Comparison of CT Severity Index and Modified CT Severity Index in the Clinical Severity Assessment of Acute Pancreatitis
Keywords:acute pancreatitis, computed tomography severity index (CTSI), determinant-based classification of acute pancreatitis severity, modified computed tomography severity index (MCTSI)
Objective: To compare the computed tomography severity index (CTSI) and the modified computed tomography severity index (MCTSI) in the clinical severity assessment of acute pancreatitis.
Material and Methods: This retrospective cohort study comprised acute pancreatitis patients who underwent contrastenhanced abdominal computed tomography (CT) scans within 4 weeks after clinical onset. Two experienced abdominal radiologists, blinded to the clinical outcome, independently reviewed the CT images and retrospectively scored them using CTSI and MCTSI. Any discrepancies were resolved by a consensus review. The clinical severity assessment of each participant was categorized by the determinant-based classification of acute pancreatitis severity. The correlations of CTSI and MCTSI with the clinical severity assessment were analyzed.
Results: This cohort study consisted of 40 participants—28 of them were men (70.0%)—with a mean age of 59.3 years. They were clinically divided into mild, moderate, severe, and critical groups comprising 11 (27.5%), 16 (40.0%), 7 (17.5%), and 6 (15.0%) participants, respectively. Due to the small number of patients in the severe and critical groups, we combined these into a single severe category (13 patients, 32.5%). The CTSI and MCTSI scores showed moderate and fair agreement with the clinical severity assessment. A trend linking poor clinical outcome with high CTSI/MCTSI scores (moderate and severe groups) more commonly than low scores (mild group) was observed. There was a very strong agreement between CTSI and MCTSI (rs=0.97).
Conclusion: CTSI and MCTSI showed a moderate and fair agreement, respectively, with the clinical severity assessment. Compared to low scores, a poor clinical outcome was more often associated with high CTSI/MCTSI scores.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 2012;262:751-64.
Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013;108:1400-16.
Mao L, Qiu Y. The classification of acute pancreatitis: current status. Intractable Rare Dis Res 2012;1:134-7.
Dellinger EP, Forsmark CE, Layer P, L vy P, Marav -Poma E, Petrov MS, et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg 2012;256:875-80.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendon a A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331-6.
Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002;223:603-13.
Mortele KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Renal and perirenal space involvement in acute pancreatitis: spiral CT findings. Abdom Imaging 2000;25:272-8.
Wiesner W, Studler U, Kocher T, Degen L, Buitrago-Tellez CH, Steinbrich W. Colonic involvement in non-necrotizing acute pancreatitis: correlation of CT findings with the clinical course of affected patients. Eur Radiol 2003;13:897-902.
Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas 2000;20:319-22.
Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am J Roentgenol 2004;183:1261-5.
Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, et al. Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. Am J Roentgenol 2011;197:386-92.
Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med 2018;18:91-3.
Meyrignac O, Lagarde S, Bournet B, Mokrane FZ, Buscail L, Rousseau H, et al. Acute pancreatitis: extrapancreatic necrosis volume as early predictor of severity. Radiology 2015;276:119- 28.
Pamies-Guilabert J, Del Val Anto ana A, Collado JJ, Rudenko P, Meseguer A. Pancreatic necrosis volume - A new imaging biomarker of acute pancreatitis severity. Eur J Radiol 2020; 130:109193.
Monreal-Robles R, Kohn-Guti rrez AE, Sordia-Ram rez J, Z iga-Segura JA, Palafox-Salinas JA, de la Rosa-Pacheco S, et al. Peritoneal cavity circumference on computed tomography predicts outcomes in acute pancreatitis. Eur J Radiol 2020;132:109327.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.