1 大垣市民病院診療検査科Department of Medical Technology, Ogaki Municipal Hospital
2 大垣市民病院放射線診断科Department of Radiology, Ogaki Municipal Hospital
目的：腹部悪性腫瘍の腹膜播種は，画像診断で発見することはしばしば困難であり，腹膜播種の有無により，治療方針を決定することも多く，的確に診断することが重要である．本研究では，超音波検査における腹部悪性腫瘍の腹膜播種診断の検討を行った．
対象および方法：対象は術前病期診断36例と術後再病期診断36例の計72症例で，PET/CTにて検出された腹部区分7領域の134結節について評価した．
結果：72症例の腹膜播種診断能は30.6%であり，その内訳は術前病期診断では27.8%，術後再病期診断では33.3%であった．腹部各領域の結節検出能は，右横隔膜下腔24.0%，左横隔膜下腔0%，大網17.9%，小腸・小腸間膜47.1%，右傍結腸溝10.5%，左傍結腸溝0%，骨盤17.4%であった．また術前病期診断および術再病期診断におけるそれぞれの検出能は，右横隔膜下腔16.6%/30.8%，左横隔膜下腔0%/0%，大網17.6%/18.2%，小腸・小腸間膜66.7%/36.4%，右傍結腸溝8.3%/14.3%，左傍結腸溝0%/0%，骨盤15.4%/22.2%であった．腹水の有無による腹膜播種診断能は，腹水貯留時40.7%，非貯留時24.4%であった．また術前病期診断および術再病期診断におけるそれぞれの診断能は，腹水貯留時30.0%/71.4%，非貯留時25.0%/24.1%であった．
結論：超音波検査の結節検出能は，小腸・小腸間膜と右横隔膜下腔の領域では他の領域と比べ比較的に高かったが，左横隔膜下腔および左傍結腸溝領域においてはまったく検出できなかった．超音波検査においては，腹膜播種の好発部位を十分観察することが重要である．
Purpose: In patients with abdominal malignancy, it is important to diagnose peritoneal dissemination as well as to detect location in view of treatment planning. The aim of this study was to investigate the detection accuracy of ultrasonography for peritoneal dissemination of abdominal malignancies.
Methods: In total, 72 patients with peritoneal dissemination (36 patients for preoperative staging and 36 patients for re-staging after surgery) were evaluated by ultrasonic diagnosis. Additionally, 134 nodules detected by PET/CT were evalated. These nodules were examined according to 7 regions.
Results: In an overall patient analysis, the sensitivity was 30.6% (22 cases). In addition, the sensitivity of patients with preoperative staging was 27.8% (10 cases), and that of the patients for re-staging after surgery was 33.3% (12 cases). Ultrasonography nodule detection abilities of the respective regions were as follows: right hemidiaphragm 24.0% (6 cases/25 cases); left hemidiaphragm 0% (0/8); omental 17.9% (5/28) small bowel and mesent 47.1% (8/17); right paracolic gutter 10.5% (2/19); left paracolic gutter 0% (0/14); and pelvis 17.4% (4/23). In addition, in the preoperative and the re-staging after surgery cases, the following abilities were obtained: right hemidiaphragm 16.6%/30.8%; left hemidiaphragm 0%/0%; omentum 17.6%/18.2%; small bowel and mesent 66.7%/36.4%; right paracolic gutter 8.3%/14.3%; left paracolic gutter 0%/0%; and pelvis 15.4%/22.2%. The sensitivity of patients with ascites was 40.7% (11 cases/27 cases). On the other hand, the sensitivity of patients without ascites was 24.4% (11 cases/45 cases). In addition, the sensitivity of patients with preoperative staging with ascites was 30.0% and without ascites, it was 25.0%. The sensitivities of patients with re-staging after surgery, with and without ascites, were 71.4% and 24.1%, respectively.
Conclusion: The sensitivity of ultrasonography was highest for structures within the small bowel and mesent, and the right hemidiaphragm. Sensitivity was reduced markedly within the left hemidiaphragm and left paracolic gutter. It was considered important to observe the region in which peritoneal dissemination exists in ultrasonography.
キーワード：腹膜播種；PET/CT；超音波検査
Key words: peritoneal dissemination; PET/CT; ultrasonography
© 2017 一般社団法人日本超音波検査学会© 2017 Japanese Society of Sonographers
This page was created on 2016-12-05T16:58:33.139+09:00
This page was last modified on 2017-01-31T09:51:42.919+09:00
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