049_41-1_43北海道CS6_念*.indd
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- えつみ ほがり
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1 : : 00,,,,, Meyer et al. Circulation 2010;121: ,ASE J Am Soc Echocardiogr 2010;23: , ASE 3 1, 10, 2 36, 3 38.ASE TAPSE,RVFAC,S. 1 / 2 / 3 TAPSE 8. 4 / / mm 16 mm, ASE,,RVFAC / / ,S 5. 0 / 6. 4 / 8. 6 cm/s10 cm/s.. 1, 1, 1, 1, 2, 3, 3, 3, 4, 3, 3, 3 1, 2, 3, ASD,, 5,TTE,.TTE,, 41 mmhg., ASD., ASD, 3. 1,, CT,,3 2., 1620 mm ASD, 2, 69, 3. 2, 23 mmhg. ASD,TTE 1, 1, 1, 2 1, 2,,,, 14,, 2 1,,,,,,,,A 1 9 mm,,, Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 49
2 ,. 1, 1, 1, 1, 2, 2, 2, 2, 2, 3, 3 1, 2, , 8 MRSA,,, MRSA MRSA mm , 40 mm CT,, MRSA,,,,, 1, 1, 1, 12, 3, 1, 1, 4, 4, 4, 4, 1 1, 2, 3, 4 60,. 25 1,, IIIIIaVF ST,, : 70 /-mmhg, 39 /,, 4 Levine 3 / 6,,,., - 52,, tethering,,,,, 1,,, 81.,, 100.,,,,, 1, 2, 1, 1, 1, 1, 2, 2, 2, 2, 3, 4, 5 1, 2, 3, 4, 5 36, ,,, 16,,,,,,,.,,,, 3 mm,.,,,,,,,,, 50 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
3 1, 2, 2, 3, 1, 2, 4, 4, 4, 4, 5, 5, 5 1, 2, 3, 4, 5 TR TR., TR, 275., TAATTH RVDRAD TR JATAA JA,, TAAc,JAc, TTHc,RVDc,RADc PH, - 32 mmhg - 14 mmhg,caf /ICD TL 275,JAc TAAc r0. 60,p ,TTHc r0. 32,p TAAc RVDc RADc r0. 55,p0. 001r 0. 62,p0. 001,TTHc r 0. 32, p0. 001r 0. 23,p PH 61,CAf 22, TL 23 JAccm 2 /m 2,PH , CAf ,TL PH,JAc TAAc TTHc r 0. 62,p r 0. 54,p CAf,JAc TAAc r 0. 51,p0. 016,TTHc TL,JAc TAAc TTHc r 0. 74, p0. 001r 0. 64,p TR,,, 1, 2, 2, 3, 3, 2, 4, 4, 4, 4, 5, 5, 5, 5 1, 2, 3, 4, 5, TR - PSPG TR PSPG,,TR PSPG,PR - RFPG, TR VC 3 mm,tr PR 106.VC 10 mm TR,7 mm TR, 3 mm TR TR PSPG, PR RFPG 106, TR 16, TR 7, TR 83 PSPG RFPG, TRy1. 8 x4. 6,r ,p TRy 1. 9 x5. 0,r ,p0. 016,,, TR PSPG RFPG. TR , TR 90 TR,VC 10 mm, TR 1, 2, 2, 2, 3, 3, 3, 3, 4, 4, 4, 4 1, 2, 3, 4 St Ssr,, HCM22,HT18 N16., StLS, SsrLSsr, t-ls,t-lssr,, 1 U,2 W, 1, LSsr LS LSsr,HCM 2, HHD N t-ls,hcm N HT p0. 01,HT N p0. 75.t-LSsr,HCM HHD N p0. 001,p0. 001, HCM HHD p N,HT 1 6, HCM 17 77,HCM p W N 5 31,HT 12 67,HCM,HT N HCM p0. 001,p HT W,HCM,, Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 51
4 1, 2, 2, 2, 1, 1, 1, 3, 1, 1, 3, 2 1, 2, 3 60,.,,1,2 16 mm,310 mm,4,5,6granular sparkling,7,8 s 6. 8 cm/s,e 6. 5 cm/s,.,,, dip and plateau,,, dip and plateau,,, AL, 1,dip and plateau, 1, 1, 1, 2, 2, 2, 2, 4, 5, 3, 1 1, 2, 3, 4, , 47 mm, 9 mm, mg/kg/ 4, 6,,., 14 mm, 20,,PCPS, IABP,, ,60 mg/kg/ 2, 49 mm, 10 mm, 60 5,,, 20 mm, 24,, PCPS IABP,, 24, 2, 1, 1, 2, 2, 3 1, 2, 3 AR,., AR ,.32 AR, TTE, TTE, 54 mm, 67, AR,.,,, accessory cusp. 250,..2010, 135 /.TTE, / / mm AR,,., AR,,,, , Hurwitz, 1 type e, 2 type a,tte,, AR,, 52 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
5 1, 2, 2, 3, 2, 1, 4, 4, 4, 4, 5, 5, 5 1, 2, 3, 4, 5 AS,AS,, AS,AVA 2. 0 cm 2, AS, 248.AS,AVA 1. 5 cm cm 2,,,,S F, S 0,F 0,S 1,F 0-2,S 2,F 0-1,Y S 3,F 0,S 3,F 1,S 3,F 3 6, 34 14, 31 13, 47 19,Y 61 25, 65 26, 10 4 AS,Y 25 / 61,41,27 / 65, 42,8 / 10, , 3 112, AVA p0. 001, AS 44 9,p AS,1 S 0-2,, AS,3 S 3 Y,, 3 AS, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, 2 AS, flow rateqmean,ava EF,, AS,Qmean , ASAVA 1. 5 cm 2 EF , AVA cm 2 Qmean 250 ml/s low flow rate L,250 ml/s normal flow rate N,Qmean AVA, RES,SVR,valvulo-arterial impedancezva L L N,,AVA,,RES, SVR,Zva Qmean,AVA,RES,Zva r 0. 53,p SVRr0. 52,p low flow rate, AVA Zva SVR RES,Qmean SVR 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 2, 2, 3, 4 1, 2, 3, , AVR2012 3,,2013 4,,,,AVPG 122 mmhg IgA 2008, AVR 2010, ,AVPG 106 mmhg,, transvalvular leakage.,,,,,,,,,, ROI, Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 53
6 N af , ie33 ROI,Direct Strain DS N af isr, istrs,pwd TDI E/e`,E/e`/iSR IAS. N isr,istrs,, af paf caf., isr, istrs,ias,n IAS 1. 0,af caf,2. 0 af,,, ROI IAS PCW/iSRr0. 79, P ,EDP/iSRr0. 72, P ,stiffness. IAS,, af,, 1, 2, 3, 1, 2, 2, 4, 4, 4, 4, 5, 5, 5, 5 1, 2, 3, 4, 5 LC,,,LC, LC,LC, LC 88.,, Child-Pugh,LC A 6,B 31, C 51 N 20 4 LVDd,LVMI,LVEF, LAD,SV,CI,. LVDd 4,LVMI B C N LAD,A,B,C N CI,B C N, C A E/e B C N LAD,,SV,LVDd, LVMI,LVEF,e,E/e,SV E/e,,, 1, 1, 1, 1, 1, 1, 1, 1, 12, 2 1, ,,,, , , 13, 2,1 13,11,1, 1 2,, 12, 3, 1. 11,,, 1, 1, 3, 1 1, 2, 1, 1, 1, 1, 1, 1, 34, 2, 4 1, 2, 3, ,, ,2012 8, , mm,,. CT, 54 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
7 , IL-6,D g/dl,,,9 20, 18 mm,2,.,,elastica-masson., 1,, 1, 1, 1, 1, 1, 1, 2, 1, 3, 3 1, 2, 3 accessory mitral valve,,, 3 D 28., follow , wide QRS tachycardia,,, 1. 8 m/s,,,,, 3 D,, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, ,2,.TTE 104 mmhg PH CT,, 110 / 57 mmhg, 82 /,SpO2 97room air, 4 Levine 3 / 6 TTE,,RVsP133 mmhg,,,.,,,,,,. Spindle cell sarcoma TTE,RVsP 63 mmhg.,,,,,,,,,,,,,,,,, m, 1 MHz, 0. 7 MPa, 3 1 5, 27, 5,, Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 55
8 , B 1, 2, 1, 1 1, 2,,, SSA- 790A, PVT-375 BT, 2. 5 MHz,,Fig. 1,,2, 11 db,,,. B , , Fig. 1 Web site,,,,,.,.,ix 70, Ultranac, mw 1064 nm X ,,, 2 3 m, 1 MHz, 3, 1. 3 MPa, ,,,, B,. 1, 2, 2, 2, 1, 1, 1 1, 2 prosound7 177,, 10, MRIT 2 WI 1 4,, 24 8,, MRI,,,,, 277,, MRIT 2 WISAG C 4 /C5, high intensity C 5, C 6,, 1, 2, 2, 3, 3, 1, 1, 1, 1, 4 1, 2, 3, 4 RAS, PSV PSV RAR, acceleration time AT AT RAS 56 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
9 PSV,IVUS,AT, PTRA IVUS 8, 13. RAS PSV180 mmhg, RAR3. 5, AT IVUS, 60 AT 70 ms 9,IVUS 85 8,85 1,AT 70 ms 4 IVUS 85, AT,AT RAS,PTRA AT AT, AT, 1, 2, 3, 1, 1, 3, 3, 3, 3, 3, 3, 4 1, 2, 3, /,, 100 6DVT, LAP DVT, DVT DVT, LAP 7 1, DVT , DVT 28, 3,LAP 14,VATS14, 8 DVT 41. 8, VATS DVT 20. 9, DVT.,,, DVT,., DVT 5. 6 DVT, 1, 2, 2, 3, 3, 3, 4, 5, 6 1, 2, 3, 4, 5, 6,, CASTCDS MCAOA 1 80,.JCS 1. CT,MRI, MRA ICA,,, ,. ICA PSV 3. 5 m/s, 3. 2 m/s, TCDS MCA OA OA ICA CAS., ICA TCDS MCA, OA OA, OA. CAS QOVQuality of Vision,TCDS MCA OA 1, 12, 1, 1, 1, 1, 3, 1, 1 1, 2, 3,Framingham risk score,pl 2012 JAS 2012, , 397,,, , Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 57
10 IMT, CCA IMT CCA,IMT 1. 1 mm PL JAS 2012,. CCA IMT,78, 50,64,PL 5,28, 53,p0. 01, PL,PL,p 0. 02,HbA 1 cp CRPp0. 001, PL, CRPp0. 03p0. 02, PL JAS 2012 PL., CRP,,,,,,,,,,,, 3 D 3 D, 2 D 2 D Sonazoid US ,2 D 3 D mm 33 mm, cm 6. 7 cm Aplio 500,3 D Sonazoid 0. 2 ml/ body,differential CHI High MI mode auto sweep scan 3 D US tomography UST,MPR, MIP,2 D Sonazoid ml/kg,pulse Subtraction Imaging Low MI mode 1. UST mm, 3 D 2 D,2. MPR,MIP 3. MIP 2 D,,MIP 5, 3 D,, 12, 12, 23, 12, 12, 12, 23, 12, 4, 4, 2, 1, 1 1, 2, 3, 4 CE-US, CE-US, , 12, 7,FNH2 Aplio XG, 500. Ceusia HP HP CE-US Region Of InterestROI,Time Intensity CurveTIC HP, db/.2., db.3. db. HP TIC , 30, 2, 7, / 39, / 30, / 9, / 32, 1007 / 7. FNH 2,,. 12, 23, 4, 4, 12, 23, 23, 23, 23, 23, 5, 5 1, 2, 3, 4, 5 RCC AML CEUS CEUS, RCC 18 18, AML 3 3., mmsd. TOSHIBA Aplio 500,AplioXG, MHz,GE Logiq E9,4. 0 MHz, ml/kg ,,Micro Flow ImagingMFI CEUS 1.,2.,3. 58 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
11 MFI CEUS RCC 1., CEUS RCC, 18, 1, 2, 0, 100, 66. 7, 95. 2, 94. 7, 100,,RCC ,,AML 1,, AML 3, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 2, 3, 1 1, 2, 3 72, ,CT 4 9,CEA,NSE,DUPAN-2 MDCT 12 8 cm,eob MRI T 1 WI,T 2 WI, defect,dwi FDG-PET, B-mode Halo Heterogeneous,Sonazoid US, 3 D Network pattern Flush sign.,he,-sma, CD34,c-kit,S ,, US US, 1, 2, 1, 1, 1, 1, 1 1, 2,CT/MRI, CT./MRI Fusion image,ct./mri esie Fusion Imaging SIEMENS ACUSON S 3000 Auto Alignment, Point Alignment, esie Fusion Imaging Fusion 4 170,Dynamic CT S 8 5 mm S 5 10 mm Fusion 10 mm 260,C. Dynamic CT S 6 RFA.Fusion 380,BC S 8 TACE Fusion 4 70,C.S 5 / 8 Gd-EOB-DTPA MRI, B,Fusion. esie Fusion Imaging,,CT/MRI, 1, 1, 1, 1, 2, 1, 2, 2, 2 1, 2 70, CT ELISA S 4 20 mm, ,, S 4 66 mm CT hypovascular area,mri worm-eaten defect appearance,western Blot,, S 7 10 mm, S 7,S 4,S 7,.,B mode worm-eaten defect appearance,, CT 1 20 mm, mm,, Jpn J Med Ultrasonics Vol. 41 No. 1(2014) 59
12 1, 23, 4, 12, 23, 23, 23, 12, 23, 23, 4 1, 2, 3, 4 CTS, CE-US CTS.,CE-US 5,CTS 5. Aplio 500,8 MHz ml/kg 10 80, ROI,, 3, 13 ROI,2 2 ROI,3 3,ICC. 1ICC1, , , ,2ICC2, , , ,3 ICC1, , , ICC,, CE-US 60 Jpn J Med Ultrasonics Vol. 41 No. 1(2014)
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