ชุดภาพรังสีช่องท้อง: บทบาทที่เปลี่ยนไป ในภาวะปวดท้องเฉียบพลัน
คำสำคัญ:
ภาวะฉุกเฉินทางช่องท้อง, เอกซเรย์คอมพิวเตอร์, การวินิจฉัยทางรังสี, อัลตร้าซาวด์บทคัดย่อ
ชุดภาพรังสีช่องท้องมักถูกใช้เป็นอันดับแรกของการวินิจฉัยทางรังสีในผู้ป่วยภาวะปวดท้องเฉียบพลัน แต่เนื่องจาก
ในปัจจุบันเทคโนโลยีของการวินิจฉัยทางรังสีได้พัฒนาไปอย่างมาก ทำให้บทบาทของชุดภาพรังสีช่องท้องลดลง
เนื่องจากมีความไวและความจำเพาะต่ำ อัลตร้าซาวด์หรือเอกซเรย์คอมพิวเตอร์ซึ่งมีความแม่นยำในการวินิจฉัยที่
ดีกวา่ ไดม้ าทดแทนชดุ ภาพรังสชี อ่ งทอ้ งในหลายๆ โรคในกลมุ่ ภาวะปวดทอ้ งเฉยี บพลนั แตแ่ พทยก์ ็ยงั สัง่ ตรวจดว้ ย
ชุดภาพรังสีช่องท้องเป็นอันดับแรกอยู่เช่นเดิม บทความนี้มีวัตถุประสงค์เพื่อทบทวนบทบาทของชุดภาพรังสีช่อง
ท้องในการวินิจฉัยผู้ป่วยภาวะปวดท้องเฉียบพลันในปัจจุบันและเครื่องมือการวินิจฉัยทางรังสีที่เปลี่ยนไปในโรคที่
พบได้บ่อยในกลุ่มภาวะปวดท้องเฉียบพลันรวมทั้งประสิทธิภาพของเครื่องมือต่างๆ เหล่านั้น
References
1. Taha MT, Kutbi RA, Allehyani SH. Effective
dose evaluation for chest and abdomen
x-ray examinations. Inter J Science Res.
2016; 5: 420-2.
2. MacKersie AB, Lane MJ, Gerhardt RT,
Claypool HA, Keenan S, Katz DS, et al.
Nontraumatic acute abdominal pain:
unenhanced helical CT compared with
three-view acute abdominal series.
Radiology. 2005; 237: 114-22.
3. van Randen A, Laméris W, Luitse JS,
Gorzeman M, Hesselink EJ, Dolmans DE, et
al. The role of plain radiographs in patients
with acute abdominal pain at the ED. Am
J Emerg Med. 2011; 29: 582-9.
4. Kellow ZS, MacIness M, Kurzencwyg D,
Rawal S, Jaffer R, Kovacina B, et al. The
role of abdominal radiography in the
evaluation of the nontrauma emergency
patient. Radiology. 2008; 248: 887-93.
5. Sreedharan S, Fiorentino M, Sinha S. Plain
abdominal radiography in acute abdominal
pain - is it really necessary? Emerg Radiol.
2014; 21: 597-603.
6. Ahn SH, Mayo-Smith WW, Murphy BL,
Reinert SE, Cronan JJ. Acute nontraumatic
abdominal pain in adult patients:
abdominal radiography compared with CT
evaluation. Radiology. 2002; 225: 159-64.
7. Assarian A, Zaidi AZ, Chung R. Plain
abdominal radiographs and acute
abdominal pain. Professional Med J. 2008;
15: 33-6.
8. Musson RE, Bickle I, Vijay RK. Gas patterns
on plain abdominal radiographs: a pictorial
review. Postgrad Med J. 2011; 87: 274-87.
9. Stoker J, van Randen A, Laméris W,
Boermeester MA. Imaging patients with
acute abdominal pain. Radiology. 2008;
253: 31-46.
10. Leschka S, Alkadhi H, Wildermuth S,
Marincek B. Multi-detector computed
tomography of acute abdomen. Eur
Radiol. 2005; 15: 2435-47.
11. Ros PR, Huprich JE. ACR Appropriateness
Criteria® suspected small-bowel
obstruction. J Am Coll Radiol. 2006; 3:
838-41.
12. Cho KC, Baker SR. Extraluminal air.
Diagnosis and significance. Radiol Clin
North Am. 1994; 32: 829–44.
13. Langell JT, Mulvihill SJ. Gastrointestinal
perforation and the acute abdomen. Med
Clin N Am. 2008; 92: 599-625.
14. Tapakis JC, Thickman D. Diagnosis of
pneumoperitoneum: abdominal CT vs.
upright chest film. J Comput Assist Tomogr.
1992; 16: 713-16.
15. Klar E, Rahmanian PB, Bücker A, Hauenstein
K, Jauch KW, Luther B. Acute mesenteric
ischemia: a vascular emergency. Dtsch
Arzetbl Int. 2012; 109: 249-56.
16. Oliva IB, Davarpanah AH, Rybicki FJ,
Hauenstein K, Jauch KW, Luther Bet al.
ACR Appropriateness Criteria® imaging
of mesenteric ischemia. Abdom Imaging.
2013; 38: 714-9.
17. Biolato M, Miele L, Gasbarrini G, Grieco A.
Abdominal angina. Am J Med Sci. 2009;
338: 389–95.
18. Mazzei MA, Guerrini S, Squitieri NC,
Imbriaco G, Chieca R, Civitelli S. Magnetic
resonance imaging: is there a role in
clinical management for ischemic colitis?
World J Gastroenterol. 2013; 19: 1256-63.
19. Petroianu A. Diagnosis of acute appendicitis.
Int J Surg. 2012; 10: 115-9.
20. Petroianu A, Alberti LR. Accuracy of the
new radiographic sign of fecal loading in
the cecum for differential diagnosis of
acute appendicitis in comparison with
other inflammatory diseases of right
abdomen: a prospective study. J Med Life.
2012; 22: 85-91.
21. Bhangu A, Richardson C, Winter H, Bleetman
A. Value of initial radiological investigations
in patients admitted to hospital with
appendicitis, acute gallbladder disease or
acute pancreatitis Emerge Med. J 2010;
27: 727.
22. Drake FT, Florence MG, Johnson MG,
Jurkovich GJ, Kwon S, Schmidt Z, et al.
Progress in the diagnosis of appendicitis:
a report from Washington state’s surgical
care and outcomes assessment program.
Ann Surg. 2012; 256: 586-94.
23. Raman SS, Osuagwu FC, Kadell B, Cryer
H, Sayre J, Lu DS, et al. Effect of CT on
false positive diagnosis of appendicitis
and perforation. N Engl J Med. 2008; 358:
972-3.
24. Keyzer C, Zalcman M, De Maerteler V,
Coppens E, Gevenois PA, Van Gansbeke D.
Comparison of US and unenhanced multidetector
row CT in patients suspected of
having acute appendicitis. Radiology. 2005;
236: 527-34.
25. Tarulli M, Rezende-Neto J, Vlachou P.
Focused CT for the evaluation of suspected
appendicitis. Abode Radiol (NY). 2019; 22:
dor: 10.1007/s00261-019-01942-3.
26. Toorenvliet BR, Wiersma F, Bakker RF,
et al. Routine ultrasound and limited
computed tomography for the diagnosis
of acute appendicitis. World J Surg. 2010;
34: 2278 e85.
27. Burford JM, Dassinger MS, Smith SD.
Surgeon-performed ultrasound as a
diagnostic tool in appendicitis. J Pediatr
Surg. 2011; 46: 1115 e20.
28. Kaiser Sylvie K, Frenckner B, Jorulf H.
Suspected appendicit is in children: US
and CT a prospective randomized study.
Radiology. 2002; 223: 633 e8.
29. Israel GM, Malguria N, McCarthy S, Copel
J, Weinreb J. MRI vs. ultrasound for
suspected appendicitis during pregnancy.
J Magn Reson Imaging. 2008; 28: 428-33.
30. Rostamzadeh A, Mirfendereski S, Rezaie MJ,
Rezaei S. Diagnostic efficacy of sonography
for diagnosis of ovarian torsion. Pak J Med
Sci. 2014; 30: 413-6.
31. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fletcher
AC. Diagnosis of ovarian torsion with color
doppler sonography: depiction of twisted
vascular pedicle. J Ultras Med. 1998; 17:
83–9.
32. Lambert MJ, Villa M. Gynecologic
ultrasound in emergency medicine. Emerg
Med Clin North Am 2004; 22: 683–96.
33. Schirmer BD, Winters KL, Edlich RF.
Cholelithiasis and cholecystitis. J Long
Term Eff Med Implants. 2005; 15: 329-38.
34. Harvey RT, Miller WT Jr. Acute biliary
disease: initial CT and follow-up US versus
initial US and follow-up CT. Radiology.
1999; 213: 831–6.
35. Rodriguez LE, Sanchez-Vivaldi JA, Velez-
Quiñones MP, Torres PA, Serpa-Perez
M, Peguero-Rivera J, et al. The impact
of a rapid imaging protocol in acute
cholecystitis-prospective cohort study. Int
J Surg Case Rep. 2018; 51: 388-94.
36. Rickes S, Treiber G, Monkemuller K, Peitz
U, Csepregi A, Kahl S, et al. Impact of the
operator’s experience on value of highresolution
transabdominal ultrasound in
the diagnosis of choledocholithiasis: a
prospective comparison using endoscopic
retrograde cholangiography as the gold
standard. Scand J Gastroenterol. 2006;
41: 838-43.
37. Shakespear JS, Shaaban AM, Rezvani M.
CT findings of acute cholecystitis and its
complications. AJR Am J Roentgenol. 2010;
194: 1523-9.
38. Chan CC, Lo KL, Chang EC, Lo SS,
Hon TY. Colonic diverticulosis in Hong
Kong: distribution pattern and clinical
significance. Clin Radiol. 1998; 53: 842-4.
39. Werner A, Diehl SJ, Farag-Soliman M, Duber
C. Multi-slice spiral CT in routine diagnosis
of suspected acute left-sided colonic
diverticulitis: a prospective study of 120
patients. Eur Radiol. 2003; 13: 2596-603.
40. Verbanck J, Lambrecht S, Rutgeerts
L, Ghillebert G, Buyse T, Naesens M,
et al. Can sonography diagnose acute
colonic diverticulitis in patients with acute
intestinal inflammation? A prospective
study. J Clin Ultrasound. 1989; 17: 661–6.
41. Ajaj W, Ruehm SG, Lauenstein T, Goehde
S, Kuehle C, Herborn CU, et al. Darklumen
magnetic resonance colonography
in patients with suspected sigmoid
diverticulitis: a feasibility study. Eur Radiol.
2005; 15: 2316-22.
42. Heverhagen JT, Sitter H, Zielke A, Klose
KJ. Prospective evaluation of the value of
magnetic resonance imaging in suspected
acute sigmoid diverticulitis. Dis Colon
Rectum. 2008; 51 1810-5.
43. Coursey CA, Casalino D, Remer EM, et al.
ACR Appropriateness Criteria® acute onset
flank pain — suspicion of stone disease.
Ultrasound Q. 2012; 28: 227-33.
44. Poletti PA, Platon A, Rutschmann OT,
Schmidlin FR, Iselin CE, et al. Low-dose.
versus standard-dose CT protocol in
patients with clinically suspected renal
colic. AJR Am Roentgenol Radiol. 2007;
188: 927-933.
45. Nicolau C1, Claudon M, Derchi LE,
Adam EJ, Nielsen MB, Mostbeck G, et al.
Imaging patients with renal colic-consider
ultrasound first. Insights Imaging. 2015; 6:
441-7.
46. Masselli G, Derchi L, McHugo J, Rockall A,
Vock P, Weston M, et al. Acute abdominal
and pelvic pain in pregnancy: ESUR
recommendations. Eur Radiol. 2013; 23:
3485-500.
47. Andreotti RF, Lee SI, Dejesus Allison SO,
et al. ACR Appropriateness Criteria® acute
pelvic pain in the reproductive age group.
Ultrasound Q. 2011; 27: 205-10.
dose evaluation for chest and abdomen
x-ray examinations. Inter J Science Res.
2016; 5: 420-2.
2. MacKersie AB, Lane MJ, Gerhardt RT,
Claypool HA, Keenan S, Katz DS, et al.
Nontraumatic acute abdominal pain:
unenhanced helical CT compared with
three-view acute abdominal series.
Radiology. 2005; 237: 114-22.
3. van Randen A, Laméris W, Luitse JS,
Gorzeman M, Hesselink EJ, Dolmans DE, et
al. The role of plain radiographs in patients
with acute abdominal pain at the ED. Am
J Emerg Med. 2011; 29: 582-9.
4. Kellow ZS, MacIness M, Kurzencwyg D,
Rawal S, Jaffer R, Kovacina B, et al. The
role of abdominal radiography in the
evaluation of the nontrauma emergency
patient. Radiology. 2008; 248: 887-93.
5. Sreedharan S, Fiorentino M, Sinha S. Plain
abdominal radiography in acute abdominal
pain - is it really necessary? Emerg Radiol.
2014; 21: 597-603.
6. Ahn SH, Mayo-Smith WW, Murphy BL,
Reinert SE, Cronan JJ. Acute nontraumatic
abdominal pain in adult patients:
abdominal radiography compared with CT
evaluation. Radiology. 2002; 225: 159-64.
7. Assarian A, Zaidi AZ, Chung R. Plain
abdominal radiographs and acute
abdominal pain. Professional Med J. 2008;
15: 33-6.
8. Musson RE, Bickle I, Vijay RK. Gas patterns
on plain abdominal radiographs: a pictorial
review. Postgrad Med J. 2011; 87: 274-87.
9. Stoker J, van Randen A, Laméris W,
Boermeester MA. Imaging patients with
acute abdominal pain. Radiology. 2008;
253: 31-46.
10. Leschka S, Alkadhi H, Wildermuth S,
Marincek B. Multi-detector computed
tomography of acute abdomen. Eur
Radiol. 2005; 15: 2435-47.
11. Ros PR, Huprich JE. ACR Appropriateness
Criteria® suspected small-bowel
obstruction. J Am Coll Radiol. 2006; 3:
838-41.
12. Cho KC, Baker SR. Extraluminal air.
Diagnosis and significance. Radiol Clin
North Am. 1994; 32: 829–44.
13. Langell JT, Mulvihill SJ. Gastrointestinal
perforation and the acute abdomen. Med
Clin N Am. 2008; 92: 599-625.
14. Tapakis JC, Thickman D. Diagnosis of
pneumoperitoneum: abdominal CT vs.
upright chest film. J Comput Assist Tomogr.
1992; 16: 713-16.
15. Klar E, Rahmanian PB, Bücker A, Hauenstein
K, Jauch KW, Luther B. Acute mesenteric
ischemia: a vascular emergency. Dtsch
Arzetbl Int. 2012; 109: 249-56.
16. Oliva IB, Davarpanah AH, Rybicki FJ,
Hauenstein K, Jauch KW, Luther Bet al.
ACR Appropriateness Criteria® imaging
of mesenteric ischemia. Abdom Imaging.
2013; 38: 714-9.
17. Biolato M, Miele L, Gasbarrini G, Grieco A.
Abdominal angina. Am J Med Sci. 2009;
338: 389–95.
18. Mazzei MA, Guerrini S, Squitieri NC,
Imbriaco G, Chieca R, Civitelli S. Magnetic
resonance imaging: is there a role in
clinical management for ischemic colitis?
World J Gastroenterol. 2013; 19: 1256-63.
19. Petroianu A. Diagnosis of acute appendicitis.
Int J Surg. 2012; 10: 115-9.
20. Petroianu A, Alberti LR. Accuracy of the
new radiographic sign of fecal loading in
the cecum for differential diagnosis of
acute appendicitis in comparison with
other inflammatory diseases of right
abdomen: a prospective study. J Med Life.
2012; 22: 85-91.
21. Bhangu A, Richardson C, Winter H, Bleetman
A. Value of initial radiological investigations
in patients admitted to hospital with
appendicitis, acute gallbladder disease or
acute pancreatitis Emerge Med. J 2010;
27: 727.
22. Drake FT, Florence MG, Johnson MG,
Jurkovich GJ, Kwon S, Schmidt Z, et al.
Progress in the diagnosis of appendicitis:
a report from Washington state’s surgical
care and outcomes assessment program.
Ann Surg. 2012; 256: 586-94.
23. Raman SS, Osuagwu FC, Kadell B, Cryer
H, Sayre J, Lu DS, et al. Effect of CT on
false positive diagnosis of appendicitis
and perforation. N Engl J Med. 2008; 358:
972-3.
24. Keyzer C, Zalcman M, De Maerteler V,
Coppens E, Gevenois PA, Van Gansbeke D.
Comparison of US and unenhanced multidetector
row CT in patients suspected of
having acute appendicitis. Radiology. 2005;
236: 527-34.
25. Tarulli M, Rezende-Neto J, Vlachou P.
Focused CT for the evaluation of suspected
appendicitis. Abode Radiol (NY). 2019; 22:
dor: 10.1007/s00261-019-01942-3.
26. Toorenvliet BR, Wiersma F, Bakker RF,
et al. Routine ultrasound and limited
computed tomography for the diagnosis
of acute appendicitis. World J Surg. 2010;
34: 2278 e85.
27. Burford JM, Dassinger MS, Smith SD.
Surgeon-performed ultrasound as a
diagnostic tool in appendicitis. J Pediatr
Surg. 2011; 46: 1115 e20.
28. Kaiser Sylvie K, Frenckner B, Jorulf H.
Suspected appendicit is in children: US
and CT a prospective randomized study.
Radiology. 2002; 223: 633 e8.
29. Israel GM, Malguria N, McCarthy S, Copel
J, Weinreb J. MRI vs. ultrasound for
suspected appendicitis during pregnancy.
J Magn Reson Imaging. 2008; 28: 428-33.
30. Rostamzadeh A, Mirfendereski S, Rezaie MJ,
Rezaei S. Diagnostic efficacy of sonography
for diagnosis of ovarian torsion. Pak J Med
Sci. 2014; 30: 413-6.
31. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fletcher
AC. Diagnosis of ovarian torsion with color
doppler sonography: depiction of twisted
vascular pedicle. J Ultras Med. 1998; 17:
83–9.
32. Lambert MJ, Villa M. Gynecologic
ultrasound in emergency medicine. Emerg
Med Clin North Am 2004; 22: 683–96.
33. Schirmer BD, Winters KL, Edlich RF.
Cholelithiasis and cholecystitis. J Long
Term Eff Med Implants. 2005; 15: 329-38.
34. Harvey RT, Miller WT Jr. Acute biliary
disease: initial CT and follow-up US versus
initial US and follow-up CT. Radiology.
1999; 213: 831–6.
35. Rodriguez LE, Sanchez-Vivaldi JA, Velez-
Quiñones MP, Torres PA, Serpa-Perez
M, Peguero-Rivera J, et al. The impact
of a rapid imaging protocol in acute
cholecystitis-prospective cohort study. Int
J Surg Case Rep. 2018; 51: 388-94.
36. Rickes S, Treiber G, Monkemuller K, Peitz
U, Csepregi A, Kahl S, et al. Impact of the
operator’s experience on value of highresolution
transabdominal ultrasound in
the diagnosis of choledocholithiasis: a
prospective comparison using endoscopic
retrograde cholangiography as the gold
standard. Scand J Gastroenterol. 2006;
41: 838-43.
37. Shakespear JS, Shaaban AM, Rezvani M.
CT findings of acute cholecystitis and its
complications. AJR Am J Roentgenol. 2010;
194: 1523-9.
38. Chan CC, Lo KL, Chang EC, Lo SS,
Hon TY. Colonic diverticulosis in Hong
Kong: distribution pattern and clinical
significance. Clin Radiol. 1998; 53: 842-4.
39. Werner A, Diehl SJ, Farag-Soliman M, Duber
C. Multi-slice spiral CT in routine diagnosis
of suspected acute left-sided colonic
diverticulitis: a prospective study of 120
patients. Eur Radiol. 2003; 13: 2596-603.
40. Verbanck J, Lambrecht S, Rutgeerts
L, Ghillebert G, Buyse T, Naesens M,
et al. Can sonography diagnose acute
colonic diverticulitis in patients with acute
intestinal inflammation? A prospective
study. J Clin Ultrasound. 1989; 17: 661–6.
41. Ajaj W, Ruehm SG, Lauenstein T, Goehde
S, Kuehle C, Herborn CU, et al. Darklumen
magnetic resonance colonography
in patients with suspected sigmoid
diverticulitis: a feasibility study. Eur Radiol.
2005; 15: 2316-22.
42. Heverhagen JT, Sitter H, Zielke A, Klose
KJ. Prospective evaluation of the value of
magnetic resonance imaging in suspected
acute sigmoid diverticulitis. Dis Colon
Rectum. 2008; 51 1810-5.
43. Coursey CA, Casalino D, Remer EM, et al.
ACR Appropriateness Criteria® acute onset
flank pain — suspicion of stone disease.
Ultrasound Q. 2012; 28: 227-33.
44. Poletti PA, Platon A, Rutschmann OT,
Schmidlin FR, Iselin CE, et al. Low-dose.
versus standard-dose CT protocol in
patients with clinically suspected renal
colic. AJR Am Roentgenol Radiol. 2007;
188: 927-933.
45. Nicolau C1, Claudon M, Derchi LE,
Adam EJ, Nielsen MB, Mostbeck G, et al.
Imaging patients with renal colic-consider
ultrasound first. Insights Imaging. 2015; 6:
441-7.
46. Masselli G, Derchi L, McHugo J, Rockall A,
Vock P, Weston M, et al. Acute abdominal
and pelvic pain in pregnancy: ESUR
recommendations. Eur Radiol. 2013; 23:
3485-500.
47. Andreotti RF, Lee SI, Dejesus Allison SO,
et al. ACR Appropriateness Criteria® acute
pelvic pain in the reproductive age group.
Ultrasound Q. 2011; 27: 205-10.
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