Skip to main content
SpringerLink
Log in

Imaging of Acute Pancreatitis According to the Revised Atlanta Classification

  • Gastrointestinal Imaging (Jeffrey D. Olpin, Section Editor)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Accurate detection and characterization of acute pancreatitis plays an increasing importantly role in modern clinical practice. In years past, there has been a lack of standardization in the nomenclature of acute pancreatitis amongst radiologists, leading to ambiguous and often misleading information being conveyed to referring clinicians.

Recent Findings

In an effort to standardize the nomenclature of acute pancreatitis, the Acute Pancreatitis Classification Working Group was established with the goal of revising the 1992 Atlanta Classification System for acute pancreatitis. The group assembled internationally renowned pancreatic experts with the goal of codifying the descriptive terminology associated with the imaging of acute pancreatitis. Following several revisions, the Revised Atlanta Classification (RAC) system was finalized in 2012.

Summary

As outlined in the 2012 RAC, acute pancreatitis is now divided into two distinct imaging categories, interstitial edematous pancreatitis and necrotizing pancreatitis, based upon the absence or presence of necrosis, respectively. Additionally, four subtypes were proposed to further characterize the nature and chronicity of pancreatitis-associated fluid collections: acute peripancreatic fluid collections and pseudocysts in the setting of interstitial edematous pancreatitis, and acute necrotic collections and walled-off necrosis in the setting of necrotizing pancreatitis. Generic, non-specific terms such as pancreatic abscess have subsequently fallen out of favor. Implementation of the classification system optimizes communication between radiologists and clinicians in the clinical management of acute pancreatitis and associated complications. This article provides an image-rich overview of various manifestations of acute pancreatitis according to the RAC classification.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. • Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA. 2021;325(4):382–90. This article provides the most up-to-date clinical overview of the acute pancreatitis, including a discussion of the Revised Atlanta Classification for non-radiologists

  2. •• Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta classification for acute pancreatitis: a pictorial essay. Radiographics. 2016;36(3):675–87. This article provides the most comprehensive overview of the imaging of acute pancreatitis according to the Revised Atlanta Classification for clinical radiologists

  3. Roxvall L, Bengtson A, Sennerby L, Heideman M. Activation of the complement cascade by trypsin. Biol Chem Hoppe Seyler. 1991;372(4):273–8.

    Article  PubMed  CAS  Google Scholar 

  4. Uehara S, Honjyo K, Furukawa S, Hirayama A, Sakamoto W. Role of the Kallikrein-Kinin system in human pancreatitis. Adv Exp Med Biol. 1989;247B:643–8.

    Article  PubMed  CAS  Google Scholar 

  5. Harvey MH, Wedgwood KR, Austin JA, Reber HA. Pancreatic duct pressure, duct permeability and acute pancreatitis. Br J Surg. 1989;76(8):859–62.

    Article  PubMed  CAS  Google Scholar 

  6. 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(1):102–11.

    Article  PubMed  Google Scholar 

  7. Bollen TL, Besselink MG, van Santvoort HC, Gooszen HG, van Leeuwen MS. Toward an update of the Atlanta classification on acute pancreatitis: review of new and abandoned terms. Pancreas. 2007;35(2):107–13.

    Article  PubMed  Google Scholar 

  8. Baker ME, Nelson RC, Rosen MP, Blake MA, Cash BD, Hindman NM, et al. ACR appropriateness criteria(R) acute pancreatitis. Ultrasound Q. 2014;30(4):267–73.

    Article  PubMed  Google Scholar 

  9. Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. N Engl J Med. 2016;375(20):1972–81.

    Article  PubMed  CAS  Google Scholar 

  10. Krishna SG, Kamboj AK, Hart PA, Hinton A, Conwell DL. The changing epidemiology of acute pancreatitis hospitalizations: a decade of trends and the impact of chronic pancreatitis. Pancreas. 2017;46(4):482–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015;386(9988):85–96.

    Article  PubMed  Google Scholar 

  12. Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, et al. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics. 2014;34(5):1218–39.

    Article  PubMed  Google Scholar 

  13. Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751–64.

    Article  PubMed  Google Scholar 

  14. Harris HW, Barcia A, Schell MT, Thoeni RF, Schecter WP. Necrotizing pancreatitis: a surgical approach independent of documented infection. HPB (Oxford). 2004;6(3):161–8.

    Article  CAS  Google Scholar 

  15. Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. AJR Am J Roentgenol. 2008;190(3):643–9.

    Article  PubMed  Google Scholar 

  16. Kamal A, Singh VK, Akshintala VS, Kawamoto S, Tsai S, Haider M, et al. CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012. Abdom Imaging. 2015;40(6):1608–16.

    Article  PubMed  Google Scholar 

  17. Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176–94.

    Article  PubMed  Google Scholar 

  18. Tuney D, Altun E, Barlas A, Yegen C. Pancreatico-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water soluble contrast media. JOP. 2008;9(1):26–9.

    PubMed  Google Scholar 

  19. Turkvatan A, Erden A, Turkoglu MA, Secil M, Yuce G. Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis. Diagn Interv Imaging. 2015;96(2):161–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dr. Hani Abujudeh for reviewing the manuscript.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Utah Health Sciences Center, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT, 84132, USA

    Jeffrey D. Olpin & April Griffith

Authors
  1. Jeffrey D. Olpin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. April Griffith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey D. Olpin.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Research Involving Human and Animal Participants

The article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Gastrointestinal Imaging.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olpin, J.D., Griffith, A. Imaging of Acute Pancreatitis According to the Revised Atlanta Classification. Curr Radiol Rep 10, 140–149 (2022). https://doi.org/10.1007/s40134-022-00402-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40134-022-00402-z

Keywords

Search

Navigation