胃と腸57巻10号

2022年09月発行

今月の主題 大腸腫瘍診療の最前線

主題

注腸X線造影検査の位置付けと将来展望

著者： 川崎啓祐¹ 梅野淳嗣¹ 鳥巣剛弘¹ 永塚真²³ 梁井俊一² 鳥谷洋右² 朝倉謙輔² 山田峻²³ 川床慎一郎¹⁴ 松野雄一¹ 冬野雄太¹ 藤岡審¹ 森山智彦¹⁵ 菅井有³ 松本主之²

所属機関： ¹九州大学大学院病態機能内科学 ²岩手医科大学内科学講座消化器内科分野 ³岩手医科大学病理診断学講座 ⁴九州大学大学院医学研究院形態機能病理学 ⁵九州大学病院国際医療部

ページ範囲：P.1225 - P.1232

文献概要

要旨●大腸腫瘍の主な検査法として注腸X線造影検査，内視鏡検査，CTC（CT colonography）が挙げられる．しかし，内視鏡，CTCの機器の進歩と普及，X線検査医の不足により注腸X線造影検査数は減少傾向にある．そこで，注腸X線造影検査の大腸腫瘍診療における位置付けと将来展望について注腸X線造影画像を提示しながら考察した．注腸X線造影検査の絶対的適応は，内視鏡検査で深達度診断に迷う症例と内視鏡挿入困難例と考える．将来展望として，X線造影所見の解析にも人工知能を用いたコンピュータ診断支援システムが搭載され，施行医・読影医の負担が軽減されることが期待される．

参考文献

1）Lee KL, Chiu NC, Su CW, et al. Less barium enema, more colonoscopy：A 12-year nationwide population-based study in Taiwan. J Chin Med Assoc　82：312-317, 2019

2）Rockey DC, Paulson E, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy：prospective comparison. Lancet　365：305-311, 2005

3）Nagata K, Endo S, Honda T, et al. Accuracy of CT colonography for detection of polypoid and nonpolypoid neoplasia by gastroenterologists and radiologists：A nationwide multicenter study in Japan. Am J Gastroenterol　112：163-171, 2017

4）Halligan S, Dadswell E, Wooldrage K, et al. Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients：two multicentre randomized trials with economic evaluation（the SIGGAR trials）. Health Technol Assess　19：1-134, 2015

5）Hirofuji Y, Aoyama T, Koyama S, et al. Evaluation of patient dose for barium enemas and CT colonography in Japan. Br J Radiol　82：219-227, 2009

6）Neri E, Faggioni L, Cerri F, et al. CT colonography versus double-contrast barium enema for screening of colorectal cancer：comparison of radiation burden. Abdom Imaging　35：596-601, 2010

7）Berner K, Båth M, Jonasson P, et al. Dose optimisation of double-contrast barium enema examinations. Radiat Prot Dosimetry　139：388-392, 2010

8）Cianci R, Pizzi AD, Esposito G, et al. Ultra-low dose CT colonography with automatic tube current modulation and sinogram-affirmed iterative reconstruction：Effects on radiation exposure and image quality. J Appl Clin Med Phys　20：321-330, 2019

9）Spada C, Hassan C, Bellini D, et al. Imaging alternatives to colonoscopy：CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy（ESGE）and European Society of Gastrointestinal and Abdominal Radiology（ESGAR）Guideline—Update 2020. Endoscopy　52：1127-1141, 2020

10）鈴木雅裕，村松幸男．大腸CTにおける検査技術の向上—実例を含めて．INNERVISION　32：71-75, 2017

11）牛尾恭輔，後藤裕夫，村松幸男，他．消化管癌のX線診断における側面像の意義—二重造影像による深達度診断．胃と腸　21：27-41, 1986

12）渕上忠彦，岩下明德，平川雅彦，他．大腸sm癌の診断—X線の立場から，特に正面像による深達度診断．胃と腸　26：737-749, 1991

13）小林広幸，渕上忠彦，大城由美，他．いわゆる側方発育型大腸腫瘍のX線診断．胃と腸　40：1744-1758, 2005

14）Watari J, Saitoh Y, Obara T, et al. Early nonpolypoid colorectal cancer：radiographic diagnosis of depth of invasion. Radiology　205：67-74, 1997

15）Matsumoto T, Esaki M, Hizawa K, et al. Accuracy of radiographic assessment for the diagnosis of invasion depth in small invasive colorectal cancer. Br J Radiol　76：611-616, 2003

16）久部高司，田邊寛，青見賢明，他．完全摘除生検可能な大腸T1（SM）深部浸潤癌の術前診断—注腸X線造影．胃と腸　49：990-1001, 2014

17）Iinuma G, Moriyama N, Miyakawa K, et al. Early invasive colorectal carcinomas with submucosal invasion：radiographic characteristics with barium double contrast images. Abdom Imaging　28：492-504, 2003

18）Kawasaki K, Torisu T, Nagahata T, et al. Role of barium enema examination for the diagnosis of submucosal invasion depth in T1 colorectal cancers. Cancer Imaging　21：66, 2021

19）Zhang JJ, Gu LY, Chen XY, et al. Endoscopic diagnosis of invasion depth for early colorectal carcinomas：a prospective comparative study of narrow-band imaging, acetic acid, and crystal violet. Medicine（Baltimore）　94：e528, 2015

20）Wada Y, Kashida H, Kudo Se, et al. Diagnostic accuracy of pit pattern and vascular pattern analyses in colorectal lesions. Dig Endosc　22：192-199, 2010

21）Sumimoto K, Tanaka S, Shigita K, et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc　85：816-821, 2017

22）Komeda Y, Kashida H, Sakurai T, et al. Magnifying narrow band imaging（NBI）for the diagnosis of localized colorectal lesions using the Japan NBI Expert Team（JNET）classification. Oncology　93：49-54, 2017

23）Kawasaki K, Nakamura S, Eizuka M, et al. Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol　39：1159-1167, 2021

24）野村昌史，村上佳世，三井慎也．挿入困難例への対策，開腹術後癒着例，多発憩室例，痩せた患者．消内視鏡　30：367-373, 2018

25）富永健司，木村隆輔，森麻紀子，他．細径大腸内視鏡による挿入法．消内視鏡　30：325-329, 2018

26）Kayashima Y, Kimura F, Inoue K, et al. Computed tomographic air-contrast enema imaging for presurgical examination of colon tumors：assessment with colon phantoms and in patients. Radiat Med　26：6-14, 2008

27）Miyasaka M, Tsurumaru D, Nishimuta Y, et al. Diagnosis of early colorectal cancer invasion depth by quantitative evaluation of the basal indentation in CT colonography. Jpn J Radiol　34：786-794, 2016

28）Nagata K, Endo S, Kudo Se, et al. CT air-contrast enema as a preoperative examination for colorectal cancer. Dig Surg　21：352-358, 2004

29）Utano K, Endo K, Togashi K, et al. Preoperative T staging of colorectal cancer by CT colonography. Dis Colon Rectum　51：875-881, 2008

30）Hoshino N, Sakamoto T, Hida K, et al. Diagnostic accuracy of computed tomography colonography for tumor depth in colorectal cancer：A systematic review and meta-analysis. Surg Oncol　30：126-130, 2019