,. Elastgraphy.,.,,.. Elastgraphy,. SY Kupffer 1 2 3, 2, 2, 2, 2, 3, 3, 3, 4, 2 3 1, 2, 3, 4,.,,B mode.fibroscan 502 Controlled Attenuation Parameter
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- いちえい うなだ
- 5 years ago
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1 ,, EUS. 1 CT MRI, safety margin US-US fusion.,vincent TACE. 2.,., EOB-MRI, EOB- MRI,, Kupffer.. 3,. 4 EUS,,,., Kupffer,. SY - initial minutes Ultrasonography in the gastrointestinal disease -.,,.,CT,.,,.,.,,.,,, CT,.. initial 5 minutes., 5. 5,.5,free air.,.,,,,,,,,.,, 1
2 ,. Elastgraphy.,.,,.. Elastgraphy,. SY Kupffer 1 2 3, 2, 2, 2, 2, 3, 3, 3, 4, 2 3 1, 2, 3, 4,.,,B mode.fibroscan 502 Controlled Attenuation Parameter CAP., Sonazoid Kupffer,. B mode US tissue harmonic imaging compound., Sonazoid 1, 200 bolus, 40 Kupffer Image labo K 40 db / / 8 NASH 38, CAP, B mode US,K 40 2 SS 7,NASH 39, Sonazoid NASH. 3 NASH 73 F 0 4,F 1 28,F 2 22,F 3 10,F 4 9,VTQ Velocity of shear wave Vs. 1,CAP R =0. 679,P =0. 002,50, US.US / / /,CAP / / / db/m R=0. 750, P ,K / / / db R= , P K 40 SS db,nash db NASH.NASH ROC AUC ,K db 69. 4, NASH P Vs,F ,F , F ,F ,F m/s P , ROC,AUC ,VTQ m/s 88. 9, P B mode,,nash CAP. NASH.,NASH,, Kupffer. shear wave imaging NASH,. SY,,,,.,,,.,,., ultrasound elastgraphy., elastisity graphy.,, shear wave velocity Vs shear wave imaging, strain strain imaging.,,.,,. SY D 1, 1, 1, 1, 1, 1, 1, 1, 1, 2 1, gray scale,,. 10 mm,lc B. navigation system, high-end, gray scale, segment 2
3 ., segment.,3d. 3 SYNAPSE VINCENT,.,.,, 100, SYNAPSE VINCENT., LAN PC 1 VINCENT 1, PC,. VINCENT, CT DICOM data,segment,. navigation system,pc navigation system,. Ascendus Logiq E9, DICOM data. SYNAPSE VINCENT CT segment DICOM data,, DICOM data,part,navigation system. S 1 S 8 segment 8,visual,. RFA. SY US 1, 1, 1, 1, 1, 1, 2, 3 1, 2, 3 US HCC.2007 Sonazoid US,,.Sonazoid Kupffer Kupffer,,.,Sonazoid US Kupffer imaging EOB- MRI HCC,HCC , HCC 77,79. 56, HBV 12,HCV 46,NBNC 19,Child-Pugh A 70,B 7,C 0., n =43, n=36, 79, MI Sonazoid US Kupffer.,EOB-MRI.Sonazoid US,EOB-MRI, 1 CEUS,EOB-MRI,2 retrospective 4.EOB-MRI Sonazoid US HCC 78 / vs 70 / ,P Sonazoid US EOB-MRI 70, 41, 29.AUROC Az CEUS EOB-MRI reader 1 : CEUS ,EOB-MRI , reader 2 : Sonazoid US ,EOB-MRI Sonazoid US EOB-MRI Az reader , reader Sonazoid US,EOB-MRI HCC, HCC,,.,Sonazoid US. SY 1, 1, 1, 1, 1, 1, 1, 2, 1 1, 2,.EOB- MRI,,., B C,.,.,RFA.2012 bipolar RFA CelonPOWER,2015 monopolar RFA VIVA RF system, RFA. RFA,,US fusion imaging,,. US fusion imaging,reference US,,.Volume-Navigation System V-Navi : GE Healthcare,reference,Active Tracker.V-Navi, VirtuTRAX. Smart Fusion.. V-Navi 3 GPS Marker 3D GPS Marker. Marker, 3
4 .Real-time Virtual Sonography RVS 3D Sim-Navigator, CelonPOWER.CelonPOWER,.,,3, 3.,,.3D Sim-Navigator,.,US fusion imaging. SY Vascular access 1, 2 1, 2, vascular access:va.,, resistance index RI..,,,VA.,,.,.,,., 60,,,. 1,.,. 2.,,.,,.,,. 3,.,., , 2.,., 350 ml/min, 1. 3 mm.,.,.,,..,.. VA,.,. SY 1, 2 1, 2,,.,,.,. 5 7 cm.,.,.,,,.,.,.,.,,.,.,. 4
5 ,.,., 90., 0 90,,90.,,.,,,,,. SY,.,.,,,,,.,,. 1.,,,,,. 2.,,,.,.,,,.,. 3.,.,,. 4.,,.,.,,,,,.,.. SY 3D-TTE 3D-TEE.3D-TTE,.,,3D-TEE,,,,.,3D-TEE 2D,2D-TEE. multi-planar reconstruction MPR,,.,,,,. MPR,.,3D-TEE,,.,,,,.,. SY SHD Structural Heart Disease SHD,,,,,,,,.,,,, SHD. SHD,,.,,,SHD,,,,,,., Transcatheter Aortic Valve Implantation: TAVI,SHD,. SY,,. 5
6 -.. MMG US, MMG,,. PD 1, 2, 1, 1, 1, 1, 1, 1, 2 1, 2,, MMG US,.MMG,.,US. MMG US , , MMG 1, 474 MMG+US 40 2, MMG US 1 MMG 1, MMG+US 2, MMG US MMG US,.. MMG US.,,.US, ,. US,.MMG,MMG US,MMG, MMG,.,MMG US, MMG. 40 MMM+US, MMG PD 1 2 1, 2.,,. RCT, J-START 40.. J-START.., ,.,. 26 +, 40 4, , 70, 51. FA.. 2. PD 1, 1, 1, 1, 2, 2 1, 2,B,, 6
7 .,.,,,,,.,,,,,.,,,.,,,.,, MRI,.,,,,,,.,.,,,B.,,.. PD,,,,, FNAC, CNB, VAB. FNAC,.,,,CNB VAB.,,,FNAC.,,,.,,.,,,,., MRI.,,., ccr,.,,. PD 1 2, 3, 2, 2 1, 2, 3,,10,,,,,., 10.,,,,..,,,., MRI,.,,,., MRI,. CT CT, 10,..,1951 Wild A. 1960,1970,, ,,.,,.1984, 7
8 .,.1985,,. 1988, MAT 1,.1994 ATL,,,..,,,.1998 JABTS,,.2007 JSTART,.,.,,.,... A. B. EUS.,,.,., CT., Perfusion CT, US.,,.,,,.,,. color Doppler twinkling artifact.,.,.,won walled-off pancreatic necrosis WON. WON EUS, US. PDAC PDAC.,PDAC,.. IPMN 2012,, 3 cm,. MCN,,,. SCN. 60. PNET.,. A.,. B.EUS EUS EUS. A. B.EUS EUS-FNA A. WON B.EUS EUS-HGS,EUS-CD.,. WS, US,. US,. 1. US, 2 cm TS 1. TS 1 Stage 1, 2 cm. 1 cm Stage 1,11 20 mm,,,. 39, CEA,CA US,1 cm US. US mass screening,1 cm. 1 cm, Stage 0 8, US. US 2. 5 mm 5 mm 1, , 42 Stage 1. 8
9 ,5 mm US. 2., ,..,.,, ,,.,,.,,..,. WS US 1, 1, 1, 1, 1, 1, 1, 2, 1, 3 1, 2, 3,.,. 1998,,., Tanaka S. Radiology, , ,., = 8 8, ,IPMC 7 non-invasive 5,invasive 2, CIS , 1, MRI 1,CT 1, 2, EUS 1.16 stage 0 7,Ⅰ 4,Ⅲ 2, Ⅳa 2, Ⅳb 1,stage 0 Ⅰ , stage 0 Ⅰ 1 10 stage Ⅲ. 6 3, 2, 1, 3 4-5, mm, 1 MRI, EUS 29 mm., 2 IPMC non-invasive 1,CIS mm, 5-17 mm, 3, , hypovascular. CT 1 mm 6, 1, 1., 3 7 mm 1, debris,.,.,., RCT, UMIN , hypovascular., debris.,,,. WS EUS,,, endoscopic ultrasonography: EUS,,,.,,.,B-mode, EUS EUS-guided fine needle aspiration., 80-85, 100, 9
10 ,., EUS EUS-elastography EG., EUS, 2,EUS ,,,,.,.,,,. EUS-EG, EG, US,,.,,,EG EUS.,EUS-EG, strain starin EG,, Color pattern Strain ratio SR. B-mode EG.,EUS-EG,.EUS EUS, EUS-EG. WS (EUS- FNA),,. WS,,,,,,,,, Endoscopic ultrasound,,,.,eus,, EUS-guided fine needle aspiration; EUS-FNA. EUS-FNA.,,,.,, EUS-guided choledocoduodenostomy; CDS, EUS-guided hepaticogastrostomy; HGS, EUS-guided gallbladder drainage; GBD,, EUS-guided pancreatic drainage; PD EUS-guided pancreatic cyst drainage; CD.,..,,19G.,,.,.,,,.,,,...,.,,,.,,,.,,.,,,.,,. 1, 2, 2, 1, 1, 3, 4, 1 1 IVR, 2, 3, ,, 28 mm.,.. Adenosquamous cell carcinoma with foci of well to moderately differentiated papillary adenocarcinoma,,.,.,,,,,,,,, 9,.5. 10
11 ,. SOL.,,,,.,. 1, 1, 2, 3, 3, 1, 1, 1, 1, 1 1, 2, 3. LITA to and fro pattern 1, 1, 1, 1, 1, 1, 1, 2, 2, 1 1, ,LAD. LAD, LITA.,LAD, SV,SVP/ DV DSVR.LITA,,,to and fro pattern. SV, LSA.,LAD SV DSVR, LITA,to and fro pattern.,lsa,lita,. MR 1, 1, 2 1, 2,,.,MRI. MR,. MR,FEM. 50 mm,,b MR. 1, 1, 1, 1, 1, 1, 1, 2 1, 2 39,.. CS,Mayo score., CS CT CT, US. 25 CS Mayo score grade 2, S grade 1, grade 0, CT,. US CS, CS. CS. US, CS. Klebsiella pneumoniae,,,, 86, K. pneumoniae 2.7, K. pneumoniae 2, 3. CT focus 2., K. pneumoniae 4. CRP 10, K. pneumoniae IE 2 6,. IE 4. IE.,,,,,,,, 70.6,,,.,,,,., mm 11
12 ,..,. EUS,,,,,,,,, 81 S1HCC, EOB-MRI S 1 5 mm HCC. SOL,.EUS S 1 hypoechoic SOL,EUS 10. EUS 2.22 G Sono-tip 1 4 ml,2 13 ml.,hcc. EUS,. MRI - - 1, 1, 2, 3 1, 2 ICT ICT, 3 MRI,2,.,MRI,,.,, MRI mm MR 0. 8.,. 1, 1, 1, 1, 1, 1, 2, 2, 2, 2 1, ,. TTE AS,,, TAVI.TAVI,., Sapien XT,,TTE,,. TAVI,,. 1, 1, 1, 2, 3, 4, 5 1, 2, 3, 4, 5,.. US,CT., US free air, free air, S, ,.. IPMN follow up US 1, 1, 1, 1, 1, 2, 2, 3, 4, 4 1, 2, 3, IPMN, follow.2014 follow up US IPMN, 1 / mm, 8 mm 2, 2, SM massive.gf 1 / 3 12
13 ,2. SM 2 US. IPMN,. IPMN follow up US 1. US Zenker 1, 1, 1, 1, 1, 2, 2, 2 1, 2. CT,US. 60..,,.CT air density,.us,,.,.,,.,,,.,, US. 1, 2, 2, 1, 1, 1, 1, 1, 1, 2 1, ,. 3,.,..,.,.,,. 1, 2, 1, 1, 1, 1, 1, 1, 1, 2 1, , ,., 3 60.,..,..,,, 3. 1, 2, 2, 2, 1, 1, 1, 1, 3, 2 1, 2, ,.3. US 3 cm,. 2 60,.2.US 1 3 cm,. 2. US..US,.. 1, 1, 2, 1, 1, 1, 1, 1, 1, 1 1, 2,, ,. :. 20 mm 13
14 ,,CT ,. : ,. :., S... GIST 1, 2, 1, 1, 1, 1, 1, 3, 2, 4 1, 2, 3, 4. B GIST 1, 1, 1, 1, 1, 2, 2, 3, 4, 4 1, 2, 3, , CT.US 14 cm. 4,, GIST. CT,,. MRI,T 1 WI,T 2 WI.MRCP.,GIST Gastrointestinal stromal tumor.us GIST 1. GVHD 1, 1, 1, 1, 2, 2, 2, 3 1, 2, 3 graft versus host disease; GVHD,.,. GVHD 2, US AML.,.US, AML,.US.. US, 83. Neuroendocrine tumor 1 2, 1 2, 1, 1, 1, 1, 3, 4, 3, 1 2 1, 2, 3, 4 40.NASH,. AST; 56 U/l,ALT; 112 U/l, -GTP; 156 U/l,CEA; 1. 1 ng/ml,ca 19-9 ; 8. 9 U/ ml. 40 mm.eob-mri T 1, T 2,DWI,. B,,. 15,120.,Neuroendocrine tumor NET,G 1. NET 1.,,, 1 70,.,. US., CT.8,., ,.,. US 1,,CT. 3,.,,
15 1, 1, 1, 2, 2, 2, 2, 3 1, 2, 3,.. 2,.,... hypo mass.. CT ,.1. 1, 2, 2, 2, 2, 2, 2, 1, 1, 3 1, 2, 3 77,.,. US multiple concentric ring sign,., CT., mucinous carcinoma.,,. 1,. 1, 1, 1, 1, 1, 2 1 PL, 2 PL US 8 mm, US. 10 mm,.,.,,. 5.US 2 cm...,. 1, 1, 1, 1, 2, 1 3 1, 2, 3 50., Hb 5. 3 g/dl,,,, 70 mmhg., S 2 cm low echo lesion CDI PDI ADF SMI 1.B S,., S 2. 5 mm Ⅰp,., 1,. US 1, 1, 1, 2 1, 2.. US.,,..,,,. first detect,. US.,,.,., US. 15
16 ,,,,,,,.,,.,,,., ,,.,2, 569,192,181.,. Controlled Attenuation Parameter CAP 1, 1, 1, 1, 1 2, 3, 4, 1 2, 2, 1 2 1, 2, 3, 4 Fibroscan 502 CAP. CAP M probe HBV/HCV/BC/ B C 16 / 45 / 1 / CAP db/m , p 0. 01,CAP r =0. 616,p cut off 232 db/m,auc CAP BMI r =0. 432,p B , 9 CAP cut off. CAP B. 1 2, 1, 1, 1, 1 1, 2 AML,. AML,.,70,AML M 2 citarabine,., CT., 5 mm. D,.,,.,,.AML,, 15, 55.,,. 1, 1, 1, 2, 1, 1, 3 1, 2, 3,, , 20, 16, 4. 69, 21, cm 33, 7. 5 cm 41, 10 cm 16, 10 cm ,2-4 16, , 33, 10, 4, , 18, 14, 9, 4.ESBL,. 47, 2, , 4.,,,. Wilson 1, 2, 2, 2, 2 1, 2 Wilson 4,,. 21 Wilson,.Wilson, 10, 6, 2, 3., 4 40, 5 83, 100, Alb, mg/dl, mg/dl. Alb mg/dl,.wilson.,,,. 16
17 1, 1 2, 1, 1, 1, 1, 1, 1, 2, 2 1, 2. 1, 2, 3, 3, 3, 3, 3, 3, 3 1, 2, 3 40, / 66 mmhg,focused Assessment with Sonograghy for Trauma FAST. CT,,. CT Ⅲa. US 4,,,. 8 US 15 7 mm,3 mm. CT.US 29 5 mm. 33 CT,.,, US 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, ASD,3 ASD, PH.2015,, TAE...,.SMV SV,. CT IMV, IVC.,PH., SMV,PV,SV,. PH.. HPS 1, 2, 3, 4, 1, 1, 1, 1, 1, 2 1, 2, 3, C.,. COPD,, HPS. CE 6,HPS ,COPD,DM.,,.CT COPD.,HPS CE.,HPS. CE, CE,.,,,,,,,, 65.,., 2. 7 cm,,. CT., CT., cm,.,1.,,. US 1, 1, 2, 1 1, 2 US,,.,US., 17
18 US., 12 6 mm,., pt , US.,, , US, 5 cm,. 1, 1, 1, 1, 1, 2, 2, 2, 3, 4 1, 2, 3, CT,.US cm,..us. CT feeder....,, 28.,,. 1, 1, 1, 1, 1, 1, 2, 2, 2, 3 1, 2, 3.,.,. 3., 2.,, cm.,.,.,,.,,. 1, 2, 3, 1, 2, 2, 2, 4 1, 2, 3, ,,. CTR,.,, V 1 V 4 QS.,,.,., M BJP ,., , 2, 2, 2, 1, 1, 1, 1, 1 1, ,..,., ATTRwt. 2 81,..,. MRI, ATTRwt., Tc-.,. 18
19 1, 2, 3, 1, 1, 2, 2, 2, 4 1, 2, 3, , ,,.3, ,,,,. PET-CT.,,..,,,,,,,,, 58.,,., EF 28,,,. EF 6, LVAD. GCM,. 2, 8 LVAD, 50 EF 68. GCM,.,LVAD,.,,,,,,,,, 40..,3.,,. CK TnT.,.EF: 48. 5,LVDd/Ds: / mm, IVSTd/PWTd: 7. 3 / 7. 6 mm.,..tapse: mm,fac: 26. 1,RV S : 7. 2 cm/s... 1, 2, 3, 4, 1, 2, 2, 2, 5 1, 2, 3, 4, ,.,IL U/ml CA U/ml.,. CT,., 19..,,,..,,.,. Trousseau 1, 2, 2, 2, 2, 2, 1, 1, 1, 2 1, 2 52., CT,.,,,.,,., 10 mm,. Trousseau,,,. 19
20 1, 1, 1, 1, 2, 1, 3, 1 1, 2, 3 60.,, cm.,,., cm. 40 mg.2. B. THCOP , 1, 1, 1, 1, 2, 2 1, 2 75,, MRI,, mm..,,.,. CT 20 cm,... 1, 1, 1, 1, 1, 1, 2, 2, 2, 2 1, CT., 38 mmhg.. 8, 21 mmhg. CT.,, 47 mmhg. 26 mmhg., 53 mmhg.,.. 1, 2 1, 2 87.,,,. 7, 8,,.., PEA.,. PEA,.,,,.,,.,.,. 1, 2, 1, 1, 2, 2, 2, 2 1, , CT,,,, , CT., 8 6 cm.,., 23,,,
21 ,,,,,,,, , 5 13., hypokinesis.,, CABG Maze., CT/ MRI /.,.. 1,. 1, 1, 2, 3, 3, 3, 4, 4, 2, 1 1, 2, 3, X 7,10.11, 2. CT,..,,, 3,..6.,.. Trousseau 1, 2, 1, 1, 1, 1, 1, 1, 3, 2 1, 2, 3 80.,,, CT.. 30 mg/day,. CT,. 2. MRI.,,.,,.Trousseau.. 1, 2, 1, 1, 1, 1, 1, 1, 3, 2 1, 2, 3 79,. CT 7. 5 cm.,.., 3..,. 1, 2, 1, 1, 1, 1, 1, 1, 1, 2 1, 2 67,.,.. color Doppler, color signal.,color signal. 5 mm,.,...,..,. 21
22 1, 1, 1, 1, 2, 3, 4 1, 2, 3, 4 IBD 20.,,...,.,,,.,,,. 1, 1, 1, 1, 1, 2 1, 2 55,,2 3 1,..,, CT.,,,., 3. 1 L/min/m 2, 9 mmhg, O2 step up,qp/qs ,.. 1, 1, 2, 2, 2, 2, 3 1, 2, , 11,. D g/dl, Low echo area. CT 20 mm..,,.,,.,,,. MS 1, 2, 3, 3 1, 2, 3 US MS HL HT. IMT I R L plaque P, MS. HbA1c ,64. 3 I mm P 83 71,52. 0 MS ,56. 1 I P 18 17, HL 219,63. 7 I P HT 243,66. 6 I P MS 有 129,65. 1 I P , I P plaque MS 36. 5, I MS, , A 1 c 5. 9,FBG 110 MS.I , 0. 38, 1. 20, , 0. 52,1. 26, ,0. 25, A1c 5. 6 I 0. 7 MS. 1, 2, 2, 2, 2, 1, 1, 1, 1, 1 1, 2 73.,.,.,.,.,.,.. 22
23 IgG 1, 1, 1, 1, 2, 1, 1, 3, 1 1, 2, 3 55., CT 6. 1 mm. Septal Bounce, MV 53,TV 38, 39 mm 24 mm.,, IgG4. 40 mg IgG4 CT 2. 3 mm. Septal Bounce,,. IgG4 CT. IgG 1, 1, 1, 2, 2, 3, 1 1, 2, 3 72,,,...,,. IE, IE. 1, 600 / g,igg4 169 mg/dl IgG4 NBTE,. IgG/IgG4 10 IgG4,.IgG4 NBTE,. 1, 2, 1, 1, 1, 1, 3, 4, 4, 4 1 JCHO, 2 JCHO, 3 JCHO, 4 JCHO 70.,2016 4,. CRP mg/dl,wbc 25, 400 / l CT,,., 16 8 mm,. Viridans streptocuccus,.,, 5.,,. 10, , 1, 1, 1, 1, 1, 1, 1, 1, 2 1, ,..MRI. MSSA, 17 MRI., mm, ,,.. MSSA, CT mm. 17, 25, CRP, 35.. E. coli 1, 1, 1, 2, 2, 3, 1 1, 2, 3 76,,CT,,, DJ,. Amp C E. coli. 7, IE. 6 23
24 .Gram IE,.,,,,,,,,, vegetation TEE,vegetation. -streptococcus., TEE,.,., TEE. D 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, ,.,,2,.2,,,. TEE, 14 7 mm,.3d,. Streptococcus gordonii,.,10 mm,.,,., 3DTEE. 1, 2, 3, 3, 3, 3, 3, 3, 4, 1 1, 2, 3, 4 43.,, ,4.,.,,.,, flail valve,. 2,.,,,.,.,,,, , 1,.,,.,, 58 mm.,. 5 mm,.,,.,. 1, 1, 1, 2, 2, 2, 2, 2 1, 2 80,2016 4,,,.,,.,. A 1,P 1,,.,. 24
25 1, 1, 1, 1, 1, 1, 2, 2, 2 1, 2. 1, 2, 1, 1, 1, 3 1, 2, 3 SMID. UCG LVDd, BSA.,SMID LVDd. 26 UCG SMID 16 LVDd LVDd/BSA,SMID LVDd BSA. SMID LVDd SD: mm,smid mm,p 0. 05,LVDd/BSA mm,smid mm,p SMID LVDd r =0. 72,p 0. 05, r=0. 16,p=0. 55 BSA r=0. 39,p= SMID LVDd LVDd/BSA.,. y =0. 20 x+9. 7,x: cm,y: LVDdmm SMID LVDd. 1, 2, 1, 2, 1, 1, 2, 3, 3, 2 1, 2, ,,..,, 30,.,, ,,. 1. 4,,,.,,. - -,,,,.,. 1,78,,,.. IVC 21 mm, 50. 2,80,,,., 36 /.,IVC 5 / 2 mm,,.,.,,. 1, 2, 1, 1, 1, 1, 1, 3, 2, 2 1, 2, X.201X. 12.,,.,,, MRI.MRI,.,.. 1, 2, 2, 1, 1, 1, 2, 2, 2, 2 1, 2 66.,.H 27 6,.,,.,,. diffuse severe hypo,ef 22,MR DCM like heart.e/e 26,BNP 450 pg/ml.,,,ace,lvef
26 .,, LVEF 46..,,. MDCT 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, 2 MDCT,,. MDCT TEE 38.TEE,4,2,,,.MDCT. TEE,MDCT.,.LA focused view. TEE LA focused view,mdct ,, 4 cm.,.mri T 2,T 1 5 cm.ercp,,. PNET.,, S 2,PNET.PNET,,. 1, 2, 3, 3, 4, 1, 1, 1, 1, 1 1, 2, 3, 4 3 US. 93. US :., US : 3,.,. 88. US :.,,. US,.. NET 1, 1, 1, 1, 1, 2, 2, 2, 2 1, 2 70.,. S 4 / mm., wash out, perfusion defect. CT, CT,,.Gd-EOB-MRI,., EUS 6 mm.,, hypervascular. EUS FNA NET,G 1, NET., NET 1. IPMN Fusion US,,,,,,,,, IPMN. US, Fusion. US Fusion IPMN EUS. 26
27 CT/MRCP,EUS,US Fusion, 6,,,.. CT/ MRCP 20 EUS.., Fusion IPMN. US 1, 1, 1, 1, 1, 1, 2, 3, 3, 3 1, 2, mm.us 22 mm,mri. US,, bubble, US 24 mm,.mri, US. US,, bubble,., US 2. US 1, 1, 1, 2 1, 2,.,,, ,. 70 / 42 mmhg, 80 /,SPO2 85, US,.,,,,, peripancreatic effusion.,., US,,debris,.,. EUS-FNA XGC 1, 1, 2, 1, 1, 1, 1, 1, 1, 1 1, 2 67,. CT,.US,,. CT,,.EUS,,. EUS,,.,XGC, EUS-FNA.,.,,,.,, XGC. EUS-FNA,,,,,,,,, ASGE EUS-FNA 25 EUS-FNA EUS-FNA ASGE Ⅰ, Ⅱ,27 Ⅲ : Ⅰ 77 : 62,Ⅱ 92 : 66,Ⅲ 95 : 75.,, Ⅰ 73 : 100 : 80,Ⅱ 91 : 100 : 92,Ⅲ 95 : 100 : 95 Ⅱ. Ⅲ, 1, 1, 2, 2, 1, 1, 1, 1, 1, 2 1, 2 67,,. 27
28 ,.,. 20 mm.,..,.,.... IDUS,,,,,,,,, 60,, ERCP. EST,. 7 IDUS. EST., 11,. IDUS,, CT..,.,.,,,,,,,,. JCHO, VTQ 1, 124.Vs,ROI cm / 30 inadequate. 5 2 inadequate, Vs. NAFLD inadequate,. NASH VTQ 1, 1 2, 3, 1, 2, 2, 4, 5, 2, 1 2 1, 2, 3, 4, 5. Shear wave elastography B 1, 1, 2, 2, 2, 1, 1, 1, 1, 1 1, 2 42.H 27 11,. 3. T-Bil 1. 6 mg/dl,d-bi l 0. 6 mg/dl,ast 6, 934 U/L, ALT 5, 550 U/L,PT 29. 9,HBsAg 250 IU/mL CLIA,IgM- HBcAb S/CO,HBeAg S/CO,HBV-DNA 8. 2 Log copies/ml,genotypec. B 4. GE LOGIQ E 9 Shear wave elastography SWE, m/s,vs. 12 HBs 28. Vs m/s,1 W m/s,2 W m/s, 3 W m/s,6 W m/s,10 W m/s,16 W m/s,24 W m/s,33 W m/s Vs.Vs, Vs. VTQ 1, 1, 1, 1, 1, 1, 1, 2, 2, 2 1, 2, Virtual Touch Quantification VTQ. Velocity of shear wave Vs,,,,. 1, 2, 1, 1, 1, 1, 1, 3, 2, 1 1, 2, 3,
29 AplioXG.,. ROC. 1 cm,f ,F , F 3 F 4 p F , , 75,92.,. Virtual Touch Quantification 1 2, 1, 1 2, 1 2 3, 1, 1, 1, 4, 5, 2 1, 2, 3, 4, 5 Virtual Touch Quantification VTQ VTQ 354, 151, 98, 78. Vs m/s, , , , , , , Vs, P , , , , ,. PL,,,,,,,,, JCHO Shear wave elastography SWE, IFN-free SWE C 107, Ascendus LF, LOGIQ E9 GE Healthcar Vs. LF Fib4 index r=0. 28,M2BP r=0. 36,Vs Fib4 index r=0. 43,M2BP r= LF 72 36,Vs 35 17,F 2 5.LF F 0 F 1,Vs F 1 F 0 : 1. 45,F 1 : 1. 77,p ,F 0 / 1,LF Vs. C DAA Real-time Tissue Elastography,,,,,,,,, C DAA Real-time Tissue Elastography. C /, /, / 35 25, 10.,,Spleen Index SI,Liver Fibrosis Index LFI,Plt,alb, AFP,FIB-4,APRI. LFI 2.16 /1.63 p 0.001,APRI 1.06/0.56 p SI,Plt,alb,AFP,FIB-4. C DAA LFI,APRI. C Shear Wave Elastography 1, 1, 1, 2, 2, 2, 1, 1, 1, 1 1, 2 / Shear wave elastography SWE. C IFN GE LOGIQ E9 SWE m/s,vs IFN A LDV / SOF 53, B OBV / PTV / RTV 28,2 50 C SOF / RBV. Vs A m/s,b m/s,c m/s. C IFN Vs. 29
30 shear wave SWE 1 2, 1, 1, 1 2, 1 2 3, 2, 4, 5, 2, 1 2 1, 2, 3, 4, 5 shear wave SWE VTQ Siemens, ACUSON S2000 / 3000 B C 928,. F VTQ, F 3-4 VTQ. F 3-4 HBV AUROC HCV. HBV F 1 Vs P ,HCV SVR F 1-2 Vs P SWE. C VTQ DCV/ASV 1, 1, 2, 2, 2, 2, 1, 3, 1, 1 1, 2, 3 VTQ MR elastography MRE,C DCV/ASV VTQ. VTQ,MRE C 79 VTQ MRE,.DCV/ASV 43 VTQ. VTQ,MRE F. AUROC F 2 /F 3 /F 4 VTQ: / / , MRE: / / ,Fib4 index: / / ,4 collagen 7 s: / / VTQ,MRE r= VTQ DCV/ASV, 12,24, m/s, m/s, m/s, m/s. VTQ.VTQ DCV/ASV. C ARFI,,,,,,,,, C,ARFI Acoustic Radiation Force Impulse.,C DAA,,, 24, 1 ARFI 110 /Peg-IFN/RBV 75,IFN-free 35 Vs,paired-t. 102 IFN-base Vs m/sec, p , IFN-free, , p IFN-free,.,,,,,,,,, 44. S 8 14 mm.,, 15. 2,,.6. CT,,,MRI T 1,T 2 DWI,. vascular phase,,postvascular phase,re-injection,.,,,.,6 MRI., 1. Hepatic angiomyolipoma 1, 1, 2, 1, 1, 1, 3, 4, 1 5, 1 5 1, 2, 3, 4, 5 Hepatic angiomyolipoma HAML,. 3 3, 30 / 40 / 60. CT,.EOB-MRI,T 2 WI,,.B,,CEUS hypervascular, iso/hypo 1 / 2,Kupffer defect/hypo 2 / 1,MIP 30
31 .,2 CEUS. HAML,. FNH,,,,,,,,, 35,. US S 8 24 mm. EOB-MRI T 1 WI,T 2 WI,DWI,,,,.,spoke wheel like pattern..b-flow Capture Recon spoke wheel like pattern.mi 0. 3 B-mode, / spoke wheel like pattern. spoke wheel like pattern. FNH,,,,,,, 60.BMI 29. 7,. HCV HBV.20 XX S 7 / 8 22 mm,.eob-mri,, FNH. 3, 32 mm,eob-mri.ceus spoke wheel pattern,,..,spoke wheel pattern,. -,SAA, Glutamine synthetase FNH,. 1, 1 2, 1, 1, 1, 1, 2, 2, 3, 4 1, 2, 3, S 4 19 mm,.hbs,hcv. AFP 3. 4 ng/ml, PIVKAⅡ 15 mau/ml,ca U/ml,CEA 2. 0 ng/ml.,, 1. MRI,T 1 WI,T 2 WI,DWI,ADC.,,..1 3, 25 mm,..,. HCC 1, 2, 3, 4, 5, 1, 1 1, 2, 3, 4, 5 60,C ,.,..Share Wave Elastography Vs,6. 5 m/s., HCC., HCC, Vs. HCC Vs,HCC Vs. 1, 2, 2, 2, 2, 2, 2, 2, 2, 1 1, ,,., B-mode sonazoid, ,, 8 cm 9 9, 4 : 5, 68. 6, cm., B-mode,. 31
32 Sonazoid 1, 1, 1, 2, 1, 1, 1, 1, 1, 1 1, 2 Sonazoid. Oncoprime,.Sonazoid mm., 3-6 Technical Success TS. Failure. 56 B-mode,65 Sonazoid,.B-mode 43 / ,Sonazoid 60 / TS. Sonazoid,. DEB-TACE 1, 2, 1, 1, 1, 2, 2, 2, 2, 1 1, 2 DEB TACE. 7 DEB-TACE. 10 cm 4-13, , TOSHIBA XarioXG, Xario 200,DEB-TACE,, B-mode. 4 / 7, 5 / 7, 3 / 7. DEB-TACE,,,.,.,,,,,,, 60., 2.. CT,,Complicated cyst.,.mri,, S 8,2. 7 cm,.,, 2.,,,, 6 ml. Enterobacter aerogenes., 2.3,.. RFA 1, 1, 1, 2, 3, 4, 4, 4, 5, 4 1, 2, 3, 4, 5 RFA,., RFA ,.,99. 5,RFA. 3 CT , ,.RFA,,. RFA,.,,,,,,,,, 65.C, EOB MRI 16 mm.,afp US 20 mm. CEUS Kupffer,AFP 44 ng/ml CT, 6 US mm,afp 35, 497 ng/ml US,,AFP 92 ng/ml. 4 CEUS,Kupffer 32
33 30 mm,afp.. sarcomatoid carcinoma 1, 1, 1, 1, 1, 2, 2, 3, 1 4, 1 4 1, 2, 3, 4 70,,B.,,. CT MRI.US SOL,S 5 / 8 S 6.CEUS, hypervascular, wash out,.kupffer defect. CT. PET-CT FDG. sarcomatoid carcinoma. sarcomatoid carcinoma 1. 1, 1, 1, 1, 1, 1, 2, 3 1, 2, , CT. US, 10 7 cm.ceus,, defect..,., US CT,,,..,.. 1, 2, 1, 1, 1, 1, 1 2, 2, 3 1, 2, 3 80.,,CT 7 cm,,,.us S 5 70 mm.,,,ml.ct,dynamic study,., US,, ML,,., Diffuse large B cell lymphoma. US,ML. MALT 1 2, 3, 3, 3, 3, 3, 3, 2, 3 1, 2, 3 MALT, MALT.. 50.X 4.X 7 MALT. X 3 CT S 3, 8 CT 15 mm,.eob-mri,t 1 WI,T 2 WI,,. B,, wash out. Kuppffer defect.,malt.,,,,,,,, 80,..CT MRI dynamic,.,,.pet-ct,, NEC. NEC.,.,. 33
34 1, 1, 1, 1, 1, 1, 1, 2, 3, 4 1, 2, 3, 4 70, mm..,.,. MRI EOB..,.,. 1, 2, 1, 1, 1, 2, 3, 4, 5, 2 1, 2, 3, 4, mm, 20 mm.,. 27 mm,,.,.,.., BilIN 2-3, Tubular adenocarcinoma tub 1. MRCP ERCP/EUS,. 1, 1, 2, 3, 1, 2, 2, 2, 3 1, 2, , , MRA. 1.,. MRA. 2 70, , MRA, , 2. 1, 1, 2, 1, 1, 1, 1, 3, 4, 2 1, 2, 3, ,, mm, 9. 2 mm. 4, mm,.mra,., , MRA, CT.. 34
35 1, 1, 1, 1, 1, 1, 1, 2 1, ,, Ⅳ / Ⅵ..,,.,..3D CT DVT PTE 1, 1, 1, 1, 1, 2, 3 1, 2, 3 DVT,DVT PTE , DVT 50 PTE ,,. PTE, 7 / 12,58 vs. 7 / 38,18,p=0. 023, / 9 / 12, 75 vs. 10 / 38,26,p = ,, PTE. 1, 1, 2, 1, 1, 1, 1, 2, 3, 2 1, 2, 3 70.,.,. bruit.abi 15 mmhg,.mri., PSV 2. 8 m/,,. PSV 4. 8 m/,,. CT,.,,. 1, 2, 1, 1, 1, 1, 3, 3, 3, 3 1, 2, 3. US, US. 2 60,,.US,. 2.,,. US. 1, 1, 1, 1, 1, 1, 1, 1, 2, 2 1, 2 60.,.,. 150 / 76 mmhg,. Glu 148 mg/dl,bnp pg/dl. Ao : 37 mm,la 42 mm,lv d/s 54 / 38 mm,lvef 53. 3,LVSV 100 ml..trpg 33 mmhg.lmt 8 mm,lad mm,rca 5. 2 mm. LAD RCA. CT LAD RCA,.,,,,.,, 5, 20.,. 35
36 1, 2, 1, 1, 1, 1, 2, 3, 2, 4 1, 2, 3, US,.,,,MIBG,.MRI, T 2,IVC S 7. US.B,.,...,,. 1, 2, 3, 3, 1, 1, 1, 1 1, 2, 3 28.,.., , 25. 8, , 8. 8.,,,.,. 1, 1, 1, 1, 1, 1, 1, 2, 2, 3 1, 2, 3 37,.CT.,1.US,,. CT,,, US.US,.. cirsoid type,.,,. 1. 1, 1, 1, 2, 3, 3, 4, 4 1, 2, 3, US CT 10 cm.us,., ,US.,. CT,,.,,,,,,,,, ,.,.,. WBC 9, 400,Hb 12. 3,CRP MRI,.,,,.,,.,, 36
37 ,., MRI. megacystis,,,,,,,,,.,,,,, ARPKD,, ARPKD. 2,,, , / TC/AC , , TC/AC ,, 23.,. 1, 1, 1, 1, 1, 1, 2 1 PL, 2 PL,.,. 28,.,. 24,..,. 37 5,., 60,,.,,. 0. 1, 2 : 1,..,,,,, 70,..CT.PET-CT, FDP, MRI.,... 2 cm,., 1.,,.,,,,,,,, CPAM, CPAM volume ratio CVR CVR. 7 CPAM CVR icvr,34 36 CVR lcvr, lcvrl/icvr, , 13.,..iCVR 2. 17,0. 71 P lCVR 0. 38,0. 12,lCVR/iCVR 0. 12, CPAM.. 1, 2 3, 2, 1, 1, 1, 1, 1, 1 1, 2, 3 NS,,,., HCM NS. 39,3, 190 g. 37
38 ,. 1 TTE, 14 mm, 6 mm, 3 mm,,.,,, NS. NS 80,,,.HCM ,.,TTE. 1, 2, 2, 3, 1, 1, 1, 1, 1, 1 1, 2, 3 68,. VSD ,.12,. 1 VSD,. 1. 8,,24,.,. 1, 1, 1, 1, 1, 2, 2, 2, 1, 1 1, , ,, ,,,,,.,,,,.,,. 1, 2, 1, 1, 1, 1, 1, 1, 1, 2 1, ,. LVDd/LVDs 33 / 20 mm,, LVEF 70., pouch..,,. MRI,,. 76,,. 1, 2, 1, 1, 1, 1, 1, 2, 3, 3 1, 2, 3 40.,,. US mm, CT. 10 US,. US,,.,.,,.,.,,.,. 1, 1, 1, 1, 1, 1, 2 1, 2 43.,,., C 8 mm., 38
39 ..,specimen radiography,,..,, FEA low grade DCIS. 1, 2, 1, 1, 1, 1, 1, 3 1, 2, 3 80.,,, 5. C 40 mm.,,,,.. 4 b,,. 17, ,., 1. SMI 1, 2, 1, 1, 1, 1, 1, 3, 1, 1 1, 2, 3 50,. U FAD. AC mm,..smi Superb Micro Vascular Imaging,. MRI C,..SMI, , RA. 23, 80., SS SS 5 cm SS 3 cm SS cm SS cm SS 1 cm SS SS SS , 31, 8, ADL , 2, 1, 1, 1, 1, 2, 2, 3, 3 1, 2, 3, US C 3, 4 FLR Fat to lesion retio,,flr AC 6 mm C 3.FLR D/W,,., FLR HE. FLR,,,. 1 2, 3, 3, 3, 3, 1, 1, 1, 1, 4 1, 2, 3, 4. 1, Logit P = cut off , Logit P , 1., 39
40 ,. LS LOGIQ GE General Imaging LS LS Aplio i-series LS LS C C Aplio i-series LV RV DT,,.,.,,,.,, Auto EF,.,,.,,.2014 ACC/ AHA,,.,,.2015 ASE,,. ASE.,,.,,,.,.,..,. B,... 40
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42 ,Time Intensity Curve TIC. c.elastography,eus Elastography, strain imaging.,,., strain.,. 2.EUS-FNA Fine Needle Aspiration EUS-FNA,EUS,.,,,., EUS EUS.,,,., WON Walled-off Necrosis.,Interventional EUS.Interventional EUS, modality,.,.,.,,,,,.,.,,elastography,,.,,,, Quality of life QOL,.,.,,,,.,,,,, 7. plaque 1. 1 mm IMC,, 1. 5 mm., vascular remodeling, IMC 1. 5 mm..,.,,,,,,.,,,. NASCET,ECST,, 2 North American Symptomatic Carotid Endarterectomy Trial European Carotid Surgery Trial,.,ECST.,,.,DSA NASCET 50 PSV ICA cm/s, PSV ICA / PSV CCA 2,DSA NASCET 70 PSV ICA cm/s, PSV ICA / PSV CCA 4.,, 42
43 ,..,,strain elastography shear wave elastography,,.strain elastography,,,,,.,,.shear wave elastography,,shear wave,.,,shear wave.shear wave,.,.,.strain elastography 10 Hz,shear wave elastography 10 Hz,.,,. 10,,, 2014 WFUMB 2015.,,.,.,, CT MRI,..,.,.,.,., 3,..,.,..,.FFT. B..,...,.,.,2 3.,,...,., ,.,,..,.,. 43
44 , 10.,.,.,.,.,,,.,.,,,. S,S,.,...,...,.,.,,,.,. 4 low echo,.,,..,. 44
41-6_50回中国地方会Pr6N__HP掲載用.indd
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