炎症性小腸病変のX線診断

Differential Diagnosis of Inflammatory Bowel Diseases (1) Centering Around Lesions in the Small Intestine (ileo-cecal region)―From the Standpoint of X-ray Diagnosis

要旨　Crohn病，虚血性小腸炎，腸結核，糞線虫症，アミロイドーシスを対象に，術前像，摘出標本レントゲノグラム，固定標本レントゲノグラムを用いて小腸二重造影像に現れるX線像とその背景について検討した．①微細顆粒状陰影に関しては明らかな関係はみられなかった．②多発，散在性，境界鮮明な小ニッシェは大部分Ul-Ⅱで，深部，特に粘膜下の病変を示唆するものと思われた．③haustra様外観は粘膜下，あるいは腸間膜の障害を示唆するものと思われた．④各IBDにおける病変の白壁のPLA理論に基づいたパターンと変形との関係を今後検討することにより，それぞれのIBDの特徴が浮かび上がり，それにより，X線像による鑑別診断も容易になると思われる．

　With Crohn's disease, ischemic enteritis of the small intestine, intestinal tuberculosis, strongylodiasis and amyloidosis as the subjects, x-ray images from double contrast radiography of the small intestine and their background were studied using preoperative images and roentgenograms of the biopsy specimens and fixed specimens.

　(1) No definite relationship was seen so far as microgranular shadows were concerned. (2) Multiple, disseminating small niches, the margins of which were very sharp were mostly of Ul-Ⅱ type and interpreted as suggesting lesions at that depth, particularly under the mucous membrane. (3) Haustra-like appearance was taken as suggesting submucosal or mesenteric impairment. (4) Future studies of the pattern and deformation, on the basis of the PLA theory of Shirakabe for lesions in each IBD, will bring characteristics of each IBD into light. This will make easy differential diagnosis with x-ray images.