臨牀消化器内科 Vol.13 No.5(4-2)


特集名 慢性膵炎 --新しい診断基準をめぐって
題名 新しい基準の適応に必要な検査 (2) CT
発刊年月 1998年 05月
著者 石原 武 千葉大学医学部第一内科
著者 税所 宏光 千葉大学医学部第一内科
【 要旨 】 1995年,日本膵臓学会により策定された新しい慢性膵炎臨床診断基準では,従来の臨床診断基準(1983)を再検討した結果から,慢性膵炎に疾患特異性の高い所見を選び,低いと考えられた所見は除かれた.膵嚢胞,膵腫瘤,膵萎縮,膵管拡張は,膵癌でも多く認められる所見であり,疾患特異性(specificity)が低いと考えられた.一方,膵辺縁所見は,詳細に検討した結果,疾患特異性が高く有用な所見であった.この結果,単純X線CT単独で慢性膵炎と診断しうる所見は,“膜内の石灰化”と“辺縁の不規則な凹凸がみられる膵の変形”の2項目にとどめられ,それぞれ確診所見,準確診所見とされた.
Theme New Criteria of Chronic Pancreatitis
Title Criteria of CT Findings in the Diagnosis of Chronic Pancreatitis in Japan
Author Takeshi Ishihara First Department of Medicine, Chiba University School of Medicine
Author Hiromitsu Saisho First Department of Medicine, Chiba University School of Medicine
[ Summary ] New clinical diagnostic criteria for chronic pancreatitis were published by the Japan Pancreas Society on May 9, 1995. In these new criteria (Criteria 1995), the characteristic CT findings for chronic pancreatitis have been confined to two definite or probable observations. The observation of definite chronic pancreatitis, associated with pancreatic stones is evidenced by intrapancreatic calcifications, and the finding of probable chronic pancreatitis with pancreatic deformities having irregular contours. Other findings, such as pancreatic swelling, pancreatic atrophy, pancreatic duct dilatations and cyst formation, which were adopted in the old criteria for chronic pancreatitis made by the Japanese Society of Gastroenterology in 1983 (Criteria 1983), are often found similarly in both pancreatic cancer and chronic pancreatitis. These findings were thought to be infrequent specificity in the diagnosis of chronic pancreatitis. So, in Criteria 1995, they were deleted.
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