Staging of acute pancreatitis

Management of patients with acute pancreatitis is based on the early assessment of severity of disease. Initial staging is established on clinical and laboratory grounds and on the findings of contrast-enhanced CT imaging. Individual clinical parameters and laboratory indices, although sometimes helpful, are not sufficiently accurate to reliable assess the severity of an acute attack. Numerical grading systems (Ranson's, APACHE II) with sensitivities of about 70% are commonly used today as indicators of systemic failure and predictors of disease severity. Helical or MDCT scanning performed during the administration of a bolus of i.v. contrast material is performed to evaluate pancreatic morphology, detect pancreatic necrosis, and depict retroperitoneal complications. CT staging and the CT severity index have proved to be a reliable indicator of disease severity, having shown an excellent correlation with the risk of death and the development of local and systemic complications in this population.