Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 514

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

 Table of Contents    
LETTER TO THE EDITOR  
Year : 2018  |  Volume : 28  |  Issue : 3  |  Page : 374-375
Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index


1 Department of Radiology, Pacific Medical College and Hospital, Udaipur, Rajasthan, India
2 Jhalawar Medical College, Rajasthan, India

Click here for correspondence address and email

Date of Web Publication26-Sep-2018
 

How to cite this article:
Aswani Y, Singh PK. Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index. Indian J Radiol Imaging 2018;28:374-5

How to cite this URL:
Aswani Y, Singh PK. Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index. Indian J Radiol Imaging [serial online] 2018 [cited 2020 May 25];28:374-5. Available from: http://www.ijri.org/text.asp?2018/28/3/374/242179


Sir,

We read with great interest the article titled “Severity assessment of acute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the Revised Atlanta Classification” by Sahu et al. published in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The manuscript is highly informative. We, however, would like to make the following pertinent observations.

One of the principal aims of the present study [1] was to calculate the degree of concordance between the CT scoring indices and the clinical grading as per the Revised Atlanta Classification for Acute Pancreatitis. The former included CT Severity Index (CTSI) and Modified CT Severity Index (MCTSI), both of which generate a score based on CECT findings, thus, stratifying acute pancreatitis (AP) as mild, moderate, or severe. Revised Atlanta Classification for Acute Pancreatitis revolutionized the management of AP by simplifying clinical as well as morphological classifications and coining newer nomenclature for radiological findings to bring in more objectivity.[1],[2] Naturally, calculation of CT scoring indices, for e.g., MCTSI on the basis of newer terminology may alter the final score. For example:

  1. Revised Atlanta Classification for Acute Pancreatitis considers any intrapancreatic collection straightaway parenchymal necrosis,[2] which is in strong disagreement with the older terminology used to compute MCTSI.[3] The latter grades intrapancreatic collection and parenchymal necrosis as two separate entities.[3] Hence, MCTSI as per the latter (the older terminology) would be 2 or 4 (depending on the percentage of necrosis whether more than or less than 30%), while the former would generate a score of 4
  2. The nomenclature of fat islands in peripancreatic collections is yet another point of disagreement.[3] While older terminology used to calculate MCTSI considers it as acute fluid collections without necrosis,[3] revised terminology labels it to be acute necrotic collection (in acute stage).[2]


The present study defines the CT parameters as per the Revised Atlanta Classification for Acute Pancreatitis.[1] However, MCTSI, if computed using the recent classification, may yield a different score compared to when calculated as per the older terminology. Hence, it would be of enormous help if the authors could clarify our doubts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sahu B, Abbey P, Anand R, Kumar A, Tomer S, Malik E. Severity assessment ofacute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the RevisedAtlanta Classification. Indian J Radiol Imaging 2017;27:152-60.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Thoeni RF. The revised Atlanta classification of acute pancreatitis: Its importance for the radiologist and its effect on treatment. Radiology 2012;262:751-64.  Back to cited text no. 2
    
3.
Sainani N, Catalano O, Sahani D. Pancreas. In: Haaga JR, Dogra VS, Forsting M, Gilkeson RC, Ha HK, Sundaram M, Editors. CT and MRI of the whole body. 5th ed. Philadelphia: Mosby Elsevier; 2009. p. 1599-674.  Back to cited text no. 3
    

Top
Correspondence Address:
Prashant K Singh
Jhalawar Medical College, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijri.IJRI_421_17

Rights and Permissions




 

Top
 
 
  Search
 
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1223    
    Printed8    
    Emailed0    
    PDF Downloaded195    
    Comments [Add]    

Recommend this journal