Ⅱb型早期胃癌のX線診断―レントゲングラムによるⅡb X線像の検討

X-ray Diagnosis of Type Ⅱb Early Gastric Cancer: Evaluation of Findings in the Roentgenogram of Ⅱb

　近年早期胃癌の診断も，対象が広がりについては2cm以下，1cm以下のものへと驚くべき速さで進歩してきている．

　一方，Ⅱcの診断も深いⅡcから浅いⅡcへと，だんだんⅡbに近づいてきて，浅いものへのアプローチもX線学的，内視鏡学的方面からようやく検討されるようになってきた．

　Four cases of Ⅱb (concomitant Ⅱb-like lesion, spreading around either Ⅱc or Ⅱa, have been studied for some possible roentgenological clues to Ⅱb.

　As there are as yet some indefinite aspects in the definition of Ⅱb allowing various interpretations to investigators, the present study is based on the understanding that Ⅱb is a type of early gastric cancer that has, on the macroscopic level, the same height as the surrounding normal mucosa.

　The en fáce pictures of Ⅱb have been studied through dividing them into a granular pattern, a sulcus-like shadow and a pale barium shadow, but after all we could not find any specific finding that characterize Ⅱb.

　Study of the above-mentioned four cases have shown that in an area between the normal and suspicious mucosal surface the patterns of the areae gastricae were such that no distinct border line could be drawn. However, on further detailed examinations, we have found the following slight difference in their x-ray findings. In Ⅱb areas granules were slightly larger, more roundish and radiolucent. Sulcus-like shadows were more uneven in breadth, irregular in shape and of varying sizes. These shadows were more often encountered. Pale barium shadow was far paler than that of Ⅱc. After all, clues to x-ray signs of Ⅱ b can only be found in the relative difference between it and the normal mucosa as visualized in x-ray pictures. In particular, slight difference in radiolucency sometimes affords a key to the diagnosis of Ⅱb.

　In the double contrast picture, slight rigidity of the gastric wall was noticed together with its irregularity and abnormal adhesion of the contrast medium.

　The possibility in the diagnosis of Ⅱb lesion is greatly influenced whether or not the lesion is concomitant, solitary, typical, or of wide extent, and also by the nature of non-cancerous adjoining mucosa. By far of utmost importance is the technical problem involved in the accurate delineation of slight difference between the normal and pathological mucosal surface. If this has been solved to a certain degree, then would the diagnosis of Ⅱb have a better chance of success.