浜崎 直樹¹, 今井 照彦², 鴻池 義純³, 平井 都始子⁴, 木村 弘⁵

Naoki HAMAZAKI¹, Teruhiko IMAI², Yoshizumi KOUNOIKE³, Toshiko HIRAI⁴, Hiroshi KIMURA⁵

¹塩谷内科診療所, ²済生会奈良病院内科, ³平成記念病院内科, ⁴奈良県立医科大学中央内視鏡・超音波部, ⁵奈良県立医科大学内科学第2講座

¹Shioya Clinic of Internal Medicine, ²Department of Internal Medicine, Saiseikai Nara Hospital, ³Department of Internal Medicine, Heisei Memorial Hospital, ⁴Department of Endoscopy and Ultrasound, Nara Medical University, ⁵the Second Department of Internal Medicine, Nara Medical University

キーワード : ultrasonography of respiratory tract, lung cancer enhanced ultrasonography, B-Flow color, lung echo

呼吸器領域に対する超音波の臨床応用は1970年代後半よりBモード法で始まった．超音波Bモード法は胸壁病変，肋骨病変，胸膜病変や胸水，胸膜に接する肺内病変（胸膜下病変），肺癌の胸膜進展，縦隔病変の診断や評価，超音波誘導下穿刺や気管支鏡検査の支援などに有用である．最近麻酔や救急領域で気胸や肺水腫など緊急性の高い疾患に超音波検査が臨床応用されその有用性が注目されている．胸膜に接する肺内病変の診断はBモード法だけでは限界があるが，血流情報を加えることで診断能は向上する．その後呼吸器領域にも超音波血流診断が導入された．パワードプラ法，血流の3D表示，B-Flow color，Levovist^®やSonazoid^®造影超音波検査などの技術の進歩に伴い呼吸器領域においてもより詳細な血流診断が可能となった．また血流診断を超音波誘導下穿刺や肺癌の治療の評価に応用して有用性が示唆されている．呼吸器領域においても超音波は他の領域と同様にその有用性が高いのである．

The clinical application of ultrasonography for the respiratory tract started in the latter half of 1970 with B-mode ultrasound. Ultrasonography is useful for diagnosis and evaluation of chest wall lesions, costal lesions, pleural lesions, pleural effusion, lung lesions in contact with the pleura (subpleural lesions), pleural invasion of lung cancer, and mediastinal lesions. Ultrasonography is also useful for ultrasound-guided biopsy and the support during bronchoscopy. Recently, the usefulness of ultrasonography has gained attention in emergency cases requiring anesthesiology and in the emergency room, e.g., pneumothorax and lung edema. The diagnosis of lung lesions in contact with the pleura has limits with use of B-mode alone, but the diagnostic ability improves by adding blood flow information. Diagnosis by means of ultrasound blood flow imaging of the respiratory tract was subsequently introduced. Power Doppler, 3D, B-Flow color, and enhanced ultrasonography with Levovist^® and Sonazoid^® enable the detailed blood flow diagnosis in the respiratory tract. Blood flow diagnosis is also useful for the evaluation of ultrasound-guided biopsy and the response to therapy for lung cancer. Like other areas where it is used, ultrasonography of the respiratory tract is very useful.