Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis – An international multicenter evaluation of the revised Atlanta classification

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift


Background For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. Results In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P < 0.0001) and non-homogeneous collections (35% versus 66%, P < 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Conclusion Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings.


  • Hanna Sternby
  • Robert C. Verdonk
  • Guadalupe Aguilar
  • Alexandra Dimova
  • Povilas Ignatavicius
  • Lucas Ilzarbe
  • Peeter Koiva
  • Eila Lantto
  • Tonis Loigom
  • Anne Penttilä
  • Sara Regnér
  • Jonas Rosendahl
  • Vanya Strahinova
  • Sophia Zackrisson
  • Kristina Zviniene
  • Thomas L. Bollen
Enheter & grupper
Externa organisationer
  • St. Antonius Hospital
  • East Tallinn Central Hospital
  • Hospital del Mar Medical Research Institute
  • University Hospital for Emergency Medicine
  • Lithuanian University of Health Sciences
  • Helsinki University Central Hospital
  • Leipzig University

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kirurgi


Sidor (från-till)791-797
Antal sidor7
Utgåva nummer5
StatusPublished - 2016 sep 1
Peer review utfördJa

Relaterad forskningsoutput

Hanna Sternby, 2017, Lund: Lund University: Faculty of Medicine. 72 s.

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

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