Balthazar Score (CTSI) Calculator

Balthazar Score (CTSI) Calculator for Gastroenterology. The original CT index ranges 0-10, with lower 0-3, intermediate 4-6 and higher 7-10 imaging-score ranges. Necrosis at exactly 30% and 50% earns 2 and 4 points respectively. CT score is distinct from actual clinical severity.

For shared guidance on choosing a tool and documenting results, read the clinical calculator workflow.

How this calculator works

Original CTSI adds a radiologist-assigned Balthazar inflammation score (0-4) to necrosis points: none 0, more than 0 through 30% 2, above 30 through 50% 4, above 50% 6. Maximum 10; this is not modified CTSI.

When to use this calculator

Use to describe an appropriately indicated contrast-enhanced CT in acute pancreatitis. Do not obtain early CT solely to populate a score; timing affects the visibility of necrosis.

Inputs used

  • Radiologist-assigned original Balthazar inflammation grade (A=0 to E=4)
  • Estimated pancreatic necrosis (%)

Clinical interpretation

The original CT index ranges 0-10, with lower 0-3, intermediate 4-6 and higher 7-10 imaging-score ranges. Necrosis at exactly 30% and 50% earns 2 and 4 points respectively. CT score is distinct from actual clinical severity.

Worked example

Fictional teaching case. Radiologist-assigned original Balthazar inflammation grade (A=0 to E=4): 4; Estimated pancreatic necrosis (%): 40. Result: 8 points. Original CT severity index: higher range. Contributions in assessment order: 4 + 4 = 8. Historical prediction is separate from Revised Atlanta clinical severity, which depends on complications and organ failure duration. Reassess the patient; do not choose fluids, surgery or ICU care from this total alone.

Limitations and safety notes

This does not read a CT image or determine whether/when contrast CT is appropriate. Necrosis estimates depend on imaging quality and timing. Historical prediction is separate from Revised Atlanta clinical severity, which depends on complications and organ failure duration. Reassess the patient; do not choose fluids, surgery or ICU care from this total alone.

Frequently asked questions

Is this the modified CTSI?

No. The original and modified indices differ and must be named and interpreted separately.

What can change the meaning of this result?

This does not read a CT image or determine whether/when contrast CT is appropriate. Necrosis estimates depend on imaging quality and timing. Historical prediction is separate from Revised Atlanta clinical severity, which depends on complications and organ failure duration. Reassess the patient; do not choose fluids, surgery or ICU care from this total alone.

References

  • Original CT index and necrosis categories; complications increase above 30%. https://pubmed.ncbi.nlm.nih.gov/2296641/
  • ACG 2024 pancreatitis guidance: repeated assessment rather than score-only management; abstract accessed. https://pubmed.ncbi.nlm.nih.gov/38857482/

Editorial review and citation methodology

Maintained by the Quick Medical Calculator Editorial Team. Content record date: September 9, 2026. A content date is not evidence of independent clinical review. Individual clinical sign-off is not recorded on this page.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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