Radiographic Diagnosis of the Small Bowel Disease Koichi Kurahara 1 , Shuji Kochi 1,2 , Keisuke Kawasaki 1,3 , Yuichiro Yoshida 1,2 , Tomohiro Nagasue 1,2 , Ema Washio 1,2 , Junji Umeno 2 , Takehiro Torisu 2 , Motohiro Esaki 4 , Yumi Oshiro 5 , Shotaro Nakamura 3 , Takashi Yao 6 , Hiroyuki Kobayashi 1,7 , Takayuki Matsumoto 3 , Akinori Iwashita 8 , Tadahiko Fuchigami 1 1Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan 2Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan 4Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan 5Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Japan 6Department of Human Pathology, Juntendo University, School of Medicine, Tokyo 7Institute of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan 8AII Research Institute of Pathology & Image Diagnosis, Chikushino, Japan Keyword: 小腸 , 小腸X線造影 , 撮影手技 , 二重造影 , X線診断 pp.1254-1269
Published Date 2019/8/25
DOI https://doi.org/10.11477/mf.1403201820
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 Small bowel radiography is classified according to the barium administration method into the per-oral and per-intestinal methods(sonde method). Barium-filled and compression images are obtained using the per-oral method ; the per-intestinal method also obtains barium-filled and compression images, but it also obtains double-contrast images by administering air in addition to barium. In the radiographic diagnosis of inflammatory disease with ulcerative lesions(particularly for cases with luminal deformity and stenosis), the analysis of(1)the morphology of the stenosis area,(2)the positional relationship of the stenosis and mesentery, and(3)the associated findings of the surrounding mucous membrane are useful for differential diagnosis. In diseases with diffuse lesions, most cases present with mucosal fold hypertrophy, combined with granular mucosa on radiography ; the analysis of both findings is important for diagnosis. For differential diagnosis of neoplastic lesions, it is useful to analyze(1)the presence or absence of SMT(submucosal tumor)-like findings,(2)the presence or absence of a tendency for extraluminal growth,(3)the presence or absence of an overhanging edge at both ends of the stenotic area, and(4)the degree of poor distensibility of the wall. The endoscopic approach is limited in cases with concurrent stenosis when the lumen of the small intestine is physiologically narrow. The concurrent use of barium radiography is often useful for obtaining an image of the entire lesion. In particular, findings of luminal deformities and stenosis on barium radiography depict contour lines, which cannot be obtained on endoscopy by intraluminal observation and are thus extremely useful for differential diagnosis. Also, from the perspective of diagnosability, it can be superior to endoscopic examination.

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