アミロイドーシスにおける小腸X線像―内視鏡および生検所見との対比

Radiographic Features of Amyloidosis of the Small Intestine: A Comparison with Endoscopic and Histological Findings

要旨　十二指腸～上部空腸にアミロイド沈着が確認された22例を対象とし，小腸X線所見と内視鏡，生検所見とを比較検討した．経口法では皺襞山の腫大，皺襞谷の縮小を認めたが，腸管幅は正常であった．二重造影法ではいずれの計測値も正常例と有意差を認めなかった．二重造影法における粘膜パターンは，①0群：粘膜下腫瘤様陰影が多発するもの（2例，②Ⅰ群：結節状陰影が多発し，びまん性に粘膜粗糙像（大小不同の小顆粒状陰影の多発から成る）を認め，小バリウム斑の散在を伴うもの（4例），③Ⅱ群：粘膜粗糙像とKerckring皺襞の凹凸像を認め，小バリウム斑の散在を伴うもの（4例），④Ⅲ群：粘膜粗糙像とKerckring皺襞の凹凸像を認めるが，小バリウム斑を伴わないもの（7例），⑤Ⅳ群：Kerckring皺襞の凹凸像のみを認めるもの（3例），⑥Ⅴ群：異常を認めないもの（2例），の6段階に分類できた．粘膜パターンとX線像計測値あるいは腹部症状とを比較した結果，Ⅰ群～Ⅴ群が通常みられる本症の粘膜パターンであり，0群はその特殊型と考えられた．X線像は内視鏡所見とよく一致したが，生検所見とは明らかな相関関係を認めなかった．以上の成績よりアミロイドーシスのX線診断は，経口充満像と二重造影像を対比することによって得られる腸管の伸展性の程度と二重造影像における粘膜パターンを組み合わせることにより可能であると考えられた．

　The purpose of the present investigation was to study the correlation between radiographic features and endoscopic or histological findings of amyloidosis of the small intestine, and also to determine the radiographic characteristics of this disease. Twenty-two cases of amyloidosis involving the duodenum and/or upper jejunum were evaluated. Barium meal study of the jejunum showed normal caliber of the lumen, thickened mucosal folds, and narrowed intervalvular distance. In double contrast study of the jejunum, there was no significant difference in caliber of the lumen, width of the folds, and intervalvular distance between amyloidosis group and control group. Mucosal appearances demonstrated by double contrast technique were divided into the following six groups:

　1) multiple submucosal tumors (4-10 mm in diameter) are seen as the main feature (Group 0, two cases);

　2) multiple nodular shadows (3-4 mm in diameter), innumerable fine granular shadows (1-3 mm in diameter), and scattered small barium flecks are seen (Group Ⅰ, four cases);

　3) innumerable fine granular shadows, irregularities of the Kerckring's folds, and scattered small barium flecks are seen (Group Ⅱ, four cases);

　4) innumerable fine granular shadows and irregularities of the Kerckring's folds are seen (Group Ⅲ, seven cases);

　5) irregularities of the Kerckring's folds are seen (Group Ⅳ, three cases);

　6) no abnormal findings are seen (Group Ⅴ, two cases).

　A comparison of radiographic mucosal patterns and various radiographic values or abdominal symptoms facilitated distinction between cases of Group Ⅰ-Ⅴ and Group 0. Radiographic features correlated with endoscopic findings but did not with biopsy findings. Our results suggest that a combination of pliability of the lumen obtained from a comparison of the radiographic findings between barium meal study and double contrast study, and mucosal appearances demonstrated by the latter technique may make the diagnosis of amyloidosis of the small intestine possible.