平井 都始子¹, 中村 卓², 丸上 亜希³, 小林 豊樹²

Toshiko HIRAI¹, Takashi NAKAMURA², Aki MARUGAMI³, Toyoki KOBAYASHI²

¹奈良県立医科大学中央内視鏡・超音波部, ²奈良県立医科大学消化器・総合外科, ³奈良県立医科大学放射線科

¹Department of Endoscopy and Ultrasound, Nara Medical University, ²Department of Surgery, Nara Medical University, ³Department of Radiology, Nara Medical University

キーワード : breast, contrast-enhanced ultrasound, Sonazoid

臨床で唯一使用可能な超音波造影剤Sonazoid^®（以下，Sonazoid^®）が，乳房腫瘤性病変に対して2012年8月より保険適応となった．現状では，臨床応用は十分に広がっておらず，標準的なプロトコールや診断基準も確立されていない．乳房造影超音波の手法や観察のポイントについてコンセンサスを得ていく必要がある．これまでの臨床経験や文献を踏まえて，肝臓と乳房に対するSonazoid^®造影超音波の違い，乳房造影超音波検査の方法や造影所見の評価についての私見を述べた．また，Sonazoid^®造影超音波の良悪性の鑑別診断や，乳癌の広がり診断，セカンドルックultrasonography，乳癌薬物療法の効果判定に対する有用性について症例を提示しながら，今後への期待について述べた．

Sonazoid^®, the only ultrasound contrast medium that can be used clinically in Japan, has been covered by insurance for focal breast lesions since August 2012. Contrast-enhanced ultrasound for focal breast lesions is not yet widespread, and a standard protocol and diagnostic criteria are not yet established. A consensus on a contrast-enhanced ultrasound method for breast lesion, phase, and observational points of contrast-enhanced findings will be needed. Based on our clinical experience and reports in the literature, the difference in contrast-enhanced ultrasound between the liver and breast and our opinions on contrast-enhanced methods and evaluation points of contrast-enhanced findings are discussed. Also, when presenting our clinical cases, we describe how contrast-enhanced ultrasound will be useful for the differential diagnosis of malignant and benign breast lesions, assessment of the spread of breast cancer, detection of lesions that cannot be detected by first ultrasonography examination, and assessment of response to chemotherapy.