Published papers

【目的】(1)立位CTの物理特性の評価,(2)大血管と骨盤底への重力の影響を評価すること.【方法】ファントムを用いて立位CTと臥位CT,それぞれの物理特性の評価を行った.健常人ボランティアを対象に立位CTと臥位CTを同日に施行,大静脈と大動脈の面積と骨盤底の変化を評価した.【結果】立位CTと臥位CT両者の物理特性に有意差は見られなかった.仰臥位と比較して直立位では,上大静脈の面積は有意に小さく,横隔膜の高さでの下大静脈の面積に有意差は見られず,下大静脈下端部での面積は有意に大きくなった.一方,大動脈の面積に関しては姿勢による有意差は見られなかった.骨盤底は直立位で下降した.【結論】立位CTと臥位CTの性能はほぼ同等であり,立位CTは,人体に対する重力の影響を評価するのに有用であった.(著者抄録)

Polycystic liver disease (PLD) may cause portal vein obstruction and portal hypertension. A woman in her 50s was admitted for hepatic encephalopathy (HE) and esophageal varices (EV). Contrast-enhanced CT revealed severe portal vein stenosis and thrombosis which were associated with compression of the right portal vein by hepatic large cysts at the hepatic hilum. CT-guided drainage of hilar hepatic cysts followed by ethanol sclerotherapy was performed. HE was immediately resolved, and endoscopic variceal ligation was added. Resolution of HE and EV has continued for 21 months. We report a patient with PLD whose symptomatic portal hypertension was successfully treated with percutaneous drainage and ethanol sclerotherapy.

Recently, endovascular treatment of visceral aneurysm has become popular. In most cases, recurrence following sac packing of visceral aneurysm is attributed to coil compaction; however aneurysm regrowth has also been proposed as a potential mechanism. We report a rare case of aneurysm regrowth after sack packing of renal artery aneurysm. After embolization, regrowth of aneurysm adjacent to the neck of the aneurysm occurred. Additional embolization of the parent artery as well as sack packing was performed.

One of the crucial functions of the lymphatic system is maintenance of fluid balance. However, due to a lack of clinical imaging and interventional techniques, the lymphatic system has remained under the radar of the radiology community. The recently developed intranodal lymphangiography and MR lymphangiography have opened the door for lymphatic imaging and intervention.Lymphatic disorders include lymphedema and lymphorrhea. Among them, idiopathic or secondary lymphatic leakage is a rare condition but can become potentially life-threatening. Postoperative lymphatic leakage is the leading cause of traumatic lymphatic leakage and can arise anywhere within the lymphatic system. Therefore, an appropriate lymphangiography technique is essential for identifying the leakage point.Recently, interventional radiology has become available for the treatment of lymphatic leaks represented by chylothorax and abdominal lymphatic leakage associated with surgery. In the field of pediatrics, plastic bronchitis and protein losing enteropathy associated with congenital heart disease are also reported to be associated with lymphatic leakage, which can be treated by intervention.This article comprehensively reviews the clinically relevant lymphatic anatomy, lymphangiography techniques and criteria for their selection, and treatment strategies for various kinds of lymphorrhea.

The incidence of lower gastrointestinal bleeding, which can be caused by a variety of underlying diseases such as colorectal diverticula, angiodysplasia, colitis, colon cancer, etc., increases with advancing age. Among the causes of lower gastrointestinal bleeding, colorectal diverticular bleeding is the most frequent, and its incidence is increasing in Japan. Presumably, the use of NSAIDS, steroids and antiplatelet drugs is spurring the increase in the incidence of diverticular bleeding. Although the severity ranges from minor to life-threatening, the bleeding often ceases spontaneously with conservative treatment alone, without the need for any special treatment. In cases of severe bleeding, hemostasis has been accomplished by endoscopic and interventional radiology (IVR) procedures. Both treatments have their own advantages and disadvantages merits and demerits. In this study, we propose to investigate investigated? the outcome of IVR procedures for lower gastrointestinal bleeding at our hospital and report the results, with some bibliographic considerations.

症例は20歳代女性で、後頸部から後頭部痛を主訴に近医を受診し、化膿性脊椎炎の疑いで当院整形外科を紹介受診した。頸部MRIでは頸椎に有意な所見を認めなかった。血液検査では好酸球増多を認め、内科で精査の方針となり入院した。入院10日目に再度CT検査を施行したところ、初回CT検査と比較してすりガラス影、小結節状陰影は消退しており、一部に新規出現を認めた。抗寄生虫抗体スクリーニング検査では、ブタ回虫がクラス2と弱陽性、糞線虫がクラス1と偽陽性であった。そこで抗体定量検査を追加したところ、ブタ回虫や糞線虫に対する抗体価の上昇はなく、トキソカラに対する抗体価が有意に上昇しており、トキソカラ症と診断した。CT画像もトキソカラ症と合致する所見であった。albendazoleの内服は行わずに経過観察の方針となった。その後、再受診することなく経過している。

症例は40歳代女性で、胸痛を主訴に近医を受診し、胸部単純X線で左気胸を指摘され当院へ紹介入院となった。胸部単純CTにて左気胸を認めた。両肺底部に複数の不整な嚢胞、両下葉に浸潤影、小葉中心性陰影および気管支拡張を認めた。なお、約1年前の肺炎時のCTでは嚢胞は認められなかった。胸腔ドレーンを留置するも気胸およびリークの改善を認めなかったため、胸腔鏡下左肺下葉嚢胞切除術を施行した。術後経過は良好で、術後約1週間で退院した。比較的若年者に繰り返す肺炎後に不整な嚢胞が散見され、難治性の気胸を発症したことから肺組織の脆弱性が示唆され、基礎疾患としてEhlers-Danlos症候群の可能性が疑われた。遺伝子検査ではCOL5A2遺伝子変異が陽性(ミスセンス変異)であり、古典型Ehlers-Danlos症候群と診断された。また、COL3A1遺伝子変異は陰性であったことから、血管型Ehlers-Danlos症候群は否定された。

症例は40歳代女性で、関節リウマチで通院中、CTで右肺下葉S9/10に結節を指摘された。PET-CTで結節の充実部に有意な集積亢進を認め、経気管支生検で悪性所見は認めなかったが洗浄細胞診で軽度異型細胞が検出された。原発性肺癌cT1aN0M0 Stage IAと診断し、右肺下葉部分切除術を施行した。組織学的に胚中心をもった濾胞構造の増加を認め、濾胞間組織には形質細胞の浸潤や膠原線維の増生を認めた。免疫染色ではCD20+B-cellやCD3+T-cellがともに増生していたが、IgG4/IgG比は10.2%と有意な上昇を認めず、標記の診断とした。その後4年の経過で両肺に、周囲にすりガラス影を伴う充実性結節→充実成分の増大とともに周囲のすりガラス影内に嚢胞構造が出現→周囲嚢胞構造が増大し中心部の充実成分を圧排することで充実成分が縮小傾向を示す、一連の特徴的な形態的変化を認めた。保存的加療にて経過観察中である。