Accuracy of a CT density threshold enhancement to identify pancreatic parenchyma necrosis in acute pancreatitis during the first week

•An enhancement threshold value <30 Hounsfield units on portal phase CT images yields 90.9% sensitivity and 94.3% specificity for the diagnosis of necrotizing pancreatitis vs. interstitial edematous pancreatitis during the first week.•Use of this threshold is associated with excellent interobserver reproducibility (ICC = 0.978).•No post-contrast attenuation threshold was identified for the diagnosis of peripancreatic fat necrosis.