X線診断からみた大腸pm癌の特徴―sm癌との対比

The Radiological Diagnosis of pm Cancer of the Large Intestine

要旨　大腸pm癌のX線像を隆起型と陥凹型に分けてsm癌と比較検討した．側面像を無変形，楔状，弓状，Ω状，半円状，台形状変形の6型に分類すると，隆起型のsm_1,2では無変形からΩ状変形を，sm₃からpm₂では弓状から半円状変形を，pm₃になると半円状以上の変形を呈し，半円状変形はpm以上の浸潤を示す隆起型癌の特徴と考えられた．陥凹型のsm癌では楔状からΩ状変形を，pm_2,3ではほとんどが半円状ないしは台形状変形を示し，apple-core signはpm₂以深，特にpm₃以深を示唆する所見と考えられた．側面像の腫瘍径，高さ，変形像の幅および高さを計測した結果，隆起型では変形高，変形幅，変形幅/側面高が，陥凹型では変形幅と変形高/側面高が深達度診断の有用な指標となると思われた．

　This report reviewed a total of 165 cases of colonic cancers whose invasion was limited to the submucosa (sm cancer, 47cases) or the proper muscle (pm cancer, 118cases). We divided the radiological appearance of pm cancers into protruded or ulcerative type, and compared them with the radiologic appearance of sm cancers. The lateral view of the radiological appearances was classified into six types: no deformity, wedge-, arc-, omega-, semicircular-, and trapezoid-shaped. In the sm_1,2 cancers there were no wedge-, arc- or omega- shaped deformities. In the sm₃, pm_1,2 cancers there were arc-, omega- or semicircular-shaped deformities. The pm₃ cancers appeared to be semicircular- or trapezoid-shaped. The semicircular-shaped deformity was thought to be a characteristic feature of protrudedtype cancers whose invasion was as far as the pm or deeper than the pm. The ulcerative sm cancers appeared to be wedge- arc- or omega-shaped deformities. The pm_2,3 cancers were mostly semicircular- or trapezoid-shaped. The “apple-core signs” seemed to be the radiological feature of invasion of pm₂ or deeper than pm₂. The width (W) and height (H) of the tumors in the lateral view, or width (w) and height (h) of the deformity were measured. It was concluded that w, h and w/H, or w and h/H can be regarded as useful markers for the diagnosis of the depth of invasion of protruded-type cancers or ulcerative-type cancers, respectively.