CT severity index

Both indices grade acute pancreatitis on contrast-enhanced CT, best done 72 hours or more after onset when necrosis is established. Answer either or both sets of questions.

Balthazar gradeA: normal pancreas(0)B: focal or diffuse enlargement of the pancreas(+1)C: pancreatic abnormality with peripancreatic inflammation(+2)D: single peripancreatic fluid collection(+3)E: two or more fluid collections, or gas in or near the pancreas(+4)

Pancreatic necrosis (Balthazar index)None(0)30% or less(+2)Over 30% to 50%(+4)Over 50%(+6)

Modified index: pancreatic inflammationNormal pancreas(0)Intrinsic pancreatic abnormality, with or without peripancreatic inflammation(+2)Pancreatic or peripancreatic fluid collection, or peripancreatic fat necrosis(+4)

Modified index: pancreatic necrosisNone(0)30% or less(+2)Over 30%(+4)

Modified index: extrapancreatic complications

Pleural effusion, ascites, vascular complications, parenchymal organ involvement or gastrointestinal tract involvement.

None(0)One or more(+2)

Enter the values above.

References

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-336.

Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. 2004;183(5):1261-1265.