炎症性腸疾患の画像所見と鑑別診断—狭窄

Imaging Findings and Differential Diagnosis of Inflammatory Bowel Disease:Stenosis

要旨●腸管狭窄合併例に対する内視鏡的アプローチには限界がある．高度の管腔狭窄を合併した炎症性腸疾患症例におけるX線造影検査は，狭窄部を含めた病変の全体像の把握に有用であり，内視鏡検査に対して相補的な意義があるが，加えて管腔変形・狭窄部のX線造影像は内視鏡検査では得られない輪郭線から構成されるため，その解析は鑑別診断にも有用となる．管腔変形・狭窄部のX線造影像を片側性狭窄，輪状狭窄と管状狭窄に分類し，変形・狭窄と腸間膜との位置関係，周囲粘膜の随伴所見を加味して解析することにより，内視鏡検査とは異なる観点からの鑑別診断が可能となる．

　Endoscopic approaches have limitations in patients with concomitant intestinal stenosis. In patients with inflammatory bowel disease complicated by severe luminal stenosis, radiographic contrast examinations are useful for general visualization of the lesions including the narrowed area and have significance as a complementary examination to endoscopy. In addition, radiographic contrast studies of luminal deformity/stenosis sites are useful for differential diagnosis because the images are composed of contour lines that cannot be obtained by endoscopy. Classification of contrast radiographs of the luminal deformity/stenosis sites into unilateral stenosis, annular stenosis, and tubular stenosis and analysis of the imaging findings with the positional relationship between the deformity or stenosis sites and the mesentery and associated features of the surrounding mucosa are effective means for differential diagnosis from a point of view different from that of endoscopy.