大腸：注腸X線造影—炎症性疾患を中心に

Essential Points in Interpreting Barium Enema X-Ray Images in Inflammatory Disorders

要旨●注腸X線造影検査による炎症性腸疾患の診断について，特に読影の観点から解説した．注腸X線造影検査が実施される機会は年々減少しており，炎症性疾患も内視鏡検査で診断される機会が多い．しかし，視点が内視鏡検査では管腔内，注腸X線造影検査では体外にある点で根本的に異なっている．注腸X線造影像は“面”と“輪郭線”で構成される．“面”は“テクスチャー”，“図形”，“線”に分解される．“輪郭線”は注腸X線造影像でのみ描出されるが，腸管のさまざまな変形は“輪郭線”により表現されるため，腸管変形の診断は注腸X線造影検査の独壇場である．本稿では，代表的な注腸X線造影所見（びまん性病変，萎縮瘢痕帯，潰瘍，隆起，敷石像，変形，ひだ・集中像，瘻孔）について実際の画像を提示するとともに解説を加えた．注腸X線造影検査の意義が再認識されることを期待したい．

　We describe the essential points in interpreting barium enema X-ray images in inflammatory disorders. The practice of this examination has recently been reduced in favor of endoscopy as the main modality for the diagnosis of inflammatory disorders. These modalities are considerably different—i.e., viewpoints are inside the lumen in endoscopy and outside in X-ray. The barium enema X-ray images are composed of “plains” and “contours”. “Plains” can be further distinguished into “textures”, “figures”, and “lines”. “Contours” can be visualized only using X-ray. Because various deformations of the bowel wall are expressed by changes in “contours”, X-ray is greatly advantageous compared with endoscopy for the detection of this particular finding. Representative findings include diffuse lesions, atrophic scarred areas, ulcers, protrusions, cobblestone appearance, deformations, convergences, and fistulae ; X-ray and endoscopic images of these findings are presented with explanations. A revival in barium enema X-ray use is expected to improve the diagnosis of bowel disorders.