縦走潰瘍―X線診断の立場から

Major and Accessory Findings for the Diagnosis of Crohn's Disease: Longitudinal Ulcers from the Viewpoints of Radiologic Diagnosis

要旨　1976年にクローン病診断基準（案）が発表されて以来，わが国のCrohn病の報告例が増加してきたが，逆にこの診断基準（案）では不都合な点も次第に明らかになってきた．そこで，われわれはCrohn病診断のための主要所見と副所見の1つとして，縦走潰瘍および縦軸要素の病変を取り上げてそのX線診断について検討した，(1) Crohn病の潰瘍性病変を形態・分布・方向により7つの型に分け，しかも縦走潰瘍領域と非連続領域に大別した．(2) 小腸の縦走潰瘍は充満像ではloopの内側辺縁に伸展不良として，二重造影像では正面像あるいはこれに近い像として描写されることが多い．充満像あるいは二重造影像で良好な像が得られないときは圧迫を上手に用いるべきである．(3) また，縦走潰瘍領域には種々の変形や辺縁の異常がみられるが，変形の診断学的意義は①小病変のチェック，②病変の性状診断，特にその方向性の診断である．

　Since diagnostic criteria of Crohn's disease (proposal) was published in 1976, the number of reported cases of Crohn's disease has been increased and weak points of this diagnostic criteria (proposal) have been disclosed. We evaluated radiologic diagnosis of a longitudinal ulcer as the major finding, and a lesion with a component of longitudinal direction as an accessory finding.

　We classified ulcerative lesions of Crohn's disease into 7 types by the morphologic features, distribution and direction of ulcers. In addition to this classification, the intestine was divided into the longitudinal ulcerative area and non-ulcerative area. A longitudinal ulcer in the small intestine may be demonstrated as a poor expansion at the medial edge of the loop by the filling method, and it may be shown in the frontal view of near frontal view by the double contrast method. When an adequate picture could not be obtained by the filling or double contrast methods, the compression method should be added. In the longitudinal ulcer area, there were various shapes of deformities and abnormalities on the edge. Diagnostic value of the deformities were 1) detection of small lesions, 2) nature of lesions especially direction of lesions.