Small Superficial Type Lesion (Type Ⅱ) of the Large Intestine: Radiologic Detection and Therapeutic Planning Yutaka Imai 1 , Yoshinori Sugino 1 , Hiroshi Amou 1 , Kenji Kumakura 1 1Department of Diagnostic Radiology, Keio University School of Medicine Keyword: 表面型上皮性病変 , 小さな大腸癌 , X線装置の改良 pp.789-799
Published Date 1990/7/25
DOI https://doi.org/10.11477/mf.1403111056
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 Recent studies using radiologic or endoscopic techniques have tacked the problem of early detection of superficial type lesion (flat elevation) in the large intestine. In this paper,53 superficial type lesions, which were flat plaque or carpet-like lesions, were selected and analyzed regarding their surface configuration and profile view findings on the radiographs. The definition of a superficial type lesion in this series is a sessile lesion that has a relatively flat surface and a height of 2 mm or less in the resected specimen or on the radiograph.

 The surface configuration of the 53 flat elevations studied radiographically is illustrated in Tables 1&2. The surface patterns of 39 lesions, which were lesions without central depression, were classified into five groups (Table 1). These categories were important because 1-c lesions tended to be adenomatous and 1-d lesions tended to be carcinomatous. The other 14 flat elevations with central depression were also analyzed. The surface patterns were classified into four groups (Table 2). Some lesions with pattern 2-a were benign, however all other cases were cancerous without exception. The basal deformity in the profile view was classified into four groups (Table 3). Most lesions which had semilunar shape and trapezoid deformity were cancers invading the submucosa or deeper colonic wall. The difference of the basal deformity in the profile view regarded as the sign of malignancy from the basal indentation due to the result of geometric function was discussed.

 Most cases of flat elevation in the large intestine in this series were discovered during the past 5 years. There have been some improvements in equipments and technical approach. First of all, examiners should always think about the existence of flat elevations in the large intestine. Secondly, examiners should fluoroscopically observe each segment of the intestine separately, from the rectum to the terminal ileum, as in endoscopic examination. Thirdly, examiners should observe the barium flow across the entire mucosal surface of the segment carefully on the fluoroscopic image and manipulate the barium pool across the anterior and posterior wall. Recently, we have been using a special grid for fluoroscopy (a low-ratio grid) which is fixed in front of a image intensifier, and another grid for radiography (a high-ratio grid) which is fixed to the moving frame below the film cassette carriage. This system is quite useful to identify the lesion fluoroscopically.

 The therapeutic approach to epithelial lesions of the large intestine depending on the radiographic findings is illustrated in Figure 5.

Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.


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