美麗な二重造影─私のコツすべて教えます─美しい注腸X線造影検査を求めて

My Concepts and Techniques for Clear Images of a Barium Enema Examination

要旨●注腸X線造影検査における美しい画像を得るための基本的な考え方と撮影技術について報告した．注腸X線造影検査では，①残渣の少ない前処置法が必要条件であるが，前処置法（等張法，高張法）の相違によって，洗腸効果だけでなく腸粘膜の状態（wet，dryなど）が異なるため，②付着性を考慮してバリウムを選択することが重要である．撮影技術は，③バリウムをできるだけまとまった状態でダイナミックに移動させ，腸管の粘液や残渣を洗い流すために2〜3往復した後に均一に付着させる．④病変を，正面像・側面像・斜め像から，さらに病変周囲に溜めるバリウム量を変えて立体的多角的に描出する．⑤S状結腸は空気量少なめ，上行結腸は空気量多めにして，必要があれば圧迫枕を使用する．⑥撮影装置にCアームがあればひだは接線方向に描出すると読影しやすい．以上，バリウムの付着ムラがなく，病変の形態学的特徴を正確に描出することが重要である．

　Herein I report the basic concepts and techniques of imaging to ensure that clear images are obtained from a barium enema examination. The concepts and techniques are as follows：（1）Although bowel preparation is required to ensure minimum residue, differences in preparation techniques（such as isotonic and hypertonic methods）affect not only the effectiveness of colonic irrigation but also the status of intestinal mucosa（such as wet and dry）.（2）Therefore, to conduct the examination, it is essential to select barium based on its adhesiveness.（3）The imaging technique should allow dynamic movement with barium having passed two to three times as concentrated as possible to ensure that the intestinal mucosa and residue are flushed out and that the barium has been evenly coated.（4）The amount of barium surrounding the lesion should be adjusted before each image, and a variety of images that provide a three-dimensional view in front, lateral, and oblique angles should be obtained.（5）It should be ensured that less amount of air is present in the sigmoid colon and extra amount of air is present in the ascending colon. When necessary, a pressure cushion should be used.（6）If the imaging device has a C-arm, the folds should be tangentially imaged to allow easier interpretation of the images. In conclusion, it is important to ensure that barium evenly coats the lesion and the morphological features of the lesion are accurately imaged.