What are the Rosemont criteria for the pancreas?

Rosemont Criteria for Pancreas Evaluation

The Rosemont criteria are a standardized classification system for endoscopic ultrasound (EUS) findings in chronic pancreatitis, providing more structured diagnostic categories than conventional criteria by weighting specific EUS features based on their importance.

Overview of Rosemont Classification

The Rosemont classification was developed to standardize EUS diagnosis of chronic pancreatitis by categorizing findings into major and minor criteria, resulting in four diagnostic categories:

1. Normal pancreas: No criteria or insufficient criteria
2. Indeterminate for chronic pancreatitis: Some criteria but not meeting thresholds for higher categories
3. Suggestive of chronic pancreatitis: Combination of minor features or limited major features
4. Consistent with chronic pancreatitis: Multiple major features or specific combinations of major and minor features

Major and Minor Criteria

Major Criteria:

• Major A features:

  • Hyperechoic foci with shadowing (pancreatic calcifications)
  • Main pancreatic duct calculi

• Major B features:

  • Lobularity with honeycombing
  • Lobularity without honeycombing

Minor Criteria:

• Cysts
• Dilated ducts ≥3.5 mm
• Irregular pancreatic duct contour
• Dilated side branches
• Hyperechoic duct walls
• Strands (hyperechoic linear structures)
• Non-shadowing hyperechoic foci

Diagnostic Categories Based on Criteria Combinations

1. Consistent with chronic pancreatitis:

   • 1 Major A feature + ≥3 Minor features
   • 1 Major A feature + Major B feature
   • 2 Major A features

2. Suggestive of chronic pancreatitis:

   • 1 Major A feature + <3 Minor features
   • 1 Major B feature + ≥3 Minor features
   • ≥5 Minor features

3. Indeterminate for chronic pancreatitis:

   • 3-4 Minor features
   • Major B feature alone or with <3 Minor features

4. Normal pancreas:

   • 0-2 Minor features only

Clinical Validation and Utility

The Rosemont classification demonstrates significant correlation with risk factors for chronic pancreatitis, including alcohol intake, smoking history, and previous acute pancreatitis 1. When compared to histopathology (the gold standard), the Rosemont "suggestive" category has shown excellent correlation with 96.2% of cases confirmed as chronic pancreatitis on histopathology 2.

However, the classification has limitations. The "normal" Rosemont classification had poor correlation with histopathology, with 55.5% of patients classified as "normal" still showing evidence of chronic pancreatitis on histopathology 2. This suggests caution when using a "normal" EUS finding to exclude chronic pancreatitis.

Comparison with Conventional Criteria

When comparing the Rosemont classification with conventional criteria (Wiersema criteria):

• There is substantial agreement between both systems for diagnosing chronic pancreatitis 3
• The Rosemont classification may be more useful in patients with high suspicion of chronic pancreatitis but with fewer than 4 standard criteria 3
• Interobserver agreement for both classification systems is moderate (κ = 0.53 for conventional and κ = 0.46 for Rosemont) 4

Clinical Application

The Rosemont criteria should be used in conjunction with clinical history, laboratory findings, and other imaging modalities. They are particularly valuable when conventional imaging is inconclusive but clinical suspicion for chronic pancreatitis remains high.

When interpreting EUS findings using Rosemont criteria, clinicians should be aware that:

• The presence of major features, particularly calcifications, carries greater diagnostic weight
• The classification can be applied regardless of patient characteristics like age, sex, BMI, or environmental factors 2
• The criteria are most reliable for diagnosing rather than excluding chronic pancreatitis

For optimal patient outcomes related to morbidity and mortality, early and accurate diagnosis of chronic pancreatitis is essential, as this condition can lead to significant complications including malnutrition, diabetes, and increased risk of pancreatic cancer.