INTESTINE Vol.16 No.3(3-4)

特集名 クローン病のTherapeutic Strategy ─ mucosal healingは治療のゴールか
題名 クローン病治療選択・効果判定のための各種modalityの意義─小腸を中心に (4) 体外式超音波検査法
発刊年月 2012年 05月
著者 伊能 崇税 成田赤十字病院内科
著者 長谷川 雄一 成田赤十字病院検査部
【 要旨 】 クローン病の活動性診断に体外式超音波検査(US)は簡便性に優れたmodalityである.高画質B-mode像で全層性炎症像が描出され,瘻孔や膿瘍などの腸管壁外病変の診断にも有用である.カラー・パワードプラ法や造影法を駆使し,壁内血流シグナルや造影パターンを解析し,狭窄性病変の線維化の程度が把握される.USは抗TNF-α抗体の適応を判断し,粘膜治癒の確診は得られずとも全層性治癒を逸早く推測し,他のmodalityを補完する役割がある.
Theme Therapeutic strategy for Crohn's disease -- Should mucosal healing be a final goal?
Title Role of ultrasonography for treating Crohn's disease patients
Author Soetsu Ino Department of Internal Medicine, Narita Red Cross Hospital
Author Yuichi Hasegawa Department of Clinical Laboratory, Narita Red Cross Hospital
[ Summary ] Ultrasonography (US) is noninvasive and convenient for assessing bowel inflammation due to Crohn's disease. Recently, advanced digital technologies have begun to provide high resolution images in the B-mode, and can be used to visualize transmural bowel inflammation. High resolution US, performed by experienced examiners is useful to detect extramural complications such as fistulae or abscess. By applying color/power Doppler ultrasonography (CD-US), increased vascularization of inflamed bowel segments can be observed. Contrast-enhanced ultrasonography (CE-US), with a low mechanical index, provides images of capillary perfusion of the bowel wall, and may be valuable in determining the grade of fibrosis within strictures. Findings obtained with CD-US or CE-US may help to determine the therapeutic effects of anti-TNF-α antibodies, and can complement other modalities. Although US is not a modality which can be used to obtain mucosal healing or transmural bowel healing, it can be employed for early detection.