CT severity index in acute pancreatitis

Last revised by Dr Jeremy Jones on 20 Sep 2021

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)
Pancreatic necrosis 
  • 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.

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Cases and figures

  • Case 1: moderate
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  • Case 2: severe
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  • Case 3: severe
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  • Case 4: severe
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