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要旨 虚血性腸病変の確定診断は虚血の証明にあり,その点で非侵襲的かつ高分解能に貫壁性の血流評価が可能な超音波検査は,本病態において本来1st lineに位置付けられるべき検査法である.特に,他のmodalityによる診断が必ずしも容易でないとされている絞扼性腸閉塞や非閉塞性腸管虚血症(NOMI)などに対する造影超音波検査(ただし本邦では保険適用外)の診断能は良好である.一方,一過性の虚血後におけるreperfusion injuryである一過性型虚血性腸炎は,超音波像上,粘膜下層の強い浮腫による壁肥厚がみられるが,同様の画像を呈する疾患は他にも存在するため,病変の分布や病歴などを加味した診断が必要となる.
The sonographic diagnosis of ischemic bowel diseases is discussed. Needless to say, visualization of bowel wall ischemia is particularly essential to make a definitive diagnosis of bowel ischemia, which is not necessarily easy by many modalities available, though. On the other hand, contrast ultrasound enables us to evaluate transmural blood perfusion with high spatial resolution, in a real-time fashion which is extremely useful for the diagnosis of bowel ischemia. Taking the non-invasiveness and handiness into account, ultrasound should be considered as the first line modality in diagnosing bowel ischemia. The sonographic diagnosis of transient type of ischemic enterocolitis, caused mainly of reperfusion injury. We should be made carefully since many other diseases mimic the sonographic image of this disorder.
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