Radiology Tutor

by Jonathan Colledge

Pancreatitis CT severity index

Tick the boxes that apply

	CTSI (1)	Modified CTSI (2)
Is the pancreas normal?	0	0
Is the pancreas enlarged?	1	2
Is there inflammation of the pancreas	2	2
Is there peripancreatic fat inflammation?	2	0
Is there a fluid collection?	3	4
Are ≥2 fluid collections present or is there retroperitoneal gas?	4	4

What percentage of the pancreas is necrotic, if any?
	CTSI (1)	Modified CTSI (2)
No necrosis	0	0
≤30%	2	2
>30%-50%	4	4
>50%	6	4

Are complications* present?	Modified CTSI only: add 2

*Includes: ascites, pleural effusion, vascular complications (thrombosis, haemorrhage, pseudoaneurysm), other organ parenchymal complication, GI complications.

CTSI =

Modified CTSI =

Interpretation

Standard CTSI: mild: 0-3 points, moderate: 4-6 points, severe: 7-10 points.

Modified CTSI: mild: 0-2 points, moderate: 4-6 points, severe: 8-10 points.

Points are not additive within each section - the highest score from the pancreatic score and necrosis score are added. An additional 2 points are added to the modified score is complications are present.

Before using this calculator the reader should familiarise him or herself with references 1 and 2. The calculator works by asking questions common to the standard and modified CT severity index. Interpretation errors may exist depending on the data the user chooses to enter, for example, pancreatic enlargement (included in the standard index) is interpreted as an intrinsic pancreatic abnormality for the purpose of calculating the modified index. Also, it should be noted that no score is assigned to peripancreatic fat inflammation in the modified system unless it is necrotic.

Multiple scoring systems are available for assessing the severity of pancreatitis. All have their shortfalls. The APACHE II score is a commonly used scoring system that predicts mortality, however, it predicts local complications less well(3). The CT severity index predicts mortality less accurately, but better predicts local complications(4). When modified the CT severity index provides better correlation with patient outcome(2) although comparison with the APACHE II score has not been made. The CT severity scoring system is provided for reference and demonstrates the usefulness of CT in not only diagnosing complications, but predicting possible future complications.

References

Balthazar, E. J., Robinson, D. L., Megibow, A. J. & Ranson, J. H. Acute pancreatitis: value of CT in establishing prognosis. Radiology 174, 331–336 (1990).
Mortele, K. J. et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Ajr Am. J. Roentgenol. 183, 1261–1265 (2004).
Lankisch, P. G. et al. The APACHE II score is unreliable to diagnose necrotizing pancreatitis on admission to hospital. Pancreas 24, 217–222 (2002).
Gates, L. K., Jr. Severity scoring for acute pancreatitis: where do we stand in 1999? Curr. Gastroenterol. Rep. 1, 134–138 (1999).

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