| Aspect | CT Severity Index (CTSI) | Modified CT Severity Index (Modified CTSI) |
|---|---|---|
| Development | Developed by Balthazar et al. in 1990. | An enhanced version of CTSI, addressing limitations of the original index. |
| Purpose | To classify acute pancreatitis into mild, moderate, and severe categories. | To better predict patient outcomes, including hospital stay and organ failure risks. |
| Key Components | Combines Balthazar Score (pancreatic inflammation) and Pancreatic Necrosis Score. | Adds Extrapancreatic Complications to the original components. |
| Limitations | – Poor correlation with organ failure. – Interobserver variability. – Redundant necrosis scoring. | Designed to overcome these limitations, providing a more accurate assessment. |
Scoring Systems
CT Severity Index (CTSI)
| Component | Score |
|---|---|
| Balthazar Score (Inflammation) | – A: Normal pancreas – 0 – B: Pancreatic enlargement – 1 – C: Inflammatory changes – 2 – D: Single fluid collection – 3 – E: Multiple fluid collections – 4 |
| Pancreatic Necrosis | – None – 0 – ≤30% – 2 – >30-50% – 4 – >50% – 6 |
| Total Score | 0-3: Mild 4-6: Moderate 7-10: Severe |
Modified CT Severity Index (Modified CTSI)
| Component | Score |
|---|---|
| Pancreatic Inflammation | – 0: Normal pancreas – 2: Intrinsic abnormalities ± peripancreatic fat changes – 4: Fluid collection or fat necrosis |
| Pancreatic Necrosis | – 0: None – 2: ≤30% – 4: >30% |
| Extrapancreatic Complications | – 2: Pleural effusion, ascites, vascular/parenchymal complications, gastrointestinal involvement |
| Total Score | 0-2: Mild 4-6: Moderate 8-10: Severe |
Key Differences Between CTSI and Modified CTSI
| Feature | CTSI | Modified CTSI |
|---|---|---|
| Necrosis Scoring | Includes >30-50% and >50% categories. | Simplifies necrosis scoring to ≤30% and >30%. |
| Extrapancreatic Complications | Not included. | Included, adding 2 points for complications like pleural effusion, ascites, etc. |
| Clinical Correlation | Less accurate in predicting organ failure and hospital stay. | Better correlates with patient outcomes, including organ failure and hospital stay. |
Clinical Applications
- CTSI: Useful for initial assessment but has limitations in predicting complications.
- Modified CTSI: More reliable for predicting patient outcomes, especially in severe cases.
Keywords:
- CT Severity Index in Acute Pancreatitis
- Modified CT Severity Index
- Pancreatitis Severity Scoring
- Balthazar Score
- Pancreatic Necrosis Scoring
- Acute Pancreatitis Treatment
- Pancreatitis Imaging
- Organ Failure in Pancreatitis
