上部消化管の炎症性疾患におけるX線検査の有用性―腫瘍性疾患との鑑別を中心として

The Benefit of Radiographic Examination for Diagnosis of Gastroduodenal Inflammatory Disease : From the Standpoint of Differential Diagnosis from Tumors

要旨　胃・十二指腸の炎症性疾患診断におけるＸ線検査の有用性について，代表的な胃のびまん性疾患と十二指腸の狭窄性疾患を呈示し，X線と内視鏡検査を比較しながら鑑別診断の要点を述べた．胃のびまん性疾患の鑑別診断では病変の伸展性と粘膜面の性状が重要である．X線検査は全体像を立体的なイメージとして容易に捉えることができ有用であったが，びまん性病変の局所に限局した異常所見の拾い上げは内視鏡がより有用であった．このため，鑑別診断困難な胃のびまん性疾患では，両検査を適宜組み合わせることが重要と思われた．一方，十二指腸の狭窄性疾患では，狭窄の部位・長さ，局所的な変形の程度・型，および腸管外所見などが鑑別診断上重要で，X線が内視鏡より有用なことが多かった．ただし，同一疾患でもそのX線像は炎症の時期や程度により多彩なため，内視鏡も含めた他の画像所見や臨床像も加味して診断を行うことが必要である．

　We discussed the way to differentiate representative gastroduodenal inflammatory diseases (diffuse lesions of the stomach and narrowing lesions of the duodenum) from morphologically mimicking gastroduodenal tumors, comparing radiographic examination with endoscopic examination.

　It was important for the differential diagnosis of diffuse gastric inflammatory diseases and diffusely infiltrating gastric tumors to diagnose the degree of rigidity of the gastric wall and abnormal findings of the gastric mucosa. Radiographic examination was usefull for imaging of the whole and for revealing the spread of the lesions three-dimensionally. On the other hand, endoscopic examination was of benefit for the recognition of minute conditions of the mucosal surface. Therefore, it is essential to rely on both radiographic and endoscopic examinations to differentiate these diseases more precisely.

　In lesions which caused duodenal stenosis or narrowing, it was important for the differential diagnosis of inflammatory diseases and infiltrating tumors to diagnose the location and the length of the stenotic area, the degree of deformity, and to obtain information about the morphological change of the duodenum associated with lesions outside it. In many cases, radiographic examinaion would detect these findings more accurately than endoscopic examination. However, it was also necessary for precise diagnosis of these diseases to evaluate the lesions by other morphological examinations and the clinical findings, because radiological findings in the same disease vary and change during the course of the disease.