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©2013 UpToDate ® Print Email CT findings and grading of acute pancreatitis (CT severity index [CTSI]) Grading based upon findings on unenhanced CT Grade Findings Score A Normal pancreas - normal size, sharply defined, smoothcontour, homogeneous enhancement, retroperitoneal peripancreatic fatwithout enhancement 0 B Focal or diffuse enlargement of the pancreas, contour mayshow irregularity, enhancement may be inhomogeneous but there is onperipancreatic inflammation 1 C Peripancreatic inflammation with intrinsic pancreatic abnormalities 2 D Intrapancreatic or extrapancreatic fluid collections 3 E Two or more large collections of gas in the pancreas or retroperitoneum 4 Necrosis score based upon contrast enhanced CT Necrosis, percent Score 0 0 <33 2 33-50 4 ≥50 6 CT severity index equals unenhanced CT score plus necrosis score: maximum = 10, ≥6 = severe disease. Adapted from Balthazar, EJ, Robinson, DL, Megibow, AJ, Ranson, JH, Radiology 1990; 174:331.