INTESTINE Vol.18 No.2(4)

特集名 炎症性腸疾患の画像診断modality
題名 MRI─腸管評価の新たな低侵襲モダリティーはIBD診療を変えるか
発刊年月 2014年 03月
著者 藤井 俊光 東京医科歯科大学消化器内科潰瘍性大腸炎・クローン病先端治療センター
【 要旨 】 クローン病は生物学的製剤の登場以降,疾患概念が変化し,慢性進行性の炎症性疾患としてとらえられるようになった.臨床的な寛解のみならず炎症をコントロールしなければ,不可逆的な器質的変化をきたし機能障害に陥る.適切な時期に適切な治療介入をすることで疾患の進行を回避することができると考えられるが,そのためには疾患活動性の評価が不可欠である.近年,炎症性腸疾患の活動性を評価するためにさまざまなモダリティーが開発されているが,MRIは苦痛と被曝から解放され,若年より繰り返し行わなければならない活動性モニタリングには最適である.コストやavailabilityについては今後解決しなければならないが,本邦でも炎症性腸疾患の活動性評価の第一選択の一つとして多くの施設に拡がっていくことが期待される.
Theme Imaging modalities for IBD
Title MRI for inflammatory bowel disease
Author Toshimitsu Fujii Department of Gastroenterology and Hepatology, Advanced Clinical Center for Inflammatory Bowel Diseases, Tokyo Medical and Dental University
[ Summary ] Inflammation associated with Crohn's disease (CD) involves the entire gastrointestinal tract, especially the small and large bowels and causes irreversible bowel damage. Frequent imaging examinations are necessary to monitor disease activity and to evaluate response to therapeutic interventions, as well as predicting recurrence in order to provide appropriate treatment. Suitable imaging modalities should be reproducible, well tolerated, safe, and free of ionizing radiation. In recent years, imaging used for CD has dramatically changed. Cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging (MRI) are used to investigate not only extraluminal abnormalities but also intraluminal changes. Recently, new techniques such as MR enteroclysis, enterography, colonography, and enterocolonography have been developed. These recent advances enable us to use MRI to assess bowel disorders with high sensitivity, specificity and accuracy. MRI can be used to simultaneously evaluate the bowel surface, bowel wall, abdominal abscesses and perianal lesions such as perianal fistulae and perianal abscesses without experiencing problems with overlapping bowel loops. Therefore, MRI has the potential to provide evaluation of overall CD disease activity without radiation exposure. We believe that MRI is a suitable first choice of imaging modality for the assessment of CD.