Revised Atlanta classification of acute pancreatitis (2012)
The Revised Atlanta classification of acute pancreatitis (2012) is an international multidisciplinary classification of the severity of acute pancreatitis, updating the 1991 Atlanta classification. This has been further revised in 2016 6.
The worldwide consensus aims for an internationally agreed-upon classification of acute pancreatitis severity, with standardized terminology for pancreatitis and its complications.
The classification system is based on both local and systemic determinants of severity, with:
- local determinants related to the presence or absence of
- (peri)pancreatic necrosis
- sterile or infected
- (peri)pancreatic necrosis
- systemic determinants related to presence or absence of
- organ failure
- transient or persistent
- organ failure
The grade of severity (mild, moderate, severe, and critical) is based on combinations of these determinants.
Furthermore, a discrimination was made between two clinical phases of pancreatitis:
- early (1st week): in which severity is based on the presence or absence of systemic organ failure
- late (>1st week): in which severity is based on the presence of local complication or persistent systemic organ failure
The Atlanta classification divides acute pancreatitis into 2 basic types:
- interstitial edematous pancreatitis (IEP)
necrotising pancreatitis (NP) which is further subdivided into:
- parenchymal necrosis
- peripancreatic necrosis
- combined type (peripancreatic and parenchymal necrosis): most common
All types of necrotising pancreatitis may be sterile or infected; gas formation is the best imaging feature to suggest infection.
Treatment decisions in the late phase rely heavily on morphologic criteria. The role of the radiologist is to aid in treatment planning by correctly addressing the morphologic changes.
A new terminology for fluid collections associated with acute pancreatitis is introduced 4,5:
- fluid collections associated with interstitial oedematous pancreatitis (i.e. minimal or no necrosis)
- fluid collections associated with necrotising pancreatitis
ANCs and WONs are collections that contain both fluid and necrotic material of various amounts (an important point to differentiate them from APFCs and pseudocysts, however, in indeterminate cases follow-up is recommended).
The terms pancreatic abscess and intrapancreatic pseudocyst are totally abandoned in this new classification.
- 1. Zaheer A, Singh VK, Qureshi RO et-al. The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging. 2013;38 (1): 125-36. doi:10.1007/s00261-012-9908-0 - Pubmed citation
- 2. Sheu Y, Furlan A, Almusa O et-al. The revised Atlanta classification for acute pancreatitis: a CT imaging guide for radiologists. Emerg Radiol. 2012;19 (3): 237-43. doi:10.1007/s10140-011-1001-4 - Pubmed citation
- 3. Sarr MG, Banks PA, Bollen TL et-al. The new revised classification of acute pancreatitis 2012. Surg. Clin. North Am. 2013;93 (3): 549-62. doi:10.1016/j.suc.2013.02.012 - Pubmed citation
- 4. Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262 (3): 751-64. doi:10.1148/radiol.11110947 - Pubmed citation
- 5. Banks PA, Bollen TL, Dervenis C et-al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2012;62 (1): 102-11. doi:10.1136/gutjnl-2012-302779 - Pubmed citation
- 6. Bryan R. Foster, Kyle K. Jensen, Gene Bakis, Akram M. Shaaban, Fergus V. Coakley. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. (2016) RadioGraphics. 36 (3): 675-87. doi:10.1148/rg.2016150097 - Pubmed
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma