Balthazar CTSI · Pâncreas

Balthazar CTSI Balthazar grade and original CT Severity Index for acute pancreatitis

vigente

Combines Balthazar morphologic grade A-E (0-4 points) with the extent of nonenhancing pancreatic necrosis on contrast-enhanced CT (0, 2, 4 or 6 points) into an original CTSI total of 0-10.

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Escala de categorias

A B C D E N0 N<30 N30-50 N>50 CTSI-0-3 CTSI-4-6 CTSI-7-10

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Procedência e vigência

Órgão emissor: Balthazar et al. / Radiology
Versão: 1990
Ano: 1990
Família: léxico
Tipo de lógica: score
Modalidade: CT
Fonte primária: Acute pancreatitis: value of CT in establishing prognosis · doi:10.1148/radiology.174.2.2296641
Última verificação: 2026-07-24
Última checagem: 2026-07-24

Lógica de decisão

Forma estruturada (score). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Calculate the original 1990 CTSI only: preserve both components, their points and the exact 0-10 total. Keep modified CTSI and Revised Atlanta severity explicitly separate.

Mostrar a lógica estruturada (JSON)

{
  "applicability": {
    "use_for": "Prognostic CT severity assessment in acute pancreatitis when contrast-enhanced CT adequately depicts pancreatic enhancement and local inflammatory findings.",
    "required_inputs": [
      "Balthazar_morphologic_grade_A_to_E",
      "percentage_of_nonenhancing_pancreatic_parenchyma"
    ],
    "necrosis_definition": "Lack of enhancement of part or all of the pancreatic gland on contrast-enhanced CT."
  },
  "feature_groups": [
    {
      "id": "balthazar_morphologic_grade",
      "choose_one": true,
      "options": [
        {
          "outcome_code": "A",
          "finding": "normal_pancreas",
          "points": 0
        },
        {
          "outcome_code": "B",
          "finding": "focal_or_diffuse_pancreatic_enlargement",
          "points": 1
        },
        {
          "outcome_code": "C",
          "finding": "intrinsic_pancreatic_abnormality_with_peripancreatic_inflammation",
          "points": 2
        },
        {
          "outcome_code": "D",
          "finding": "single_ill_defined_peripancreatic_fluid_collection_or_phlegmon",
          "points": 3
        },
        {
          "outcome_code": "E",
          "finding": "two_or_more_peripancreatic_collections_or_gas_in_or_adjacent_to_pancreas",
          "points": 4
        }
      ]
    },
    {
      "id": "pancreatic_necrosis",
      "choose_one": true,
      "options": [
        {
          "outcome_code": "N0",
          "extent": "none",
          "points": 0
        },
        {
          "outcome_code": "N<30",
          "extent": ">0_and_<30_percent",
          "points": 2
        },
        {
          "outcome_code": "N30-50",
          "extent": "30_to_50_percent_inclusive",
          "points": 4
        },
        {
          "outcome_code": "N>50",
          "extent": ">50_percent",
          "points": 6
        }
      ]
    }
  ],
  "calculation": "Original CTSI = Balthazar morphologic points (0-4) + pancreatic necrosis points (0, 2, 4 or 6); valid total range 0-10.",
  "score_map": [
    {
      "total": "0-3",
      "outcome_code": "CTSI-0-3",
      "interpretation": "lower CT severity band"
    },
    {
      "total": "4-6",
      "outcome_code": "CTSI-4-6",
      "interpretation": "intermediate CT severity band"
    },
    {
      "total": "7-10",
      "outcome_code": "CTSI-7-10",
      "interpretation": "high CT severity band"
    }
  ],
  "reporting_requirements": [
    "report_Balthazar_grade_and_points",
    "report_necrosis_percentage_category_and_points",
    "report_exact_CTSI_total_0_to_10",
    "describe_collections_and_gas_using_current_morphologic_terminology"
  ],
  "do_not_conflate": {
    "modified_CTSI": "The modified CTSI uses a different inflammatory component, only 0/2/4 necrosis points, and adds extrapancreatic complications; do not apply those rules here.",
    "revised_Atlanta_severity": "Mild, moderately severe and severe acute pancreatitis in the Revised Atlanta classification are based chiefly on organ failure and complications, not these CTSI numeric bands."
  },
  "limitations": [
    "CTSI is a prognostic imaging index, not a standalone diagnosis or treatment algorithm.",
    "Necrosis can evolve and may be underestimated on an early examination; retain examination timing and adequacy of enhancement."
  ],
  "source_locator": "Balthazar et al., Radiology 1990;174:331-336, PMID 2296641, original CTSI method and abstract; Balthazar, Radiology 2002;223:603-613, PMID 12034923, clinical/CT context; Revised Atlanta consensus, Gut 2013;62:102-111, DOI 10.1136/gutjnl-2012-302779, for the distinct current clinical severity definitions."
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
A	Balthazar grade A, 0 morphologic points Balthazar morphologic grade A: normal pancreas and no peripancreatic inflammatory abnormality on CT; contributes 0 morphologic points to the original CTSI.	This component does not prescribe treatment. Combine its 0 points with the necrosis component, report the exact CTSI total, and use the result as one prognostic imaging input alongside the patient's clinical status.	Grade A contributes the minimum morphologic burden, but grade A alone is not a mortality or complication estimate because the total CTSI also depends on pancreatic necrosis.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original CTSI morphologic component: normal pancreas=0 points; PMID 2296641.
B	Balthazar grade B, 1 morphologic point Balthazar morphologic grade B: focal or diffuse enlargement of the pancreas, contributing 1 morphologic point to the original CTSI.	This component does not prescribe treatment. Combine its 1 point with the necrosis component, report the exact CTSI total, and use the result as one prognostic imaging input alongside the patient's clinical status.	Grade B contributes 1 point to CT severity, but it is not a standalone outcome-risk estimate; overall risk depends on the complete CTSI and clinical course.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original CTSI morphologic component: focal or diffuse enlargement=1 point; PMID 2296641.
C	Balthazar grade C, 2 morphologic points Balthazar morphologic grade C: intrinsic pancreatic abnormality with inflammatory change in the peripancreatic fat, contributing 2 morphologic points to the original CTSI.	This component does not prescribe treatment. Combine its 2 points with the necrosis component, report the exact CTSI total, and separately describe the current morphology and clinical severity.	Grade C contributes 2 points to CT severity, but it is not a standalone outcome-risk estimate; overall risk depends on the complete CTSI and clinical course.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original CTSI morphologic component: pancreatic abnormality plus peripancreatic inflammation=2 points; PMID 2296641.
D	Balthazar grade D, 3 morphologic points Balthazar morphologic grade D: one ill-defined peripancreatic fluid collection or phlegmon in the original terminology, contributing 3 morphologic points to the original CTSI.	This component does not prescribe treatment. Combine its 3 points with the necrosis component and describe the collection using current acute-pancreatitis morphology and timing rather than relying on the historical term alone.	Grade D contributes 3 points to CT severity, but it is not a standalone outcome-risk estimate; the complete CTSI and clinical course determine prognostic context.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original CTSI morphologic component: single ill-defined collection or phlegmon=3 points; Revised Atlanta consensus, Gut 2013, section on pancreatic/peripancreatic collections, for current terminology.
E	Balthazar grade E, 4 morphologic points Balthazar morphologic grade E: two or more poorly defined peripancreatic fluid collections, or gas in or adjacent to the pancreas, contributing 4 morphologic points to the original CTSI.	This component does not prescribe treatment. Combine its 4 points with the necrosis component; explicitly describe collections, necrotic content and gas because those findings require clinical interpretation beyond the historical grade.	Grade E contributes the maximum 4 morphologic points, but it is not a standalone outcome-risk estimate; the complete CTSI and clinical course determine prognostic context.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original CTSI morphologic component: multiple collections or gas=4 points; Revised Atlanta consensus, Gut 2013, infected-necrosis and collection definitions.
N0	No pancreatic necrosis, 0 necrosis points No pancreatic parenchymal necrosis on an adequately enhanced contrast CT; the pancreatic gland enhances and the necrosis component contributes 0 points.	Add 0 necrosis points to the morphologic points. Absence of visible necrosis does not itself determine disposition or treatment, particularly when examination timing or contrast enhancement is suboptimal.	In the original cohort, patients without necrosis had markedly lower morbidity and no deaths, but this historical cohort result is not an individual prediction.	okfonte Balthazar et al. 1990, PMID 2296641 abstract: necrosis was defined by lack of gland enhancement; patients without necrosis had 6% morbidity and 0% mortality. Original CTSI table assigns 0 points for no necrosis.
N<30	Pancreatic necrosis below 30%, 2 necrosis points More than 0% but less than 30% of the pancreatic parenchyma lacks enhancement on contrast CT; contributes 2 necrosis points to the original CTSI.	Add 2 necrosis points to the morphologic points and report the estimated percentage category. The component quantifies prognostic imaging burden and does not by itself mandate an intervention.	Any pancreatic necrosis increases concern compared with no necrosis, but this component must be interpreted through the total CTSI and the patient's evolving clinical status.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original necrosis component: below 30%=2 points; PMID 2296641 abstract defines necrosis by lack of enhancement and evaluates extent.
N30-50	Pancreatic necrosis 30-50%, 4 necrosis points From 30% through 50% of the pancreatic parenchyma lacks enhancement on contrast CT; contributes 4 necrosis points to the original CTSI.	Add 4 necrosis points to the morphologic points and report the estimated percentage category. The component quantifies prognostic imaging burden and does not by itself mandate an intervention.	The original study associated more than 30% necrosis with serious complications, but the percentage remains one component of a broader clinical assessment.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original necrosis component: 30-50%=4 points; PMID 2296641 abstract states serious complications occurred when more than 30% necrosis was present or developed.
N>50	Pancreatic necrosis above 50%, 6 necrosis points More than 50% of the pancreatic parenchyma lacks enhancement on contrast CT; contributes the maximum 6 necrosis points to the original CTSI.	Add 6 necrosis points to the morphologic points and report the estimated percentage category. The component indicates substantial imaging severity but does not itself specify treatment.	This is the highest necrosis-point category and contributes strongly to a high CTSI; individual prognosis still depends on organ failure, infection and the clinical course.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original necrosis component: greater than 50%=6 points; PMID 2296641 abstract describes the prognostic impact of pancreatic necrosis.
CTSI-0-3	Original CTSI total 0-3, lower CT severity band Original CTSI total from 0 through 3 after adding Balthazar morphologic points and pancreatic-necrosis points; lower CT severity band.	Use the exact total as a prognostic imaging input, not as a treatment algorithm. A lower CTSI does not override organ failure, infection, worsening symptoms or other clinical indicators.	The original study's low-index group had 2% morbidity and no deaths; these cohort figures provide historical context and are not calibrated patient-specific probabilities.	okfonte Balthazar et al. 1990, PMID 2296641 abstract: low CT severity index group had 2% morbidity and no mortality; original CTSI total combines morphologic and necrosis points.
CTSI-4-6	Original CTSI total 4-6, intermediate CT severity band Original CTSI total from 4 through 6 after adding Balthazar morphologic points and pancreatic-necrosis points; intermediate CT severity band.	Use the exact total as a prognostic imaging input, not as a treatment algorithm. Clinical severity and management require assessment of organ failure, complications, infection and trajectory.	This intermediate band lies between the low and high CT-burden groups; the original abstract does not provide a separate patient-level probability for every score in this range.	okfonte Balthazar et al. 1990, Radiology 174:331-336, original 0-10 CTSI construction and prognostic stratification; PMID 2296641.
CTSI-7-10	Original CTSI total 7-10, high CT severity band Original CTSI total from 7 through 10 after adding Balthazar morphologic points and pancreatic-necrosis points; high CT severity band.	Use the exact total as a high-burden prognostic imaging input, not as a treatment algorithm. Escalation decisions require the patient's organ failure, infection, complications and overall clinical course.	The original study's high-index group had 92% morbidity and 17% mortality; these historical cohort figures are context rather than individualized probabilities.	okfonte Balthazar et al. 1990, PMID 2296641 abstract: high CT severity index group had 92% morbidity and 17% mortality; original CTSI total combines morphologic and necrosis points.

Referências cruzadas

fronteira compartilhadaRevised Atlanta. Revised Atlanta classification of acute pancreatitisBalthazar CTSI is a 0-10 imaging prognostic index. Revised Atlanta uses organ failure and local/systemic complications for current clinical severity; identical words such as mild or severe do not make the systems interchangeable.

Histórico de versões

Data	Evento	Detalhe	Situação
2002-06-01	revised	CT Severity Index for acute pancreatitis described.	confirmado
1990-02-01	published	Original CT Severity Index for acute pancreatitis published.	confirmado

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