Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay

被引:151
作者
Foster, Bryan R. [1 ]
Jensen, Kyle K. [1 ]
Bakis, Gene [1 ]
Shaaban, Akram M. [2 ]
Coakley, Fergus V. [1 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Diagnost Radiol, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA
[2] Univ Utah, Dept Radiol, Salt Lake City, UT 84132 USA
关键词
NECROTIZING PANCREATITIS; FLUID COLLECTIONS; COMPLICATIONS; DIAGNOSIS; CONSENSUS; SEVERITY; UPDATE; DUCT; CT;
D O I
10.1148/rg.2016150097
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute pancreatitis and associated complications based on research advances made over the past 2 decades. Acute pancreatitis is now divided into two distinct subtypes, necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively. The revised classification system also updates confusing and sometimes inaccurate terminology that was previously used to describe pancreatic and peripancreatic collections. As such, use of the terms acute pseudocyst and pancreatic abscess is now discouraged. Instead, four distinct collection subtypes are identified on the basis of the presence of pancreatic necrosis and time elapsed since the onset of pancreatitis. Acute peripancreatic fluid collections (APFCs) and pseudocysts occur in IEP and contain fluid only. Acute necrotic collections (ANCs) and walled-off necrosis (WON) occur only in patients with necrotizing pancreatitis and contain variable amounts of fluid and necrotic debris. APFCs and ANCs occur within 4 weeks of disease onset. After this time, APFCs or ANCs may either resolve or persist, developing a mature wall to become a pseudocyst or a WON, respectively. Any collection subtype may become infected and manifest as internal gas, though this occurs most commonly in necrotic collections. In this review, the authors present a practical image-rich guide to the revised Atlanta classification system, with the goal of fostering implementation of the revised system into radiology practice, thereby facilitating accurate communication among clinicians and reinforcing the radiologist's role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. (C) RSNA, 2016
引用
收藏
页码:675 / 687
页数:13
相关论文
共 29 条
[1]   ACR Appropriateness Criteria® Acute Pancreatitis [J].
Baker, Mark E. ;
Nelson, Rendon C. ;
Rosen, Max P. ;
Blake, Michael A. ;
Cash, Brooks D. ;
Hindman, Nicole M. ;
Kamel, Ihab R. ;
Kaur, Harmeet ;
Piorkowski, Robert J. ;
Qayyum, Aliya ;
Yarmish, Gail M. .
ULTRASOUND QUARTERLY, 2014, 30 (04) :267-273
[2]   Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus [J].
Banks, Peter A. ;
Bollen, Thomas L. ;
Dervenis, Christos ;
Gooszen, Hein G. ;
Johnson, Colin D. ;
Sarr, Michael G. ;
Tsiotos, Gregory G. ;
Vege, Santhi Swaroop .
GUT, 2013, 62 (01) :102-111
[3]   Toward an update of the Atlanta classification on acute pancreatitis - Review of new and abandoned terms [J].
Bollen, Thomas L. ;
Besselink, Marc G. H. ;
van Santvoort, Hjalmar C. ;
Gooszen, Hein G. ;
van Leeuwen, Maarten S. .
PANCREAS, 2007, 35 (02) :107-113
[4]   Imaging of Acute Pancreatitis: Update of the Revised Atlanta Classification [J].
Bollen, Thomas L. .
RADIOLOGIC CLINICS OF NORTH AMERICA, 2012, 50 (03) :429-+
[5]  
BRADLEY EL, 1993, ARCH SURG-CHICAGO, V128, P586
[6]  
Dunnick N Reed, 2008, J Am Coll Radiol, V5, P626, DOI 10.1016/j.jacr.2007.12.015
[7]   BI-RADS: Revised and Replicated [J].
Ellenbogen, Paul H. .
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, 2014, 11 (01) :2-2
[8]   Interventions for Necrotizing Pancreatitis Summary of a Multidisciplinary Consensus Conference [J].
Freeman, Martin L. ;
Werner, Jens ;
van Santvoort, Hjalmar C. ;
Baron, Todd H. ;
Besselink, Marc G. ;
Windsor, John A. ;
Horvath, Karen D. ;
vanSonnenberg, Eric ;
Bollen, Thomas L. ;
Vege, Santhi Swaroop .
PANCREAS, 2012, 41 (08) :1176-1194
[9]   CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012 [J].
Kamal, Ayesha ;
Singh, Vikesh K. ;
Akshintala, Venkata S. ;
Kawamoto, Satomi ;
Tsai, Salina ;
Haider, Maera ;
Fishman, Elliot K. ;
Kamel, Ihab R. ;
Zaheer, Atif .
ABDOMINAL IMAGING, 2015, 40 (06) :1608-1616
[10]   Fistulization in the GI tract in acute pancreatitis [J].
Kochhar, Rakesh ;
Jain, Kapil ;
Gupta, Vikas ;
Singhal, Manphool ;
Kochhar, Suman ;
Poornachandra, Kuchhangi S. ;
Kochhar, Rashi ;
Dutta, Usha ;
Nagi, Birinder ;
Singh, Kartar ;
Wig, Jai D. .
GASTROINTESTINAL ENDOSCOPY, 2012, 75 (02) :436-440