超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 46(4): 330-339 (2021)
doi:10.11272/jss.342

研究Research Paper

特発性孤立性上腸間膜動脈解離における超音波検査画像の経時的解析Time-lapse Analysis of Ultrasound Images in Spontaneous Isolated Superior Mesenteric Artery Dissection

福岡徳洲会病院臨床検査科Fukuoka Tokushukai Hospital, Department of Clinical Laboratory

受付日:2020年9月15日Received: September 15, 2020
受理日:2021年1月15日Accepted: January 15, 2021
発行日:2021年8月1日Published: August 1, 2021
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目的:本研究の目的は,特発性孤立性上腸間膜動脈解離(Spontaneous Isolated Superior Mesenteric Artery Dissection: SISMAD)における超音波画像の経時的な変化を解析することである.

対象と方法:対象は2013年3月~2020年1月に当院で超音波検査にて最初にSISMADと診断された21例のうち10例(平均年齢48.2±3.9歳,男10例)である.計測項目はSMAにおける最大外径,最小内径,最大狭窄率,平均狭窄率で,これらを発症日,発症から約3日後,約1週間後,約1か月後,約3か月後と分類した各フェーズで計測した.さらに各フェーズにおける,発症日を基点とした増減率を算出した.

結果:最大外径:発症から徐々に血管径は拡大し,約1か月後に+9.8%と最大の拡大率となった.最小内径:約1か月後に−31.4%と最大の内腔狭小化が生じた.最大狭窄率:発症日から徐々に狭窄が進行し,約1ヶ月後に+26.3%とピークとなった.平均狭窄率:発症から約3日後に−3.3%とわずかな軽快傾向があったが,約1か月後には+22.5%とピークとなった.全てのパラメータは約3か月後にはピークアウトした.

結語:SISMADの経時的超音波画像所見として,狭窄は約1週間後から一度増悪し,約1か月後にピークになる傾向を認めた.画像所見は増悪傾向となっても,腹痛の増強などの臨床所見に注意しながら,保存的加療が期待できる可能性がある.

Purpose: The purpose of this study was to analyze the temporal changes in ultrasound (US) signals in patients with spontaneous isolated superior mesenteric artery dissection (SISMAD).

Subjects and methods: Out of the first 21 cases diagnosed with SISMAD, 10 male patients were included in this study using US at our hospital between March 2013 and January 2020 (mean age 48.2±3.9 years).

The calculated parameters included the maximum outer diameter, minimum inner diameter, maximum stenosis rate, and mean stenosis rate. All parameters were measured retrospectively in distinct phases categorized into the day of onset, approximately three days after, approximately one week after, approximately one month after, and approximately three months after the onset. Subsequently, we analyzed the respective change over time from the day of onset.

Results: The rate of change of maximum stenosis rate was +3.8% approximately three days and +16.0% after approximately one week after onset, respectively. Stenosis gradually progressed and reached a peak of +26.3% after approximately one month. In contrast, the rate of change of mean stenosis rate was initially improved slightly to −3.3% approximately three days after the onset, however, it subsequently reversed to +9.0% after one week, and peaked at +22.5% approximately one month later. Furthermore, the rates of change of maximum outer diameter and minimum inner diameter after one month were +9.8% and −31.4%, respectively. All parameters reached their maximum values after approximately three months post onset.

Conclusions: Based on time-lapse US image analysis in SISMAD, we identified that stenosis tended to become worse after approximately one week and continued to worsen for approximately one month. Despite these US findings, conservative treatment may be expected by focusing on clinical findings such as aggravated abdominal pain.

Key words: superior mesenteric artery dissection; ultrasonography; ultrasound; vascular remodeling

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