JOP. J Pancreas (Online) 2006; 7(1):104-109. © 2006 JOP and author(s). Free circulation of this article is permitted only for research and study purposes. Any commercial and for-profit usage is subject to authorization by the Publisher: see the JOP Special Copyright Statement at http://www.joplink.net/jop/special.html for license details. JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 7, No. 1 Supplement - January 2006. [ISSN 1590-8577] 104 Table 1. Modified CT severity index [6]. Points Pancreatic inflammation Normal pancreas Intrinsic pancreatic abnormalities with or without inflammatory changes in peripancreatic fat Pancreatic or peripancreatic fluid collection or peripancreatic fat necrosis 0 2 4 Pancreatic necrosis None =30% >30% 0 2 4 Extrapancreatic complications Presence of one or more of pleural effusion, ascites, vascular complications, parenchymal complications, or gastrointestinal tract involvement 2 AISP - 29 th National Congress. Bologna (Italy). September 15-17, 2005. Imaging Techniques for Acute Necrotizing Pancreatitis: Multidetector Computed Tomography Lucia Calculli 1 , Raffaele Pezzilli 2 , Riccardo Casadei 3 , Marta Fiscaletti 1 , Giampaolo Gavelli 1 Departments of 1 Radiology, Department of 2 Internal Medicine and 3 Department of Surgery, Sant’Orsola-Malpighi Hospital. Bologna, Italy In clinical practice, it is important to establish the severity of acute pancreatitis as soon as possible. At present, the assessment of the severity of acute pancreatitis is defined according to the Atlanta clinical criteria [1]. From the clinical point of view we know that the severity of acute pancreatitis is related to the age of patients, the male sex, and the alcoholic and idiopathic etiology of the illness [2]. Furthermore, from a microbiological point of view, the infection of the necrosis reaches a peak in the third week from the onset of an acute attack of pancreatitis [3]. Imaging plays an important role in answering the clinical question: is the pancreatitis mild or severe? The best way to answer to this question is to determine the presence of pulmonary or pleuric alterations at chest X- ray, associated or not with an increase in serum creatinine greater than 2 mg/dL. This simple severity assessment has already been demonstrated in clinical practice and a multicenter Italian study was published in 1999 [4]. The authors demonstrated that in 539 acute pancreatitis patients, 163 of whom (30.2%) had necrotizing pancreatitis, the presence of pulmonary or pleural alterations with or without a creatinine concentration greater than 2 mg/dL had a sensitivity of 60% and a specificity of 88% in evaluating the presence of necrosis, a sensitivity of 73% and a specificity of 75% in evaluating the presence of infected necrosis, and a sensitivity of 90% and a specificity of 76% in evaluating the mortality rate. However, computed tomography (CT) and the recently introduced multidetector CT (MDCT) had an important role in defining not only the presence of