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英文誌(2004-)

Journal of Medical Ultrasonics

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2021 - Vol.48

Vol.48 No.01

Original Article(原著)

(0035 - 0044)

自己免疫性膵炎の活動性評価を目的とした超音波内視鏡下shear-wave測定の臨床的実現可能性と有用性の検討:前向き探索的研究

Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study

大野 栄三郎1, 廣岡 芳樹2, 川嶋 啓揮1, 石川 卓哉1, 田中 浩敬1, 酒井 大輔1, 石津 洋二1, 葛谷 貞二1, 中村 正直1, 本多 隆1

Eizaburo OHNO1, Yoshiki HIROOKA2, Hiroki KAWASHIMA1, Takuya ISHIKAWA1, Hiroyuki TANAKA1, Daisuke SAKAI1, Yoji ISHIZU1, Teiji KUZUYA1, Masanao NAKAMURA1, Takashi HONDA1

1名古屋大学大学院医学系研究科消化器内科学, 2名古屋大学医学部附属病院光学医療診療部

1Department of Gastorenterology and Hepatology, Nagoya University Graduate School of Medicine, 2Department of Endoscopy, Nagoya University Graduate School of Medicine

キーワード : EUS elastography, shear-wave elastography, EUS-SWM (EUS shear-wave measurement), autoimmune pancreatitis (AIP)

目的:自己免疫性膵炎(AIP)の診断および治療における,新開発された超音波内視鏡検査(EUS)のshear-wave(せん断波)elastography法(EUS shear-wave測定:EUS-SWM)の臨床的実現可能性と有用性を評価する.方法:患者160名の膵臓の組織弾性を測定した.EUS-SWMの成功率,shear-wave速度(Vs, m/s),およびVs測定の信頼度指数(VsN)を評価し,弾性(平均Vs)をAIP群(n=14)および正常対照群との間で比較した.結果:有害事象はなく合計3,837件のEUS-SWMを実施した.全体の測定成功率は97.6%(3,743/3,837)であった.平均VsNは74%であった.膵臓の平均Vsは,次のとおりであった.膵頭部(十二指腸球部より観察:プッシュポジション)では2.22 m/s,膵頭部(十二指腸下行脚より観察:プルポジション)では2.36 m/s,膵体部では1.99 m/s,そして膵尾部では2.25 m/s.AIP群(2.57 m/s)の平均Vsは,正常対照群の平均Vs(1.89 m/s)(P=0.0185)に比べて有意に高かった.平均Vsは,ステロイド治療(n=6)(P=0.0234)後,3.32 m/sから2.46 m/sへと有意に減少した.結論:EUS-SWMは臨床的に実現可能な手技であり,信頼性のある結果が得られた.EUS-SWMは,AIP患者へのステロイド治療の効果を評価する上で有効な方法である.

Purpose: To assess the feasibility and the clinical usefulness of a newly developed endoscopic ultrasonography (EUS) shearwave elastography technique (EUS shear-wave measurement: EUS-SWM) in the diagnosis and treatment of autoimmune pancreatitis (AIP). Methods: Tissue elasticity was measured in the pancreas in 160 patients. The success rate of EUS-SWMs, the velocity of the shear wave (Vs, m/s), and the reliability index of the Vs measurement (VsN) were evaluated, and the elasticity (median Vs) was compared between AIP patients (n=14) and normal controls. Results: A total of 3837 EUS-SWMs were performed without adverse events. Overall, 97.6% (3,743/3,837) were successful. The median VsN was 74%. The median Vs values of the pancreas were as follows: 2.22 m/s in the pancreatic head (push position), 2.36 m/s in the head (pull position), 1.99 m/s in the body, and 2.25 m/s in the tail. The median Vs of the AIP group (2.57 m/s) was significantly higher than that of the normal controls (1.89 m/s) (P=0.0185). The mean Vs significantly decreased from 3.32 m/s to 2.46 m/s after steroid therapy (n=6) (P=0.0234). Conclusion: EUS-SWM is feasible and generates credible results. EUS-SWM was a useful method for assessment of the effect of steroid therapy in AIP patients.