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Modified CT Severity Index Calculator (CTSI)


Pancreatic Necrosis:

Extrapancreatic complications (pleural effusion, ascites, vascular complications gastrointestinal tract involvement):

Modified CT severity index:
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Radiology Spotters Collection

Mortele Modified CT Severity Index (CTSI)for scoring acute pancreatitis

Prognostic IndicatorPoints
Pancreatic Inflammation
Normal pancreas0
Intrinsic pancreatic abnormalities with or without inflammatory changes in peripancreatic fat.2
Pancreatic or peripancreatic fluid collection or peripancreatic fat necrosis4
Pancreatic Necrosis
≤ 30%2
≥ 30%4
Extra Pancreatic Complications
One or more of the following: Pleural Effusion, ascites, vascular complications, parenchymal complications, or gastrointestinal tract involvement.2

Atlanta Classification for Acute Pancreatitis

Type of acute pancreatitisDurationCollectionsCT description
Interstitial edematous pancreatitis< 4 weeksAcute Peripancreatic Fluid Collections
Homogeneous fluid density collection confined by normal peripancreatic fascial planes. No definable wall encapsulating. Adjacent to the pancreas (no intrapancreatic extension)
>4 weeksPseudocystWell circumscribed, usually round or oval homogeneous fluid density. No non-liquid component. Well defined wall; completely encapsulated
Necrotizing pancreatitis< 4 weeksAcute Necrotic Collections
Heterogeneous, non-liquid density of varying degrees (some appear homogeneous early in the course). No definable wall encapsulating the collection.Location: Intrapancreatic and/ or extrapancreatic
>4 weeksWalled-off Necrosis (WONHeterogeneous, liquid, and non-liquid density with varying degrees of loculations (some may appear homogeneous). Well-defined wall; completely encapsulated. Location:Intrapancreatic and/or extrapancreatic

References and further reading:

Thanks to Dr. Pradosh Kumar Sarangi for the corrections.

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About the Author

Dr. Amar Udare, MD, DNB

Dr Amar UdareDr. Amar Udare is a board-certified radiologist. He is currently working as a fellow radiologist at McMaster University, Canada. He has a passion for teaching (#FOAMrad and #FOAMed) and has been a semi-finalist for the 2018 and 2020 Aunt-Minnie Most effective Radiology Educator Awards. He has authored multiple peer-reviewed publications which can be accessed on PubMed and Google Scholar.


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