BT şiddet indeksi (CTSI ve mCTSI)

Özet

CTSI, pankreas morfolojisini Balthazar A–E derecesi ile nekroz puanını birleştirir; mCTSI inflamasyonu daha sade puanlar ve ekstrapankreatik komplikasyonları ekler. Bu indeksler akut pankreatitin morfolojik bulgularını sınıflandırmak için kullanılır ve klinik sonuçlarla korele olur. Erken dönemde çekilen BT incelemeleri hastalığın gerçek şiddetini tam yansıtmayabilir, bu nedenle rutin şiddet evrelemesi amacıyla erken BT önerilmez.

Okuma sırası

1. pankreas parankimi. CECT’de akut pankreatit şiddeti CTSI ve mCTSI ile puanlanır.
2. peripankreatik koleksiyonlar. Peripankreatik sıvı birikimleri ve bu birikimlerin görüldüğü alanların sayısı kaydedilir.
3. pankreas parankimi. Kontrastlı BT’de pankreatik nekroz, mCTSI’nin nekroz bileşeni kapsamında puanlanır.
4. toraks bazalleri, damarlar ve bağırsak. mCTSI puanına ekstrapankreatik komplikasyonlar dahil edilir; mCTSI ile Revize Atlanta sınıflamasının şiddet dereceleri arasındaki uyum ayrıca karşılaştırılabilir.

Faz ve pencere

Portal tanısal

Balthazar morfolojik derece için büyüme, yağ çizgilenmesi ve koleksiyon sayısı; nekroz yüzdesi için kontrastlanmayan bez; mCTSI için pankreas bulgusu ve ekstrapankreatik komplikasyonlar kaydedilir.

Kontrastsız

Kontrastsız BT’de Balthazar morfolojik derecelendirmesi yapılabilir; erken dönemdeki morfolojik bulgular tek başına klinik seyri öngörmek için yeterli olmayabilir.

BT bulguları

• Balthazar sınıflaması akut pankreatit bulgularını BT’de A–E dereceleriyle sınıflandırır.
• Balthazar sınıflaması akut pankreatit bulgularını BT’de A–E dereceleriyle sınıflandırır.
• CTSI, akut pankreatitte BT ile şiddet değerlendirmesi için kullanılır.
• mCTSI, pankreatik inflamasyon ve nekrozun yanı sıra pankreas dışı komplikasyonları da değerlendirir. mCTSI, akut pankreatit şiddetini hafif, orta ve ağır kategorilerde sınıflandırır.
• mCTSI, pankreatitik süreç dışındaki komplikasyonların (ekstrapankreatik bulgular) varlığını da skorlamaya dahil eder.
• Balthazar sınıflaması akut pankreatitte morfolojik şiddeti derecelendirmek için kullanılır.

Ölçütler ve sınıflamalar

Erken rutin CT zamanı

Erken dönemde çekilen BT incelemeleri hastalığın gerçek şiddetini tam yansıtmayabilir, bu nedenle rutin şiddet evrelemesi amacıyla erken BT önerilmez.

Balthazar CTSI

CTSI, akut pankreatit şiddetini değerlendirmede kullanılan BT temelli bir indekstir. CTSI ile akut pankreatit olguları hafif, orta ve ağır olarak sınıflandırılabilir.

Modified CTSI (Mortele)

mCTSI, pankreas yapısındaki değişiklikleri ve peripankreatik inflamasyon/koleksiyonları basit bir ölçekle puanlandırır. Nekroz oranı ve ekstrapankreatik komplikasyonlar mCTSI skoru üzerinde ayrı puan katkısı sağlar. mCTSI, pankreatit şiddetini sınıflandırmak için kullanılır.

Normalde

Puanlarken aynı incelemede kontrastlanmayan alanın bez hacmine oranını ve mCTSI için plevral efüzyon/asit/tromboz gibi ekstrapankreatik bulguları tek tek kıyasla.

Ayırıcı tanı

Atlanta klinik şiddet sınıfı

organ yetmezliği ve komplikasyon süresine dayanır; CTSI puanıyla aynı kavram değildir.

Revize Atlanta morfolojik tip

interstisyel/nekrotizan ve koleksiyon adlarını tanımlar; toplam CTSI puanını vermez.

Tuzaklar

• Erken BT’de daha yüksek Balthazar dereceleri daha olumsuz klinik sonuçlarla sayısal olarak ilişkili bulunmuş, ancak D–E derecelerinin A–C derecelerine göre daha yüksek olumsuz sonuç olasılığı istatistiksel anlamlılığa ulaşmamıştır.
• CTSI ve mCTSI ayrı BT şiddet indeksleridir; her birini kendi puanlama şemasına göre değerlendirin.
• Erken dönemde çekilen kontrastsız BT, akut pankreatit şiddetinin değerlendirilmesi için sınırlı bilgi sağlayabilir.
• Akut pankreatitin erken döneminde BT hastalık şiddetini doğru yansıtmayabilir; ağır hastalık bulgusu yoksa rutin BT gerekli değildir. Akut pankreatitin erken döneminde BT hastalık şiddetini doğru yansıtmayabilir; ağır hastalık bulgusu olmayan ve tipik klinik-laboratuvar bulguları bulunan hastalarda rutin görüntüleme gerekli değildir.

Kendini dene

1. mCTSI’nin tüm bileşenlerini birlikte içeren seçenek hangisidir?

   • Pankreas inflamasyonu, nekroz ve pankreas dışı komplikasyonlar
   • Pankreas inflamasyonu ve nekroz
   • Nekroz ve organ yetmezliği
   • Pankreas inflamasyonu ve serum amilaz düzeyi
   Cevabı göster

   Pankreas inflamasyonu, nekroz ve pankreas dışı komplikasyonlar. mCTSI, pankreas inflamasyonu ve nekrozun yanı sıra pankreas dışı komplikasyonları da puanlamaya dahil eder.

2. S50’de BT indekslerinin Revize Atlanta sınıflamasıyla uyumu için hangi sonuç bildirilmiştir?

   • mCTSI uyumu %90,0; CTSI uyumu %78,3 olarak bildirilmiştir
   • CTSI uyumu %90,0; mCTSI uyumu %78,3 olarak bildirilmiştir
   • Her iki indeksin uyumu da %100 olarak bildirilmiştir
   • İki indeksin de Revize Atlanta sınıflamasıyla uyum göstermediği bildirilmiştir
   Cevabı göster

   mCTSI uyumu %90,0; CTSI uyumu %78,3 olarak bildirilmiştir. Çalışmada Revize Atlanta derecelendirmesiyle uyum mCTSI için 54/60 (%90,0), CTSI için 47/60 (%78,3) olguda bildirilmiştir.

İlgili konular

• Akut nekrotizan pankreatit

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 23 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.