ACUTE PANCREATITIS

CT severity index as prognostic factor

Dr Sri Inggriani Sp Rad.
Department of Diagnostic Imaging
MEDISTRA HOSPITAL
JAKARTA .

Severe Pancreatitis :
Pancreatic changes: difuse enlargement with focal or difuse area of
unenhanced pancreatic parenchyma due to pancreas necrosis.
Peripancreatic changes : acute fluid collections and exudates formation
around the gland which located typically in :
- lesser sac
- left anterior pararenal space
- posterior pararenal space
- perirenal space
- mesocolon and mesentery
- psoas muscle
- pelvis
- posterior mediastinal mass

Diagram of intraperitoneal and retroperitoneal spaces

PROGNOSTIC INDEX
5. CT Scan
Balthazar scoring system ( 1985 )
Grade A = normal appearing pancreas
Grade B = focal or difuse enlargement of the pancreas
Grade C = pancreatic gland abnormalities asociated with
peripancreatic fat infiltration
Grade D = a single fluid collection
Grade E = two or more fluid collections

Grade A-B-C = Mild acute pancreatitis

Grade D-E
= Severe acute pancreatitis

PROGNOSTIC INDEX
CT SEVERITY INDEX ( CTSI ): Balthazar EJ, Radiology 1990, 174:331:6

plus
10 points .

based on Balthazar score

with maximum score of

pancreatic necrosis ,

PROGNOSTIC INDEX
CT SEVERITY INDEX (CTSI)
Balthazar EJ, Radiology 1990, 174:331:6

Index point

Morbidity(%)

Mortality(%)

<3
Mild Disease

8%

3%

4-6
Moderate

35%

6%

7-10
Severe

92%

17%

Sensitivity 92%, Spesificity 100% (Clavien et al)

Sensitivity 80-90 % ( Balthazar et al)

PROGNOSTIC INDEX
MODIFIED CT SEVERITY INDEX.
(Koenrad J Mortele et al. 2004 )

0-2points = mild , 4-6 points= moderate , 8-10 points = severe

(AJR 183 ( 5) :1261-1265,2004).