胃と腸59巻10号

2024年10月発行

増大号 炎症性腸疾患2024

主題 炎症性腸疾患の画像所見

Crohn病におけるCT・MRI検査

著者： 橋本真一¹² 松本怜子³ 浜本果歩⁴ 大木美穂⁴ 児玉愛実⁴ 山本美音⁴ 吉松祐希⁴ 中村克彦⁴ 山本一太⁴ 青山将司⁴ 伊藤駿介⁴ 五嶋敦史⁴ 浜辺功一⁴ 西川潤⁵ 高見太郎¹²⁴

所属機関： ¹山口大学医学部附属病院光学医療診療部 ²山口大学医学部附属病院IBDセンター（炎症性腸疾患センター） ³地域医療機能推進機構下関医療センター ⁴山口大学大学院医学系研究科消化器内科学 ⁵山口大学大学院医学系研究科基礎検査学分野

ページ範囲：P.1445 - P.1452

文献概要

要旨●小腸病変はCrohn病の予後に関わる重要な因子であり正確な評価が望まれるが，狭窄などの消化管合併症により内視鏡単独では小腸全体の評価が難しい症例を経験する．CT/MR enterographyの開発により腸管炎症と消化管合併症を俯瞰的に評価することが可能となり，CT・MRIはCrohn病診療における重要な検査法となった．本稿においてはCT・MRIを実臨床において有効に使用するために，それぞれの有用性だけでなく欠点についても解説した．今後，本邦におけるCT・MRIの適切な位置付けに関するエビデンスの蓄積が望まれる．

参考文献

1）Hyun SB, Kitazume Y, Nagahori M, et al. Magnetic resonance enterocolonography is useful for simultaneous evaluation of small and large intestinal lesions in Crohn's disease. Inflamm Bowel Dis　17：1063-1072, 2011

2）Huprich JE, Fletcher JG. CT enterography：principles, technique and utility in Crohn's disease. Eur J Radiol　69：393-397, 2009

3）Lee SJ, Park SH, Kim AY, et al. A prospective comparison of standard-dose CT enterography and 50% reduced-dose CT enterography with and without noise reduction for evaluating Crohn disease. AJR Am J Roentgenol　197：50-57, 2011

4）竹中健人，藤井俊光，大塚和朗，他．MR enterography．胃と腸　58：1491-1498, 2023

5）厚生労働科学研究費補助金難治性疾患等政策研究事業「難治性炎症性腸管障害に関する調査研究」（鈴木班）．クローン病MR enterography（MRE）アトラス．2017

6）Bruining DH, Zimmermann EM, Loftus EV Jr, et al. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn's disease. Gastroenterology　154：1172-1194, 2018

7）Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR guideline for diagnostic assessment in IBD part 1：Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis　13：144-164, 2019

8）Nakase H, Esaki M, Hirai F, et al. Treatment escalation and de-escalation decisions in Crohn's disease：Delphi consensus recommendations from Japan, 2021. J Gastroenterol　58：313-345, 2023

9）Samuel S, Bruining DH, Loftus EV Jr, et al. Endoscopic skipping of the distal terminal ileum in Crohn's disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol　10：1253-1259, 2012

10）Omori T, Ohmiya N, Watanabe K, et al. Nationwide multicenter study on adverse events associated with a patency capsule：Additional survey of appropriate use of patency capsule study. J Gastroenterol Hepatol　39：337-345, 2024

11）Hashimoto S, Shimizu K, Shibata H, et al. Utility of computed tomographic enteroclysis/enterography for the assessment of mucosal healing in Crohn's disease. Gastroenterol Res Pract　2013：984916, 2013

12）Takenaka K, Ohtsuka K, Kitazume Y, et al. Comparison of magnetic resonance and balloon enteroscopic examination of the small intestine in patients with Crohn's disease. Gastroenterology　147：334-342, e3, 2014

13）Turner D, Ricciuto A, Lewis A, et al. STRIDE-II：an update on the selecting therapeutic targets in inflammatory bowel disease（STRIDE）initiative of the International Organization for the Study of IBD（IOIBD）：determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology　160：1570-1583, 2021

14）Takenaka K, Kawamoto A, Kitazume Y, et al. Transmural remission characterized by high biologic concentrations demonstrates better prognosis in Crohn's disease. J Crohns Colitis　17：855-862, 2023

15）Fujimura H, Hashimoto S, Shimizu K, et al. The evaluation of transmural healing by low-dose computed tomography enterography in patients with Crohn's disease. Intern Med　61：2999-3007, 2022

16）Panés J, Bouzas R, Chaparro M, et al. Systematic review：the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther　34：125-145, 2011

17）橋本真一，松本怜子，大木美穂，他．CT enterography．胃と腸　58：1483-1489, 2023

18）Li X, Liang D, Meng J, et al. Development and validation of a novel computed-tomography enterography radiomic approach for characterization of intestinal fibrosis in Crohn's disease. Gastroenterology　160：2303-2316, e11, 2021

19）Matsuoka K, Fujii T, Okamoto R, et al. Characteristics of adult patients newly diagnosed with Crohn's disease：interim analysis of the nation-wide inception cohort registry study of patients with Crohn's disease in Japan（iCREST-CD）. J Gastroenterol　57：867-878, 2022