食道炎のX線診断―逆流性食道炎を中心とする食道・胃接合部における炎症性病変と腫瘍性病変のX線的鑑別診断

Radiological Diagnosis of Esophagitis: Radiological Differential Diagnosis of Inflammation with Reflux Esophagitis and Neoplasm at the Esophagogastric Junction

要旨　逆流性食道炎を中心に，食道・胃接合部における炎症性病変と腫瘍性病変との鑑別診断について検討した．ロサンゼルス分類（LA分類）Grade Bに相当する5mm以上のびらんを伴う食道炎はX線的に描出可能であった．しかし，5mm以下のGrade Aでは空気量の調節など撮影条件を工夫しないと容易には描出できなかった．食道・胃接合部において，隆起や陥凹を伴う病変に遭遇した場合には，隆起性病変では隆起の辺縁不整の有無，隆起表面の凹凸不整や陥凹の有無が鑑別の手がかりとなり，陥凹性病変に関しては陥凹境界の明瞭さ，辺縁不整の有無，辺縁隆起の有無などが鑑別点と考えられた．変形，狭窄を伴う病変では，変形の辺縁像に不整や二重線を伴うかどうか，また変形，狭窄の周囲に粘膜不整がみられるかどうかが鑑別点であった．この部位の診断ではBarrett食道も考慮に入れて病変の背景粘膜を把握することが重要であり，そのためにはSCJ（squamocolumnar junction）の描出とEGJ（esophagogastric junction）の同定が必要となるため，良質な二重造影によって，病変部だけでなく，その周囲粘膜も多角的にとらえる姿勢が大切である．

　We tried an analysis, using our cases actually undergoing radiological diagnosis of reflux esophagitis and differential diagnosis of inflammation and neoplasm at the EGJ（esophagogastric junction）. Mucosal breaks 5mm or more in length equivalent to Grade B of the Los Angels classification were easily demonstrated, but Grade A 5mm or less in length were not easily demonstrated without knowledge of radiography guidelines in such cases as the adjustment of the amount of air. When elevation or depression caused by the inflammation were seen, in the case of elevated lesions, existence of border irregularity and existence of unevenness and surface depression become the clues for differentiation. In the case of depressed lesions, the existence of clearness of the depression boundary, border irregularity and marginal elevation and were the differentiation points. These were the differentiation points in lesions with deformation or constriction, irregularity and a double line seen in the esophagography of the deformation, or membranous irregularity in the surroundings of the deformation and constriction. Because a Barrett esophagus may be involved, it is important to grasp the background mucosa of the occurring part of a lesion. For that reason, the visualization of SCJ（squamocolumnar junction）and the estimation of EGJ are necessary. So high-quality double contrast images from multiple directions and under various conditions, and efforts to understand the lesions from different angles are important.