# Modified CTSI (mCTSI) — Modified CT Severity Index for acute pancreatitis

> Contrast-enhanced-CT index that adds pancreatic inflammation (0, 2 or 4), necrosis (0, 2 or 4) and one noncumulative extrapancreatic-complication term (0 or 2) into an even total from 0 to 10. The valid bands are mild 0-2, moderate 4-6 and severe 8-10; it is not the original Balthazar CTSI, does not equal Revised Atlanta clinical severity and cannot select treatment by itself.

**Situação:** vigente · **Órgão:** Pâncreas · **Órgão emissor:** Mortele et al. / pancreatitis imaging literature · **Versão:** Mortele 2004; imaging timing and clinical-severity boundaries reviewed through 2024 · **Ano:** 2004

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Mortele KJ, Wiesner W, Intriere L, et al.. A modified CT severity index for evaluating acute pancreatitis (2004) — https://doi.org/10.2214/ajr.183.5.1831261
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Use the modified-index even totals and its 0-2, 4-6 and 8-10 bands. Require adequate CECT for necrosis, add extrapancreatic complications once, and keep imaging burden separate from Revised Atlanta clinical severity and treatment.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| mild | Mild mCTSI imaging band (0-2) | Mild modified CT Severity Index imaging band: total 0 or 2, displayed as 0-2. Sum one pancreatic-inflammation value (normal 0; intrinsic abnormality with or without peripancreatic inflammatory fat change 2; pancreatic/peripancreatic fluid collection or peripancreatic fat necrosis 4), one CECT necrosis value (none 0; 30% or less 2; more than 30% 4), and a single extrapancreatic-complication term (none 0; one or more qualifying pleural, ascitic, vascular, extrapancreatic-parenchymal or gastrointestinal complications 2). Odd totals are impossible. | Do not order CT or choose treatment merely from a mild band. If the examination was obtained early, note that necrosis may be underestimated; act on the patient's physiology and any individually reported complication. The 2024 ACG guidance reserves CT mainly for uncertain diagnosis or failure to improve after 48-72 hours. | This is the lowest CT-burden band, not a low-risk guarantee or a personalized event probability. Early CECT can underestimate evolving necrosis, and organ failure or another actionable complication remains clinically important regardless of the aggregate total. | Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, modified-index component table and mild 0-2 group; Mikó et al., PMC6718714, Table 1B reproduction of mCTSI components; Banks et al., DOI 10.1136/gutjnl-2012-302779, CECT timing and separate clinical severity; ACG 2024 guideline highlights, imaging recommendation 3. | ✓ |
| moderate | Moderate mCTSI imaging band (4-6) | Moderate modified CT Severity Index imaging band: total 4 or 6, displayed as 4-6. Calculate the same three components with values 0/2/4 for inflammation, 0/2/4 for necrosis and 0/2 once for any number of qualifying extrapancreatic complications. Exactly 30% necrosis remains in the 2-point necrosis bracket. | Use the component findings and current clinical state, not the word moderate, to plan care. Report necrosis extent, collections and each extrapancreatic complication explicitly; decisions about monitoring level, nutrition, antibiotics, drainage, ERCP or intervention require organ failure, infection, timing, anatomy and multidisciplinary context. | The intermediate CT-burden band is associated with worse outcomes than lower scores in cohorts, but it carries no validated patient-specific probability of ICU admission, intervention, organ failure, length of stay or death. Different component combinations can produce the same total. | Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, modified-index component table and moderate 4-6 group; Mikó et al., PMC6718714, Table 1B and pooled discrimination results; ACG 2024 guideline highlights, management recommendations; Revised Atlanta consensus, DOI 10.1136/gutjnl-2012-302779, organ failure and local complications. | ✓ |
| severe | Severe mCTSI imaging band (8-10) | Severe modified CT Severity Index imaging band: total 8 or 10, displayed as 8-10. The total still uses one inflammation value, one necrosis value and a single noncumulative 2-point extrapancreatic-complication term. A total of 7 is not reachable and belongs to neither the modified-index calculation nor its severe band. | Promptly communicate the actual severe imaging features and complications, but do not let the band autonomously prescribe ICU admission, antibiotics, drainage, necrosectomy or surgery. Management follows hemodynamics, organ failure, infection, hemorrhage, obstruction, collection maturity and current multidisciplinary guidance. | This is the highest mCTSI CT-burden band and correlates with worse cohort outcomes. Meta-analytic AUCs describe population-level discrimination and are not an individual's mortality or organ-failure probability; Revised Atlanta severe clinical pancreatitis still requires persistent organ failure rather than an mCTSI threshold. | Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, severe 8-10 group; Mikó et al., DOI 10.3389/fphys.2019.01002, Table 1B and pooled AUC analysis; Banks et al., DOI 10.1136/gutjnl-2012-302779, severe clinical pancreatitis definition; ACG 2024 guideline highlights, management recommendations. | ✓ |

### Citações por categoria
- **mild**: Mortele KJ, Wiesner W, Intriere L, et al.. A modified CT severity index for evaluating acute pancreatitis (2004) — https://doi.org/10.2214/ajr.183.5.1831261 · Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, modified-index component table and mild 0-2 group; Mikó et al., PMC6718714, Table 1B reproduction of mCTSI components; Banks et al., DOI 10.1136/gutjnl-2012-302779, CECT timing and separate clinical severity; ACG 2024 guideline highlights, imaging recommendation 3.
- **moderate**: Mortele KJ, Wiesner W, Intriere L, et al.. A modified CT severity index for evaluating acute pancreatitis (2004) — https://doi.org/10.2214/ajr.183.5.1831261 · Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, modified-index component table and moderate 4-6 group; Mikó et al., PMC6718714, Table 1B and pooled discrimination results; ACG 2024 guideline highlights, management recommendations; Revised Atlanta consensus, DOI 10.1136/gutjnl-2012-302779, organ failure and local complications.
- **severe**: Mortele KJ, Wiesner W, Intriere L, et al.. A modified CT severity index for evaluating acute pancreatitis (2004) — https://doi.org/10.2214/ajr.183.5.1831261 · Mortele et al., AJR 2004, DOI 10.2214/ajr.183.5.1831261, severe 8-10 group; Mikó et al., DOI 10.3389/fphys.2019.01002, Table 1B and pooled AUC analysis; Banks et al., DOI 10.1136/gutjnl-2012-302779, severe clinical pancreatitis definition; ACG 2024 guideline highlights, management recommendations.

## Referências cruzadas
- _fronteira compartilhada_ → [Revised Atlanta — Revised Atlanta classification of acute pancreatitis](https://radcommons.laudos.ai/systems/atlanta-pancreatitis.md) — mCTSI is an even-valued 0-10 CECT imaging-burden index with 0-2, 4-6 and 8-10 bands. Revised Atlanta clinical severity depends on organ-failure duration and complications; shared severity words are not a numeric crosswalk.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2024-03-01 | revised | The ACG guideline supplied current CT-timing and management context. It does not turn an mCTSI band into an imaging indication or treatment order. | confirmed |
| 2013-01-01 | revised | The Revised Atlanta consensus established the independent, time-dependent clinical severity and morphology framework used here to prevent a silent mCTSI crosswalk; it did not revise the mCTSI point table. | confirmed |
| 2004-11-01 | published | Mortele and colleagues published the modified CT severity index with three even-valued components and the 0-2, 4-6 and 8-10 imaging bands. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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