浜崎 直樹¹, 今井 照彦¹, 柴 五輪男¹, 北村 友宏¹, 仲川 房幸², 空 昭洋³, 林田 幸治³, 鴻池 義純⁴, 平井 都始子⁵, 木村 弘⁶

Naoki HAMAZAKI¹, Teruhiko IMAI¹, Iwao SHIBA¹, Tomohiro KITAMURA¹, Husayuki NAKAGAWA², Akihiro SORA³, Kouji HAYASHIDA³, Yoshizumi KOUNOIKE⁴, Toshiko HIRAI⁵, Hiroshi KIMURA⁶

¹済生会奈良病院内科, ²済生会奈良病院放射線科, ³済生会奈良病院臨床検査部, ⁴平成記念病院内科, ⁵奈良県立医科大学中央内視鏡・超音波部, ⁶奈良県立医科大学第2内科

¹Department of Internal Medicine, Saiseikai Nara Hospital, ²Department of Radiology, Saiseikai Nara Hospital, ³Department of Clinical Labolatory, Saiseikai Nara Hospital, ⁴Department of Internal Medicine, Heisei Memorial Hospial, ⁵Department of Endoscopy and Ultrasound, Nara Medical University, ⁶The second Department of Internal Medicine, Nara Medical University

キーワード : Sonazoid-enhanced ultrasonography, lung cancer, squamous cell carcinoma, coded harmonic angio, coded phase inversion

我々はCoded Phase Inversion（CPI）モードとCoded Harmonic Angio（CHA）モードを用いたSonazoid^®造影超音波検査が腫瘍血流信号描出に有用であった肺扁平上皮癌の1例を経験した．85歳の女性が右肺のS⁶に腫瘤影を指摘された．彼女は超音波誘導下針生検で肺扁平上皮癌と診断された．Bモードでは，胸膜浸潤を伴う低エコー腫瘤であった．カラードプラ法，パワードプラ法，B-flow colorでは屈曲，蛇行する枝状血流信号であった．Sonazoid^®は，第二世代の超音波造影剤である．まず，0.4mlのSonazoid^®が注入された．これは推奨容量の半分の量である．CPIモードは低MIのモードであり，CHAモードは高MIモードである．CPIで観察したところ豊富な腫瘍濃染が得られたが，血管は不鮮明で空間分解能は不十分であった．さらに，Sonazoid^® 0.4mlを注入しCHAで観察したところ空間分解能に優れた腫瘍血管が腫瘍の内部や辺縁に描出された．

We encountered a case of squamous cell carcinoma of the lung in which Sonazoid^®-enhanced ultrasonography using coded phase inversion (CPI) mode and coded harmonic angio (CHA) mode appeared to be useful for enhancing tumor vessels. A tumor shadow in S⁶ of the right lung was detected in an 85-year-old woman. She was diagnosed with squamous cell carcinoma of the lung with ultrasonography-guided needle biopsy. B-mode showed a hypoechoic tumor with pleural invasion. Color Doppler, power Doppler sonography, and B-flow color showed tortuous and bronchial color flow inside and around the tumor. Sonazoid^® (GE Health Care, Oslo, Norway) is a second-generation sonographic contrast agent. A 0.4-ml dose of Sonazoid^® was injected into an antecubital vein, which was half the recommended dose.CPI mode imaging software is a low mechanical index, and CHA mode imaging software is a high mechanical index. CPI mode images obtained after injection of Sonazoid^® showed more flow signals both inside and around the tumor. But the spatial resolution was poor. Another 0.4-ml dose of Sonazoid^® was injected. CHA mode images obtained after injection of Sonazoid^® showed more and clearer flow signals both inside and around the tumor.