Balthazar Score (CTSI)
CT severity index for evaluating acute pancreatitis.
The Balthazar Score (CTSI): CT Evaluation of Pancreatitis
The CT Severity Index (CTSI), universally known as the Balthazar Score, was developed in 1990. It is the radiologic standard for assessing the severity of acute pancreatitis using contrast-enhanced computed tomography (CT). Unlike clinical scores (like Ranson) that assess systemic response, the CTSI directly evaluates local organ damage.
How does the CTSI work?
The CTSI score, out of 10 points, is the sum of two distinct components observed on the CT scan, usually performed 48 to 72 hours after symptom onset:
- The Balthazar Radiologic Grade (0 to 4 points): Evaluates the extent of pancreatic and peripancreatic inflammation.
- The Percentage of Necrosis (0 to 6 points): Evaluates the portion of the gland that does not enhance after contrast injection, indicating tissue death.
The Importance of Necrosis
The presence of pancreatic necrosis drastically increases the risk of complications (infection, sepsis) and prolongs hospitalization. Infected necrosis (often marked by the presence of gas - Grade E) frequently justifies the introduction of broad-spectrum antibiotics like carbapenems (e.g., Imipenem) and drainage.
Interpretation of CTSI
| CTSI Score | Severity | Morbidity / Mortality |
|---|---|---|
| 0 - 3 pts | Mild Pancreatitis | 8 % / 3 % |
| 4 - 6 pts | Moderate Pancreatitis | 35 % / 6 % |
| 7 - 10 pts | Severe Pancreatitis | 92 % / 17 % |
References:
1. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-336.
[Radiology Journal]
2. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603-613.
[RSNA - Radiology]
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