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:
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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
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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.
