小腸疾患のX線学的鑑別―基本的所見からみた鑑別の進め方

Radiography for Small Intestinal Diseases: Basic Abnormal Patterns and Their Differential Diagnosis

要旨　近年，小腸内視鏡が進歩し小腸病変を内視鏡で直接観察する時代になった．しかし，X線検査は内視鏡検査と比較しても診断面における有用性は変わっていない．X線検査は，微小な血管性病変を除けば，簡便性，安全性，ならびに診断能では内視鏡検査と同等と考えられる．そこで，現時点での小腸X線診断の要点と有用性を再確認した．本稿では，基本的なX線学的異常所見を，①隆起（辺縁欠損），②狭窄，③浮腫，皺襞肥厚，④小さな陰影斑（潰瘍），⑤敷石像，⑥複雑な陰影斑（潰瘍），⑦びまん性疾患，に分けて所見を解説し，基本的なX線学的所見の鑑別について述べた．

　Recently, new endoscopic techniques (capsule endoscopy and double balloon endoscopy) have been devised and used often to scrutinize lesions of small intestinal diseases. The conventional method of radiography for small intestinal lesions has been used for a long time and still has a definite role to play in the diagnosis of even subtle and small intestinal lesions. Radiography can diagnose elevated lesions, stenotic lesions, ulcerative lesions, and diffuse lesions. In this review, the basic abnormal patterns cited above are presented and their differential diagnosis is discussed partly by using endoscopy comparatively.