Acil Cerrahide Görüntüleme
Özet
Akut abdominal ağrı, acil servis başvurularının %5'ini oluşturmakta ve travma dışı abdominal acillerde doğru görüntüleme tekniğinin seçimi tanı ve tedavi süreçlerinde kritik bir rol oynamaktadır. X-ray grafiler, kolay ulaşılabilirliği ve düşük maliyeti nedeniyle genellikle ilk basamak olarak tercih edilse de sınırlılıkları mevcuttur. Bilgisayarlı Tomografi (BT), güncel veriler ışığında travma dışı abdominal acillerde en etkin ve ilk seçilmesi gereken altın standart yöntemdir; akut apandisit, pankreatit ve perforasyon gibi durumlarda yüksek doğruluğa sahiptir. Ultrasonografi (USG) ise radyasyon içermemesi ve hızlı uygulanabilirliği ile özellikle sağ üst kadran ağrılarında ve gebelikte ilk tercih edilen yöntemdir. Manyetik Rezonans Görüntüleme (MRG), yüksek doğruluğuna rağmen uzun çekim süresi ve maliyeti nedeniyle acil servis pratiğinde sınırlı yer bulsa da radyasyon hassasiyeti olan gebelerde güvenle kullanılmaktadır. Sonuç olarak, hastanın klinik durumuna göre doğru radyolojik stratejinin belirlenmesi, hayatı tehdit eden patolojilerin erken tanısı ve yönetimi için klinisyen ve radyolog iş birliğini zorunlu kılmaktadır.
Acute abdominal pain accounts for 5% of all emergency department admissions, and selecting the appropriate imaging technique is critical for diagnosis and treatment in non-traumatic abdominal emergencies. Although X-ray radiographs are traditionally preferred as a first-line method due to accessibility and low cost, they exhibit significant diagnostic limitations. Computed Tomography (CT) stands as the most effective gold standard method, particularly successful in diagnosing acute appendicitis, pancreatitis, and gastrointestinal perforations. Ultrasonography (USG), being radiation-free and rapidly applicable, is the primary choice for evaluating right upper quadrant pain and acute abdomen in pregnant patients. Magnetic Resonance Imaging (MRI) offers high diagnostic success across almost all etiologies; however, due to long scan times and high costs, its emergency use is mostly restricted to pregnant patients where radiation exposure must be avoided. Ultimately, establishing an accurate radiological strategy requires effective communication between clinicians and radiologists to ensure proper test selection and prompt identification of life-threatening conditions.
Referanslar
Stoker J, van Randen A, Laméris W, et al. Imaging patients with acute abdominal pain. Radiology 2009;253(1):31-46. doi:10.1148/radiol.2531090302
MacKersie AB, Lane MJ, Gerhardt RT, et al, Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology2005;237(1):114-122. doi.org/10.1148/radiol.2371040066
Morgan M, Bell D. Abdominal radiography , Available from: Radiopaedia.org. (Accessed on 07 Jun 2022) https://doi.org/10.53347/rID-38094
Grant TH, Rosen MP, Fidler JL. ACR Appropriateness Criteria acute abdominal pain and fever or suspected abdominal abscess. American College of Radiology.Reston (VA): 2008.
Sandrasegaran K, Rydberg J, Tann M, et al. Benefits of routine use of coronal and sagittal reformations in multi-slice CT examination of the abdomen and pelvis. Clinical radiology;2007;62(4):340-347.
Leite NP, Pereira JM, Cunha R., Pinto P,et al. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings.AJR. American Journal of Roentgenology; 2005;185(2):406-417.
Anderson SW, Soto JA., Lucey BC, et al. Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. American Journal of Roentgenology; 2009;193(5):1282-1288.
Andersson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. The European journal of surgery= Acta chirurgica; 1992;158(1):37-41.
Leschka S, Alkadhi H, Wildermuth S, et al. Multi-detector computed tomography of acute abdomen. European radiology; 2005;15(12):2435-2447.
Shakespear JS, Shaaban AM, Rezvani M. CT findings of acute cholecystitis and its complications. American Journal of Roentgenology; 2010;194(6): 1523-1529.
Yarmish GM, Smith MP, Rosen, MP, et al. ACR appropriateness criteria right upper quadrant pain. Journal of the American College of Radiology; 2014;11(3):316-322.
Wertz JR, Lopez JM, Olson D, et al. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. AJR. American journal of roentgenology, 2018;211(2): 92-97.
Fagenholz PJ, Fuentes E, Kaafarani H, et al. Computed tomography is more sensitive than ultrasound for the diagnosis of acute cholecystitis. Surgical infections;2015;16(5):509-512.
Kapral NM, Pesch AJ,Khot R. Abdominal Emergencies. In Seminars in Roentgenology; 2020;55(4):336-363.
Mirvis SE, Whitley NO, Miller JW.CT Diagnosis of acalculous cholecystitis. Journal of computer assisted tomography,1987;11(1):83-87.doi:10.1097/00004728-98701000-00016
Murray N, Darras KE, Walstra FE, et al. Dual-energy CT in evaluation of the acute abdomen. Radiographics,;2019;39(1):264-286. doi:10.1148/rg.2019180087
Brant WE, Helms CA, Dunnick NR. Fundamentals of diagnostic radiology. AJR-American Journal of Roentgenology 1994;163(1): 30-30.
Allemann F, Cassina P, Röthlin M, Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. European Journal of Surgery1999;165(10):966-970.
Walsh PF, Crawford D, Crossling FT, et al. The value of immediate ultrasound in acute abdominal conditions: a critical appraisal. Clinical radiology1990;42(1): 47-49.
Yarmish GM, Smith MP, Rosen MP et al. ACR appropriateness criteria right upper quadrant pain. Journal of the American College of Radiology 2014;11(3):316-322.
Masselli G, Derme M, Laghi F, et al. Evaluating the Acute Abdomen in the Pregnant Patient. Radiol Clin North Am. 2015 ;53(6):1309-25. doi: 10.1016/j.rcl.2015.06.013
Greenberg, T. D., Hoff, M. N., Gilk, T. B., et al. (2020). ACR guidance document on MR safe practices: Updates and critical information Journal of Magnetic Resonance Imaging,2019;51(2):331-338.
Garcia-Bournissen, F., Shrim, A., & Koren, G. Safety of gadolinium during pregnancy. Canadian family physician, 2006;52(3): 309-310.
