior lobe , cerebellar Tonsil Left cerebellum ,posterior lobe ,cerebellar Tonsil Right occipital lobe ,lingual gyrus Left occipital lobe ,lingual gyrus ,BA19 Left temporal lobe ,middle temporal gyrus ,BA 37. M>F F(<60) < F(≧60) Right cerebrum ,sub-lobar ,extra-nuclear ,white matter Left cerebrum ,sub-lobar ,extra-nuclear ,white matter F(<60) > F(≧60) right temporal lobe ,superior temporal gyrus ,BA 38 Left frontal lobe ,inferior frontal gyrus ,BA 47 M(<60) < M(≧60) M(<60) > M(≧60) Right limbic lobe ,anterior cingulate ,BA24 Right cerebellum ,posterior lobe ,Tuber right frontal lobe ,inferior frontal gyrus ,BA47 Left inferior frontal gyrus. 48.
(50) 第四章 討論 第一節 結果討論 就本次研究的結果來看,在年紀輕(小於 60 歲)的男女之比較.只有 男性較女性有明顯的局部腦部葡萄糖代謝增加,主要有下列五個區 域 1. Right cerebellum ,posterior lobe , cerebellar Tonsil 2. Left cerebellum ,posterior lobe ,cerebellar Tonsil 3. Right occipital lobe ,lingual gyrus 4. Left occipital lobe ,lingual gyrus ,BA19 5. Left temporal lobe ,middle temporal gyrus ,BA 37. 由一份分析 82 篇研究論文的 Brodmann area 功能結果指出,BA19 跟視覺,動作較有關係.BA37 跟記憶語言較有關係.. 在年紀大(大於 60 歲)的男女之比較.男性與女性都沒有明顯的局部 腦部葡萄糖代謝增加. 在年紀大(大於 60 歲)與年紀輕(小於 60 歲)的男生相比較之下, 年紀輕的比年紀大的,有明顯的局部腦部葡萄糖代謝增加,主要有 下列四個區域 49.
(51) 1. Right limbic lobe ,anterior cingulate ,BA24 2. Right cerebellum ,posterior lobe ,Tuber 3. right frontal lobe ,inferior frontal gyrus ,BA47 4. Left. inferior frontal gyrus. 由一份分析 82 篇研究論文的 Brodmann area 功能結果指出,BA24 跟理解力較有關係.BA47 跟情緒反應較有關係.. 而年紀大的比年紀輕的,則沒有明顯的局部腦部葡萄糖代謝增加.. 在年紀大(大於 60 歲)與年紀輕(小於 60 歲)的女生相比較之下, 年紀輕的比年紀大的,有明顯的局部腦部葡萄糖代謝增加,主要有 下列兩個區域 1. right temporal lobe ,superior temporal gyrus ,BA 38 2. Left frontal lobe ,inferior frontal gyrus ,BA 47. 由一份分析 82 篇研究論文的 Brodmann area 功能結果指出,BA38 跟情緒反應較有關係.BA47 跟情緒反應較有關係.. 而年紀大的比年紀輕的, 有明顯的局部腦部葡萄糖代謝增加,主要 50.
(52) 有下列兩個區域 1. Right cerebrum ,sub-lobar ,extra-nuclear ,white matter 2. Left cerebrum ,sub-lobar ,extra-nuclear ,white matter. 在臨床上則沒有意義. 51.
(53) 第二節 研究限制 本研究的個案數可以隨時間無限增加,最大的限制就在於接受正子 造影的成本過高.且個案數年紀偏輕.. 52.
(54) 第五章 結論與建議 第一節 結論. 綜合以上的研究結果結論出，健康成人的腦部葡萄糖代謝,在不同 性別及年齡有基本上的不同. 就男性而言,年輕男性在理解力(BA24)及情緒反應(BA47)較為激 烈 就女性而言,年輕女性在情緒反應(BA38,47)較為激烈 年輕男性較年輕女性於視覺動作（BA19）及記憶語言(BA37)有較 佳表現. 53.
(55) 第二節 建議. 以後在分析個案腦部局部葡萄糖代謝增加的研究中,必須考慮年 齡與性別有基本上的不同.不可一概而言. 54.
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