title: Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis.
abstract: OBJECTIVE
  The purpose of this study was to compare the modified CT severity index (MCTSI) with the CT severity index (CTSI) regarding assessment of severity parameters in acute pancreatitis (AP). Both CT indexes were also compared with the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) index.
  
  
  METHODS
  Of 397 consecutive cases of AP, 196 (49%) patients underwent contrast-enhanced CT (n = 175) or MRI (n = 21) within 1 week of onset of symptoms. Two radiologists independently scored both CT indexes. Severity parameters included mortality, organ failure, pancreatic infection, admission to and length of ICU stay, length of hospital stay, need for intervention, and clinical severity of pancreatitis. Discrimination analysis and kappa statistics were performed.
  
  
  RESULTS
  Although for both CT indexes a significant relationship was observed between the score and each severity parameter (p < 0.0001), no significant differences were seen between the CT indexes. Compared with the APACHE II index, both CT indexes more accurately correlated with the need for intervention (CTSI, p = 0.006; MCTSI, p = 0.01) and pancreatic infection (CTSI, p = 0.04; MCTSI, p = 0.06) and more accurately diagnosed clinically severe disease (area under the curve, 0.87; 95% CI, 0.82-0.92). Interobserver agreement was excellent for both indexes: for CTSI, 0.85 (95% CI, 0.80-0.90) and for MCTSI, 0.90 (95% CI, 0.85-0.95).
  
  
  CONCLUSIONS
  No significant differences were noted between the CTSI and the MCTSI in evaluating the severity of AP. Compared with APACHE II, both CT indexes more accurately diagnose clinically severe disease and better correlate with the need for intervention and pancreatic infection.
authors.affiliation: Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. t.bollen@antoniusziekenhuis.nl
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Kathryn
authors.initials: K
authors.lastname: Repas
authors.forename: Hendrik W
authors.initials: HW
authors.lastname: van Es
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.forename: Koenraad J
authors.initials: KJ
authors.lastname: Mortele
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003287:Contrast Media; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging / Q000401:mortality; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000401:mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media