CT Normal Pancreas Vs Acute Pancreatitis | Balthazar Modified CT Severity Index (MCTSI) Scoring

CT Normal Pancreas Vs Acute Pancreatitis | Balthazar Modified CT Severity Index (MCTSI) Scoring

*Cases

Normal Pancreas - 0:00
MCTSI - 2:06
Interstitial Edematous Pancreatitis (IEP) - 6:54
Autoimmune Pancreatitis - 18:05
Necrotizing Pancreatitis - 19:41

Normal Pancreas:
- Gland Length: 15-20 cm
- Width: Head - 3cm, Body - 2.5cm, Tail - 2cm
- Inflammation Score: 0 (Normal); Necrosis: None - 0
- MCTSI Score: 0

The CT Severity Index (CTSI) is a scoring system used to assess the severity of acute pancreatitis based on CT findings. It combines the Balthazar grading of pancreatic inflammation and the extent of pancreatic necrosis. This index helps predict the prognosis and potential complications of acute pancreatitis.

The CTSI is calculated by summing the points from the Balthazar grading and the necrosis score.

The Modified CT Severity Index (MCTSI) is an adaptation of the original CTSI, designed to provide a more comprehensive assessment of the severity of acute pancreatitis by including both pancreatic and extrapancreatic complications. It adds more emphasis on the extrapancreatic manifestations of the disease.

MCTSI:
Pancreatic Inflammation (0-4 points)
Pancreatic Necrosis (0-6 points)
Extrapancreatic Complications (0-2 points)

Calculating Modified CTSI: Pancreatic Inflammation (0-4 points)
Normal pancreas (0 points)
Intrinsic pancreatic abnormalities with or without inflammatory changes in peripancreatic fat (2 points)
Peripancreatic fluid collection or peripancreatic fat stranding (4 points)

Calculating Modified CTSI: Pancreatic Necrosis (0-6 points)
None (0 points)
Less than 30% (2 points)
Greater than 30% (4 points)

Calculating Modified CTSI: Extrapancreatic Complications (0-2 points)
One or more of pleural effusion, ascites, vascular complications (e.g., thrombosis), parenchymal complications (e.g., renal or hepatic failure), or gastrointestinal tract involvement (e.g., perforation) (2 points)

The MCTSI is calculated by summing the points from pancreatic inflammation, pancreatic necrosis, and extrapancreatic complications.
0-2 points: Mild pancreatitis
4-6 points: Moderate pancreatitis
8-10 points: Severe pancreatitis