CT severity index in acute pancreatitis
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The CT severity index (CTSI) is based on findings from an enhanced CT scan to assess the severity of acute pancreatitis. The severity of acute pancreatitis CT findings has been found to correlate well with clinical indices of severity.
The CT severity index sums two scores:
- Balthazar score: grading of pancreatitis (A-E) 1
- grading the extent of pancreatic necrosis
The necrosis scoring system was added to the traditional Balthazar score in 1990 by the same author 1,2.
Modifications have been made to the CTSI, resulting in the modified CTSI (2004) 3.
CT severity index
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.
Treatment and prognosis
The CT severity index is the sum of the scores obtained with the Balthazar score and those obtained with the evaluation of pancreatic necrosis:
- 0-3: mild acute pancreatitis
- 4-6: moderate acute pancreatitis
- 7-10: severe acute pancreatitis
There is good correlation of clinical pancreatitis scores and imaging pancreatitis scores, so imaging is not always necessary to assess the severity of pancreatitis 3.
- 1. 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
- 2. Balthazar EJ, Robinson DL, Megibow AJ et-al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174 (2): 331-6. Radiology (abstract) - 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