On CT pancreas in acute pancreatitis, the Balthazar CT Severity Index (CTSI) assigns points based on two components. Which combination correctly describes the scoring system?
- A Pancreatic size + peripancreatic fluid collections only, maximum 5 points
- B Balthazar grade (0–4 points) + percentage of pancreatic necrosis (0–6 points), maximum 10 points ✓
- C Unenhanced CT density + pancreatic duct diameter, maximum 6 points
- D CRP level + CT grade, maximum 8 points
Correct answer: B. Balthazar grade (0–4 points) + percentage of pancreatic necrosis (0–6 points), maximum 10 points
Explanation
The Balthazar CTSI combines the Balthazar grade (A through E scored 0–4 points based on pancreatic and peripancreatic inflammatory changes) with the degree of pancreatic parenchymal necrosis on contrast-enhanced CT (0% = 0 pts; <30% = 2 pts; 30–50% = 4 pts; >50% = 6 pts), for a maximum score of 10. Higher scores correlate with increased morbidity and mortality. Scoring incorporates both extent of inflammation and degree of ischaemic necrosis.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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