Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay

Published Online:https://doi.org/10.1148/rg.2016150097

Use of the revised Atlanta classification in imaging of acute pancreatitis is discussed, with emphasis on distinguishing between various pancreatitis-associated collections such that the new lexicon can be implemented immediately by the radiologist, thereby facilitating accurate communication with referring providers.

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.

©RSNA, 2016

An earlier incorrect version of this article appeared online. This article was corrected on March 28, 2019.

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Article History

Received: Apr 6 2015
Revision requested: June 30 2015
Revision received: Aug 10 2015
Accepted: Aug 31 2015
Published online: May 10 2016
Published in print: May 2016