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The CTSI sums two scores:
- Balthazar score: grading of pancreatitis (A-E)
- grading the extent of pancreatic necrosis
The Balthazar score was originally used alone, but the addition of a score for pancreatic necrosis improved correlation with clinical severity scores.
The CTSI has since been updated to the modified CTSI (2004).
Grading of pancreatitis (Balthazar score)
- A: normal pancreas: 0
- B: enlargement of pancreas: 1
- C: inflammatory changes in pancreas and peripancreatic fat: 2
- D: ill-defined single peripancreatic fluid collection: 3
- E: two or more poorly defined peripancreatic fluid collections: 4
- none: 0
- ≤30%: 2
- >30-50%: 4
- >50%: 6
The maximum score that can be obtained is 10.
Stratification of pancreatitis severity
- mild pancreatitis (interstitial pancreatitis): Balthazar B or C, without pancreatic or extrapancreatic necrosis
- intermediate (exudative pancreatitis): Balthazar D or E, without pancreatic necrosis; peripancreatic collections are due to extrapancreatic necrosis
- severe pancreatitis (necrotizing): necrosis of the pancreas (non-enhancing areas in the pancreas on contrast-enhanced CT)
Treatment and prognosis
There is good correlation of clinical pancreatitis scores and current CT pancreatitis severity scores (such as the CTSI and modified CTSI) so imaging is not always necessary to assess the severity of pancreatitis 3.
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- 2. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223 (3): 603-13. Radiology (full text) - doi:10.1148/radiol.2233010680 - Pubmed citation
- 3. Bollen TL, Singh VK, Maurer R et-al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am. J. Gastroenterol. 2011;107 (4): 612-9. doi:10.1038/ajg.2011.438 - Pubmed citation