桑口 愛¹, 工藤 正俊², 川崎 俊彦², 前野 知子¹, 市島 真由美¹, 前川 清¹, 井上 達夫², 伊藤 龍生³

Ai KUWAGUCHI¹, Masatoshi KUDO², Toshihiko KAWASAKI², Tomoko MAENO¹, Mayumi ICHIZIMA¹, Kiyoshi MAEKAWA¹, Tatuo INOUE², Tatuki ITOU³

¹近畿大学医学部附属病院中央臨床検査部腹部超音波検査室, ²近畿大学医学部附属病院中央臨床検査部消化器内科, ³近畿大学医学部附属病院中央臨床検査部病理学教室

¹Abdominal Ultrasound Unit, Kinki University School of Medicine, ²Department of Gastroenterology and Hepatology, Kinki University School of Medicine, ³Department of Pathology, Kinki University School of Medicine

キーワード : color Doppler imaging, gastric cancer, ultrasonography

目的：体外式超音波カラードプラ法を用い, 胃癌原発巣内の血流について検討した. 方法：Bモード像にて病変部を同定し得た胃癌症例78例と, 胃癌以外の壁肥厚症例14例を対照とし, カラードプラ法を用いて, 壁肥厚部と周囲の正常胃粘膜との血流の多寡を比較検討した. 壁肥厚部の血流シグナルの程度が周囲の正常胃粘膜の血流シグナルの程度より少ないまたは同程度を(-), 軽度増加例を(+), 著増例を(++)の三段階に分類し, また, 病理組織標本での血管面積比も比較検討した. 結果：検討した胃癌71症例のうち, 血流の著増例は44例(62%), 軽度増加例は14例(20%), ほとんど変わらなかった, もしくは少なかった例は13例(18%)であった. 胃癌以外の症例14例の内, 血流著増例は1例(7%), 軽度増加例は4例(28%), ほとんど変わらなかった, もしくは少なかった例は9例(65%)であった. 胃癌部と胃癌以外の壁の血流の程度の差は有意であった(p=0.0002). 病理組織標本での血管面積比と超音波カラードプラでの血流シグナルの多寡との比較では, 血流の増加している群では, 増加していない群に比べて有意に大きな値となった(p=0.002). 結論：胃癌の血流は大多数の症例(58/71: 82%)で増加していることがわかった. 一方, Bモードで壁は肥厚していたが胃癌でなかった症例では14例中9例(65%)の症例で血流は増加していなかった. 以上よりカラードプラ法は胃癌のスクリーニング検査に有用であると考えられた.

Purpose. The purpose of this study was to investigate the vascularity of primary gastric cancer lesions using color Doppler ultrasonography. Methods. We used color Doppler ultrasonography to study 78 patients with gastric cancer detected on Bmode ultrasonographic examination and 14 patients without gastric tumors but with a slightly thickened gastric wall that was also detected on B-mode ultrasound. The color Doppler signals of the gastric lesions were graded as (-), no color signals; (+), slight increase in number of color signals; and (++), an obvious increase in number of color signals. The vessel area outside the tumor area in the microscopic pathological specimens was also calculated. Results. The color signals of 13 (18%) of the 71 gastric cancer patients were graded (-); those of 14 (20%) patients were graded (+); and those of 44 (62%) patients were graded (++). The color signals for 9 (65%) of 14 patients without gastric tumors were graded (-); those of 4 (28%) patients were graded (+), and those of 1 patient (7%) were graded (++). These differences were significant (P=0.0002). The vessel count ratio in the microscopic pathologic specimens was also significantly higher in patients with an increased number of color signals than in those without an increased number of color signals (P=0.002). Conclusion. Color Doppler ultrasound showed increased vascularity in the gastric cancers in most of the subjects (82%, 58/71). Furthermore, color Doppler ultrasound also showed no increase in vascularity in most subjects (65%, 9/14) whose B-mode ultrasonograms showed thickened gastric walls but who did not have gastric cancer. Thus, color Doppler imaging may prove useful as a screening modality for gastric cancer.