Mortele Modified CT Severity Index (CTSI)for scoring acute pancreatitis
| Prognostic Indicator | Points |
|---|---|
| Pancreatic Inflammation | |
| Normal pancreas | 0 |
| Intrinsic pancreatic abnormalities with or without inflammatory changes in peripancreatic fat. | 2 |
| Pancreatic or peripancreatic fluid collection or peripancreatic fat necrosis | 4 |
| Pancreatic Necrosis | |
| None | 0 |
| ≤ 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 pancreatitis | Duration | Collections | CT description |
|---|---|---|---|
| Interstitial edematous pancreatitis | < 4 weeks | Acute Peripancreatic Fluid Collections (APFC) | Homogeneous fluid density collection confined by normal peripancreatic fascial planes. No definable wall encapsulating. Adjacent to the pancreas (no intrapancreatic extension) |
| >4 weeks | Pseudocyst | Well circumscribed, usually round or oval homogeneous fluid density. No non-liquid component. Well defined wall; completely encapsulated | |
| Necrotizing pancreatitis | < 4 weeks | Acute Necrotic Collections (ANC) | 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 weeks | Walled-off Necrosis (WON | Heterogeneous, 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:
- A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome.
- Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay
Thanks to Dr. Pradosh Kumar Sarangi for the corrections.
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Dr. Amar Udare, MD, DNB
Dr. Amar Udare is a board-certified radiologist. He is a clinical assistant professor at the University of Calgary. 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.