Mortele et al reported a modified version of the CT Severity Index (CTSI) of Balthazar et al for the diagnosis of acute pancreatitis. This can help to identify a patient with severe disease who may require more aggressive management. The authors are from Brigham and Women's Hospital in Boston.
Patient selection: acute pancreatitis
Exam: abdominal CT
Parameters:
(1) pancreatic inflammation
(2) pancreatic necrosis
(3) extra-pancreatic complications (pleural effusion, ascites, venous thrombosis, arterial hemorrhage, pseudoaneurysm, parenchymal infarction, parenchymal subcapsular fluid accumulation, GI involvement)
Parameter
Finding
Points
pancreatic inflammation
none (normal)
0
focal enlargement of pancreas
1
diffuse enlargement of pancreas
1
intrinsic pancreatic abnormalities with inflammatory changes in peripancreatic fat
2
single, ill-defined fluid collection or phlegmon
3
>= 2 poorly defined collections
4
presence of gas in or adjacent to pancreas
4
pancreatic necrosis
none
0
< 30%
2
>= 30%
4
extra-pancreatic complications
no
0
yes
2
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the more severe the pancreatitis.
Total Score
Points
0 to 2
mild
4 to 6
moderate
7 to 10
severe
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