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

based on Balthazar score plus pancreatic necrosis ,

with maximum score of 10 points .

CT SEVERITY INDEX (CTSI)

Balthazar EJ, Radiology 1990, 174:331:6

Sensitivity 92%, Spesificity 100% (Clavien et al)Sensitivity 80-90 % ( Balthazar et al)

PROGNOSTIC INDEX

Index pointMorbidity(%)Mortality(%) < 3Mild Disease8%3%4-6Moderate35%6%7-10Severe 92%17%

MODIFIED CT SEVERITY INDEX.

(Koenrad J Mortele et al. 2004 )

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

PROGNOSTIC INDEX

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