炎症性腸疾患の画像所見と鑑別診断—輪状潰瘍

Annular Ulcer, Circular Ulcer

要旨●輪状潰瘍には幅の狭い狭義の輪状潰瘍と幅の広いもの（帯状潰瘍）があり，炎症性腸疾患の鑑別においては輪状潰瘍を特徴とする疾患（腸結核，非特異性多発性小腸潰瘍症，NSAIDs起因性腸症）と輪状潰瘍を呈することがある疾患を区別して鑑別する必要がある．その際，輪状潰瘍の局在，辺縁の性状，周囲粘膜の色調や粘膜模様に着目することが重要である．また，輪状潰瘍に随伴する病変の存在も鑑別の一助となる．画像評価は内視鏡所見が中心となるが，病変の分布や全体像の把握にはX線造影検査も有用であり，診断は問診，各種検査所見と経過を含め総合的に行う必要がある．

　We outlined the diseases that commonly present with annular ulcers. There are two types of annular ulcers—narrow-width circular ulcers and wide-width ulcers（girdle ulcers）. In the differentiation of inflammatory bowel diseases, it is important to pay attention to the localization of lesions, nature of the margins, and color and pattern of the surrounding mucosa.

　In some cases, an annular ulcer may be one of the various clinical features, and the presence of other forms of ulcers may help in diagnosis. Although imaging evaluation is primarily based on endoscopic findings, X-ray examination may be useful for understanding the distribution of the lesions and the overall clinical picture. Diagnosis should be made comprehensively considering interviews, various examination findings, and the course of the disease.