Skip to main content
Log in

Acute pancreatitis: radiologic scores in predicting severity and outcome

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Acute pancreatitis (AP) is a common inflammatory disease which can be mild and self-limiting without complications or severe with prolonged hospitalization, high morbidity, and high mortality. Different radiological scoring systems to predict severity and outcome in AP have been developed since the early 1990s. In the meantime, new insights in the pathophysiology of AP and consequently, therapeutic management of these patients have been introduced. The purpose of this review is therefore (1) to describe the current terminology and new concepts in the pathophysiology, (2) to outline the long existing and newly developed radiological scoring systems in prediction of severity and outcome with their respective advantages and limitations, and (3) to define the role of radiological prognostic scoring systems in the new environment of perception of the last decade. Risk stratification in AP requires scoring systems that can be calculated early in the course of disease which allows time for intervention. For that reason, scoring systems based on necrosis are not useful in severity prediction. The recent developed radiological scoring systems based on signs of systemic inflammatory response syndrome and organ dysfunction are promising in prediction of severity early after onset of AP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Knoepfli AS, Kinkel K, Berney T, et al. Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis? Abdom Imaging 2007;1:111-115.

    Article  Google Scholar 

  2. Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. The Lancet 2000;9219:1955-1960.

    Article  Google Scholar 

  3. Whitcomb DC. Acute Pancreatitis. N Engl J Med 2006;20:2142-2150.

    Article  Google Scholar 

  4. Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician 2007;10:1513-1520.

    Google Scholar 

  5. Mitchell RMS, Byrne MF, Baillie J. Pancreatitis. The Lancet 2003;9367:1447-1455.

    Article  CAS  Google Scholar 

  6. Isenmann R, Beger HG. Natural history of acute pancreatitis and the role of infection. Best Practice & Research in Clinical Gastroenterology 1999;2:291-301.

    Article  Google Scholar 

  7. McKay CJ, Buter A. Natural history of organ failure in acute pancreatitis. Pancreatology 2003;2:111-114.

    Article  Google Scholar 

  8. Papachristou GI, Clermont G, Sharma A, Yadav D, Whitcomb DC. Risk and Markers of Severe Acute Pancreatitis. Gastroenterology Clinics of North America 2007;2:277-296.

    Article  Google Scholar 

  9. McKay CJ, Imrie CW. The continuing challenge of early mortality in acute pancreatitis. Br J Surg 2004;10:1243-1244.

    Article  Google Scholar 

  10. Bradley EL. A Clinically Based Classification-System for Acute-Pancreatitis - Summary of the international symposium on Acute-Pancreatitis, Atlanta, Ga, September 11 Through 13, 1992. Archives of Surgery 1993;5:586-590.

    Google Scholar 

  11. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994;2:297-306.

    Google Scholar 

  12. Banks PA, Freeman ML. Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006;10:2379-2400.

    Article  Google Scholar 

  13. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. British Journal of Surgery 2002;3:298-302.

    Article  Google Scholar 

  14. Papachristou GI, Whitcomb DC. Predictors of severity and necrosis in acute pancreatitis. Gastroenterol Clin North Am 2004;4:871-890.

    Article  Google Scholar 

  15. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995;10:1638-1652.

    Article  Google Scholar 

  16. Vincent JL, Moreno R, Takala J, 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;7:707-710.

    Article  Google Scholar 

  17. De Campos T, Cerqueira C, Kuryura L, et al. Morbimortality indicators in severe acute pancreatitis. JOP 2008;6:690-697.

    Google Scholar 

  18. Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;1:69-81.

    Google Scholar 

  19. Mofidi R, Patil PV, Suttie SA, Parks RW. Risk assessment in acute pancreatitis. Br J Surg 2009;2:137-150.

    Article  Google Scholar 

  20. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;9:1340-1344.

    Article  Google Scholar 

  21. Mofidi R, Duff MD, Wigmore SJ, et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. British Journal of Surgery 2006;6:738-744.

    Article  Google Scholar 

  22. Beger HG, Bittner R, Block S, Buchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 1986;2:433-438.

    Google Scholar 

  23. Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009;3:267-273.

    Article  Google Scholar 

  24. Swaroop VS, Chari ST, Clain JE. Severe acute pancreatitis. JAMA 2004;23:2865-2868.

    Article  Google Scholar 

  25. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;10:818-829.

    Article  Google Scholar 

  26. Balthazar EJ. Acute pancreatitis: Assessment of severity with clinical and CT evaluation. Radiology 2002;3:603-613.

    Article  Google Scholar 

  27. De Sanctis JT, Lee MJ, Gazelle GS, et al. Prognostic indicators in acute pancreatitis: CT vs APACHE II. Clin Radiol 1997;11:842-848.

    Article  Google Scholar 

  28. Balthazar EJ, Ranson JHC, Naidich DP, et al. Acute-Pancreatitis - Prognostic Value of Ct. Radiology 1985;3:767-772.

    Google Scholar 

  29. Merkle EM, Gorich J. Imaging of acute pancreatitis. Eur Radiol 2002;8:1979-1992.

    Google Scholar 

  30. Isenmann R, Buchler M, Uhl W, et al. Pancreatic necrosis: an early finding in severe acute pancreatitis. Pancreas 1993;3:358-361.

    Article  Google Scholar 

  31. Bollen TL, van Santvoort HC, Besselink MGH, et al. Update on acute pancreatitis: Ultrasound, computed tomography, and magnetic resonance Imaging features. Seminars in Ultrasound Ct and Mri 2007;5:371-383.

    Article  Google Scholar 

  32. Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointestinal Endoscopy 2002;1:7-17.

    Article  Google Scholar 

  33. Baron TH, Morgan DE, Vickers SM, Lazenby AJ. Organized pancreatic necrosis: endoscopic, radiologic, and pathologic features of a distinct clinical entity. Pancreas 1999;1:105-108.

    Article  Google Scholar 

  34. Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996;3:755-764.

    Article  Google Scholar 

  35. Werner J, Feuerbach S, Uhl W, Buchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut 2005;3:426-436.

    Article  Google Scholar 

  36. Uhl W, Warshaw A, Imrie C, Bassi C, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology 2002;6:565-573.

    Article  Google Scholar 

  37. Bollen TL, van Santvoort HC, Besselink MG, et al. The Atlanta Classification of acute pancreatitis revisited. Br J Surg 2008;1:6-21.

    Article  Google Scholar 

  38. Acosta JM, Katkhouda N, Debian KA, et al. Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg 2006;1:33-40.

    Article  Google Scholar 

  39. Mortelé KJ, Banks PA, Silverman SG. State-of-the-art imaging of acute pancreatitis. JBR-BTR 2003;4:193-208.

    Google Scholar 

  40. Mortelé KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features. J Comput Assist Tomogr 2001;1:50-54.

    Article  Google Scholar 

  41. Mortelé KJ, Mergo PJ, Taylor HM, et al. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol 2004;1:67-72.

    Article  Google Scholar 

  42. Mortelé 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;5:1261-1265.

    Google Scholar 

  43. Neff R. Pancreatic pseudocysts and fluid collections: percutaneous approaches. Surg Clin North Am 2001;2:399-403.

    Article  Google Scholar 

  44. Casas JD, Diaz R, Valderas G, Mariscal A, Cuadras P. Prognostic value of CT in the early assessment of patients with acute pancreatitis. AJR Am J Roentgenol 2004;3:569-574.

    Google Scholar 

  45. Ju S, Chen F, Liu S, Zheng K, Teng G. Value of CT and clinical criteria in assessment of patients with acute pancreatitis. Eur J Radiol 2006;1:102-107.

    Article  Google Scholar 

  46. London NJ, Neoptolemos JP, Lavelle J, Bailey I, James D. Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: a prospective study. Br J Surg 1989;3:268-272.

    Article  Google Scholar 

  47. Rotman N, Chevret S, Pezet D, et al. Prognostic value of early computed tomographic scans in severe acute pancreatitis. French Association for Surgical Research. J Am Coll Surg 1994;5:538-544.

    Google Scholar 

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

    Google Scholar 

  49. Beger HG, Buchler M. Surgical therapy of acute pancreatitis. A status determination. Med Klin (Munich) 1986;8:281-285.

    Google Scholar 

  50. Block S, Maier W, Bittner R, et al. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut 1986;9:1035-1042.

    Article  Google Scholar 

  51. Bradley EL, 3rd, Murphy F, Ferguson C. Prediction of pancreatic necrosis by dynamic pancreatography. Ann Surg 1989;4:495-503; discussion 503-494.

    Article  Google Scholar 

  52. Runzi M, Raptopoulos V, Saluja AK, et al. Evaluation of necrotizing pancreatitis in the opossum by dynamic contrast-enhanced computed tomography: correlation between radiographic and morphologic changes. J Am Coll Surg 1995;6:673-682.

    Google Scholar 

  53. Johnson CD, Stephens DH, Sarr MG. CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis. American Journal of Roentgenology 1991;1:93-95.

    Google Scholar 

  54. Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg 1997;2:130-135.

    Article  Google Scholar 

  55. Lankisch PG, Struckmann K, Assmus C, et al. Do We Need a Computed Tomography Examination in All Patients with Acute Pancreatitis within 72 h after Admission to Hospital for the Detection of Pancreatic Necrosis? Scandinavian Journal of Gastroenterology 2001;4:432-436.

    Article  Google Scholar 

  56. Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg 2000;5:352-355.

    Article  Google Scholar 

  57. Leung TK, Lee CM, Lin SY, et al. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol 2005;38:6049-6052.

    Google Scholar 

  58. Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg 2005;4:497-502.

    Article  Google Scholar 

  59. Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C. Acute Pancreatitis: Interobserver Agreement and Correlation of CT and MR Cholangiopancreatography with Outcome. Radiology 1999;3:727-735.

    Google Scholar 

  60. Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas 2000;3:319-322.

    Article  Google Scholar 

  61. Kaya E, Dervisoglu A, Polat C. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World J Gastroenterol 2007;22:3090-3094.

    Google Scholar 

  62. Mortelé KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Renal and perirenal space involvement in acute pancreatitis: spiral CT findings. Abdom Imaging 2000;3:272-278.

    Google Scholar 

  63. Wiesner W, Studler U, Kocher T, et al. Colonic involvement in non-necrotizing acute pancreatitis: correlation of CT findings with the clinical course of affected patients. Eur Radiol 2003;4:897-902.

    Google Scholar 

  64. McMenamin DA, Gates LK. A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis. American Journal of Gastroenterology 1996;7:1384-1387.

    Google Scholar 

  65. Schmidt J, Hotz HG, Foitzik T, et al. Intravenous Contrast-Medium Aggravates the Impairment of Pancreatic Microcirculation in Necrotizing Pancreatitis in the Rat. Annals of Surgery 1995;3:257-264.

    Article  Google Scholar 

  66. De Waele JJ, Delrue L, Hoste EA, et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis - Evaluation of a new scoring system. Pancreas 2007;2:185-190.

    Article  Google Scholar 

  67. Delrue L. Validation of the EPIC score in patients with severe acute pancreatitis. Radiological Society of North America (RSNA); Chicago, USA: American Association of Physicist in Medicine; 2008. p. 106.

    Google Scholar 

  68. Schröder T, Kivisaari L, Somer K, et al. Significance of extrapancreatic findings in computed tomography (CT) of acute pancreatitis. Eur J Radiol 1985;4:273-275.

    Google Scholar 

  69. Ishikawa K, Idoguchi K, Tanaka H, et al. Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes. Eur J Radiol 2006;3:445-452.

    Article  Google Scholar 

  70. Hjelmqvist B, Wattsgard C, Borgstrom A, et al. Early diagnosis and classification in acute pancreatitis. A comparison of clinical outcome with findings at computed tomography and Ranson’s prognostic signs. Digestion 1989;4:177-183.

    Article  Google Scholar 

  71. King NK, Powell JJ, Redhead D, Siriwardena AK. A simplified method for computed tomographic estimation of prognosis in acute pancreatitis. Scand J Gastroenterol 2003;4:433-436.

    Article  Google Scholar 

  72. Ueda T, Takeyama Y, Yasuda T, et al. Simple scoring system for the prediction of the prognosis of severe acute pancreatitis. Surgery 2007;1:51-58.

    Article  Google Scholar 

  73. Neoptolemos JP, Raraty M, Finch M, Sutton R. Acute pancreatitis: the substantial human and financial costs. Gut 1998;6:886-891.

    Article  Google Scholar 

  74. Arvanitakis M, Delhaye M, De Maertelaere V, et al. Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 2004;3:715-723.

    Article  Google Scholar 

  75. De Waele JJ, Blot SI. Severity prediction in acute pancreatitis using the CT severity index. A self-fulfilling prophecy. JOP 2006;4:432-433 author reply 433-434.

    Google Scholar 

  76. Finley JW. Respiratory complications of acute pancreatitis. Am Surg 1969;8:591-598.

    Google Scholar 

  77. Lankisch PG, Struckmann K, Lehnick D. Presence and extent of extrapancreatic fluid collections are indicators of severe acute pancreatitis. Int J Pancreatol 1999;3:131-136.

    Article  Google Scholar 

  78. Fischer JE, Bachmann LM, Jaeschke R. A readers’ guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Med 2003;7:1043-1051.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Louke J. Delrue.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delrue, L.J., De Waele, J.J. & Duyck, P.O. Acute pancreatitis: radiologic scores in predicting severity and outcome. Abdom Imaging 35, 349–361 (2010). https://doi.org/10.1007/s00261-009-9522-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-009-9522-y

Keywords

Navigation