D01:10.3179/jjmu. J] MU. A. 34 。 ORIGINALARTICLE 0 肝組織脂肪化における B モード像の再検討 -Non alcoholic fatty liver disease activity score との比較ー 伝法秀幸 l 斎藤 聡2 窪田幸一 1 宇賀神陽子 l 竹内和男 3 井上雅文4 抄録 目的:近年の機器の進歩により,脂肪肝における各 Bモード所見の出現頻度が変化している.また. nonalcoholic 白ttyliver disease activity score (NAS) では組織脂肪化を 5% 以上と分類しているため.B モードでの各脂肪化所見 に関して. NAS の脂肪化分類に準拠し検討を行った.対象と方法:肝組織診断と超音波検査を施行した 75 症例. 東芝製 AplioXG を使用し Bモードの脂肪化所見である肝腎コントラスト. bright liver ,深部減衰の増強.脈管不明 瞭化に加え限局性低脂肪化域の出現頻度と NAS の脂肪化分類を比較検討した.結果: NASとUS 脂肪肝の比較; 肝腎コントラストおよび brightIi ver の両方を認める例,ないしはそれらの所見が軽微な場合.限局性低脂肪化域 を併せて認める例を US 脂肪肝とすると .NAS 脂肪化分類の Grade0 / 1 /2 /3 (S 0 -3) では 0%/ 52% /100% /100% が US 脂肪肝となった.また. 5 -33% の軽度脂肪化例では組織脂肪化を 5-10%11 卜 20%/2 卜 33% に細分類す ると. 21 % / 88 % / 100% が US 脂肪肝となった. Bモードでの各脂肪化所見の有無;高度脂肪肝の所見である深部 減衰の増強は S2 : 10% / S 3 : 75%. 脈管不明瞭化は S2 : 0% /S 3 : 38% に認められ.限局性低脂肪化域は SI/2/3 では 32%/70% /88% と高度になるにつれ認められた.まとめ:機器の進歩により深部減衰の増強と脈管 不明瞭化の出現頻度は減少した.また. brightliver. 肝腎コントラストはもちろんのこと.限局性低脂肪化域の所 見も重要であり. 10% 程度の軽度脂肪化から指摘可能と考えられた. Re-examinationof B-modeimages of fatty changesin theliver -a comparison with the non alcoholic fatty liver disease activity score - Hideyuki DENPO , RMS 1 , Satoshi SAITOH , SJSUM 2 , Koichi KUBOTA , RMS 1 , Yoko UGAJIN , RMS t , Kazuo TAKEUCHI , SJSUM 3 , Masafumi INOUE 4 Abstract Purpose:Duetoadvancesinthetechnology , thefrequenciesof appearanceof eachof theB-modefindingsthatare characteristic to the fatty I i ver are changing. In addition , because fatty changes in tissues are classified as a surface area of 5% or greater according to the non-alcoholic 白tty I i ver disease activity score(NAS).weinvestigated each of the fatty changefindingsobservedduringtheB-modeimaging.PatientsandMethods:Weinvestigated75patientswho underwent a hepatic cytology and an ultrasound(US)imaging using a Toshiba Aplio XG. We performed a comparative investigationbetweenthefrequencyof 白ttychangefindingsonB-modeimages , suchashepato ・ renalechocontrast , bright I i ver , enhanceddeepattenuation , vascular blurring , andfocalsparedarea , andNASfattychange c1 assification. Results: Acomparison between NAS and fatty liver on USimaging showed that if subjects had both hepato ・ renalecho contrast and bright liver or if these findings were mild and when the 白ttyliver onUSimaging showed aforementioned findingsalongwithfocalsparedarea , thentheNASfattychange c1 assificationof grade0/ 1 /2/3 (S0 -3) co 汀'espondedto0% /52% / 100% / 100%of thefatty liver tissueobserved ,問spectively.Inaddition , insu 句 ectswith mildfatty changes of 5 %ー 33% or less , fatty changesin tissues were subdividedinto5 %ー 10%/ 11 % -20%/21 % - 33% , whichcorrespondedto21% /88% / 100%of the白ttyliver tissueobserved , respectively.Thepresenceof each fatty change finding on B-mode images is as follows: Enhanced deep attenuation , a finding indicative of high-grade 白tty liver , was present in S 2:10% /S 3:75% , while vascular blurring was observed in S 2: 0% /S 3:38%and focal spared areawasobservedinS 1 /2/3in32% /70% /88% , respectively.Conclusion:Thefrequencyof observationof enhanced deep attenuation and vascular blurring has decreased.In addition , the findings such as bright liver and hepat o- renalechoco 附 astaswellasfocalsparedareaareimportantbecausethese 白 ndingscanindicatemildfattychanges involving10% ofthe liver. Jpn J Med Ultrasonics 2015; 42(3): 337-345 Keywords ultrasound , fatty liver , hepatic steatosis , NAFLO activi 句 'score , focal spared area I 虎の門病院分院臨床検査部メ虎の門病院肝臓センタ同消化器内科. "JCHO 東京新宿メデイカルセンター病理診断科(元虎の門病 院病理部) IOepartmentof ClinicalLaboratory , ToranomonHospital kajigaya , 1-3-1Kajigaya , Takatsu , Kawasaki , Kanagawa , 213-8587 , Japan. 20epartment of Hepatology , 30epartment of Gastroenterology. ToranomonHospi 凶, 2-2-2 Toranomon , Minato , Tokyo , 105-8470 , Japan. "Oepartmentof OiagnosticPathology , JapanCommunityHealthcareOrganizationTokyoShinjukuMedicalCenter , 5-1 , Tsukudocho , Shinjuku , Tokyo , 162-8543 , Japan Received on Oecember 15 , 2014; Revision accepted on February 5 , 2015 J-STAGE. Advanced published. date: April 7 , 2015 Jpn J Med Ul trasonics Vo l . 42 No. 3 (2015) 337
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Re-examination of B-mode images of fatty changes in the liver -a comparison with
the non alcoholic fatty liver disease activity score -
Hideyuki DENPO, RMS1, Satoshi SAITOH, SJSUM
2, Koichi KUBOTA, RMS
1, Yoko UGAJIN, RMSt,
Kazuo TAKEUCHI, SJSUM3, Masafumi INOUE4
Abstract
Purpose: Due to advances in the technology, the frequencies of appearance of each of the B-mode findings that are characteristic to the fatty Iiver are changing. In addition, because fatty changes in tissues are classified as a surface area of 5 % or greater according to the non-alcoholic白ttyIiver disease activity score (NAS). we investigated each of the fatty change findings observed during the B-mode imaging. Patients and Methods: We investigated 75 patients who underwent a hepatic cytology and an ultrasound (US) imaging using a Toshiba Aplio XG. We performed a comparative investigation between the frequency of白ttychange findings on B-mode images, such as hepato・renalecho contrast, bright Iiver, enhanced deep attenuation, vascular blurring, and focal spared area, and NAS fatty change c1assification. Results: A comparison between NAS and fatty liver on US imaging showed that if subjects had both hepato・renalecho contrast and bright liver or if these findings were mild and when the白ttyliver on US imaging showed aforementioned findings along with focal spared area, then the NAS fatty change c1assification of grade 0/ 1 /2/3 (S 0 -3) co汀'espondedto 0% /52% / 100% / 100% of the fatty liver tissue observed,問spectively.In addition, in su句ectswith mild fatty changes of 5 %ー33% or less, fatty changes in tissues were subdivided into 5 %ー 10%/ 11 % -20%/21 % -33%, which corresponded to 21% /88% / 100% of the白ttyliver tissue observed, respectively. The presence of each fatty change finding on B-mode images is as follows: Enhanced deep attenuation, a finding indicative of high-grade白ttyliver, was present in S 2: 10% /S 3: 75%, while vascular blurring was observed in S 2: 0% / S 3: 38% and focal spared area was observed in S 1 /2/3 in 32% /70% /88%, respectively. Conclusion: The frequency of observation of enhanced deep attenuation and vascular blurring has decreased. In addition, the findings such as bright liver and hepato-renal echo co附 astas well as focal spared area are important because these白ndingscan indicate mild fatty changes involving 10% ofthe liver.
Jpn J Med Ultrasonics 2015; 42(3): 337-345
Keywords
ultrasound, fatty liver, hepatic steatosis, NAFLO activi句'score,focal spared area