谷川 佳世子, 石井 耕司, 住野 泰清

Kayoko TANIKAWA, Koji ISHII, Yasukiyo SUMINO

東邦大学医療センター大森病院消化器内科

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center

キーワード : contrast-enhanced sonography , diffuse liver disease, intrahepatic peripheral vessel divergence angle, Levovist

目的：造影超音波で描出される肝末梢血管像から慢性肝疾患の病期進展が把握できるかどうかを明らかにすることを目的とし検討を行った. 対象：肝生検を行い得た慢性肝疾患54 例で, 心肺疾患, 肝細胞癌の合併症例は除外した. 方法：装置は東芝Power Vision 8000 を使用し, Levovist^®300 mg ⁄ml を秒間1 ml でボーラス静注した後, Dynamic flow mode で肝表近傍門脈枝の分岐形状を観察し, 得られた所見と病理組織学的に得られた肝線維化の程度(F1‐F4：新犬山分類)とを比較検討した. 結果：F1‐F3 症例において, 肝表近傍門脈枝は分岐部の前後いずれも直線的に走行し, その分岐角度は病期が進展しても有意な変化を示さなかった. 一方F4 症例においては, 末梢枝が不整な走行を呈し, 分岐のふところ部分はU 字状を呈していた. このU 字状分岐を肝硬変の特徴と仮定するとそのsensitivity 76％, specificity 98％, overall accuracy 91％であった. 結論：肝表近傍門脈枝におけるU 字状分岐は肝硬変に特異的所見と思われた.

Purpose: To use contrast-enhanced color Doppler ultrasonography and histopathologic examination modalities to investigate changes in hepatic blood vessel architecture that accompany development of chronic liver disease. Methods: Subjects were 54 patients with biopsy-proven chronic liver disease; individuals with cardiopulmonary disease or intrahepatic tumors were excluded. The divergence angles of the intrahepatic peripheral vessels were measured onto the liver surface with color Doppler sonography (Toshiba Power Vision 8000) in the dynamic-flow mode after contrast enhancement with 300 mg ⁄ml of Levovist. Biopsy specimens were classified according to the New Inuyama classification. Results: Peripheral vessel divergence angle and histopathologic findings were not significantly correlated. Linear blood vessels were always observed in F1 to F3 patients; however, U-shaped vessels were observed only in F4 (Liver cirrhosis) patients. Sensitivity, specificity, and overall accuracy of detecting U-shaped blood vessels in the patients with liver cirrhosis were 76％, 98％, and 91％, respectively. Conclusion: Development of U-shaped vessels is characteristic of the peripheral hepatic vasculature in patients with liver cirrhosis.