Chronic pancreatitis - Cambridge classification based on ERCP, ultrasound, and CT

The Cambridge classification divides chronic pancreatitis to five severity groups according to morphologic changes of the main pancreatic duct and its side branches. It was defined in 1983 in the Cambridge symposium.

Score Cambridge Class Severity ERCP findings Ultrasound or CT findings
Score 1 0 none no abnormal signs no abnormal signs
Score 2 0 equivocal <3 abnormal branches one abnormal sign:
  • main pancreatic duct 2 - 4mm in diameter
  • enlarged gland 1 to 2 times the normal
Score 3 I mild 3 or more abnormal branches ≥ 2 abnormal signs:
  • cavities <10mm
  • duct irregularity
  • focal acute necrosis
  • panrenchymal heterogeneity
  • increased echogenicity of duct wall
  • contour irregularity of head or body
Score 4 II moderate >3 abnormal side branches and abnormal main duct as score 3
Score 5 III severe all above and 1 or more of:
  • large cavity >10mm
  • intraductal filling defects
  • duct obstruction (stricture)
  • duct dilatation or irregularity
 all above and 1 or more of:
  • large cavity >10mm
  • intraductal filling defects
  • duct obstruction (stricture)
  • duct dilatation or irregularity
  • calculi and/or pancreatic calcification
  • contiguous organ invasion

A modified, clearer version of Cambridge classification:

MPD: main pancreatic duct. LSB: lateral side branches.

Severity ERCP findings Ultrasound or CT findings
none no abnormal LSB normal gland size and shape, homogeneous parenchyma
equivocal MPD normal one of the following:
  • <3 abnormal LSB
  • MPD 2-4mm
  • gland enlarged over 2 times the normal size
  • heterogeneous parenchyma
mild MPD normal two or more of the following:
  • >3 abnormal LSB
  • MPD 2-4mm
  • slight gland enlargement
  • heterogeneous parenchyma
moderate MPD changes
LSB changes
  • small cysts <10mm
  • MPD irregularity
  • focal acute pancreatitis (<1/3 of the gland)
  • increased enhancement or echogenicity of MPD walls
  • gland contour irregularity
severe Any of the above changes plus one or more of the following:
  • cavity >10mm in diameter
  • intraductal filling defects
  • calculi
  • MPD obstruction or stricture
  • severe MPD irregularity
  • contiguous organ invasion

References:

1. Sai JK, Suyama M, Kubokawa Y, Watanabe S. Diagnosis of mild chronic pancreatitis (Cambridge classification): Comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World J Gastroenterol. 2008 Feb 28;14(8):1218–21.
2. Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984 Jul;25(7):756–9.
3. Berry M, Chowdhurry V, Mukhopadhyay S, Suri S. Gastrointestinal and Hepatobiliary Imaging. Jaypee Brothers Publishers. 2004.
4. Karthikeyan D, Chegu D. CT Abdomen, A Pattern Approach. Jaypee Brothers Publishers. 2007.
5. Axon AT, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR. Pancreatography in chronic pancreatitis: international definitions. Gut. 1984 Oct;25(10):1107–12
6. Prokop M, Galanski M. Computed Tomography of the Body. Georg Thieme Verlag. 2003.

Updated 12/8/2013 09:41 by Lambert