肉眼所見との対比からみたX線診断―潰瘍を伴わない陥凹型について

Radiological Diagnosis in View of Comparison with Macroscopic Findings: on Depressive Lesions without Ulceration

要旨　1cm以上の潰瘍を伴わない陥凹型早期癌のうち，術前に空気量を変えて病変を写し分けたX線所見とホルマリン固定後の肉眼所見との対比が可能であった39病変（m癌25病変，sm癌14病変；分化型27病変，未分化型12病変）を材料とした．ルーチンX線検査を施行した33病変のうち11病変（33.3％）を拾い上げた．陥凹面の性状は顆粒状では陥凹が0.5mm以下が87％（20/23）を占め，均一無構造状では1.0mm以上が56％（9/16）と多く，陥凹の深さと関連がみられた．陥凹周囲に隆起所見を認めたものは4＆1％（19/39）で，分化型に多く，X線所見において隆起所見は78.9％（15/19）にあり，いずれも圧迫法で透亮像としてみられた．辺縁の変形のあるものはsmが80％（4/5），ないものはmが81．8％（9/11）を占め，変形と深達度とに関連がみられた．肉眼所見とX所見との対比が困難な症例を呈示し，圧迫では陥凹周囲の隆起性変化の有無が描出には重要であること，二重造影では陥凹が軽微になるほど肉眼所見とX線所見の一致は難しく，この差を認識して診断する訓練や部位，空気量の違いを考慮する必要があることが考えられた．

　Study was conducted on 39 lesions of depressive type early gastric cancer in which preoperative x-ray findings using various amounts of air to destend the stomach and macroscopic findings in formalin fixed specimen were compared (m cancer: 25 lesions, sm cancer: 14, differentiated: 27, undifferentiated: 12). Eleven lesions among 33 lesions were detected on standard radiological examination. While 87% (20/23) of the depressive lesions with granular surface had the depth less than 0.5 mm, 56% (9/16) of the lesions with smooth surface more than 1.0 mm, suggesting the presence of the relationship between the depth and the suface characteristics. Elevated lesions around the depression were seen on formaline fixation in 48.1% (19/39) of the lesions, mostly in defferentiated type, and in 78.9% (15/19) by compression method as a filling defect. Marginal deformity was seen in 80.0% (4/5) of sm cancer, but it was not seen in 81.8% (9/11) of m cancer, suggesting the presence of the relationship between the deformity and the depth of invasion. We then present the cases in which macroscopic and x-ray findings were difficult to compare, showing the diagnostic importance of an elevated lesion around depression by compression method. There is also the tendency of inconsistence between macroscopic and x-ray findings as the depression becomes shallower on contrast method, implication the necessity of taking it into consideration regarding diagnostic training. The site of the lesion and amount of air infilled seem to be important diagnostic considerations too.