Acinarization (parenchymal blush) observed during secretin-enhanced MRCP: Clinical implications

Kumaresan Sandrasegaran, Uttam Bodanapally, Gregory A. Cote, Stephen Benzinger, Aashish A. Patel, Fatih M. Akisik, Stuart Sherman

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

OBJECTIVE. T2 hyperintensily of pancreatic acini during secretin-enhanced MRCP is called "acinarization." We sought to determine the clinical significance of this finding. MATERIALS AND METHODS. Patients were selected if the radiology report included the phrases "acin∗" (where∗ represented a wild card search) or "blush" using the institution's customized lexicon-search software. Sixty-seven consecutive patients without acinarization on secretin-enhanced MRCP who also underwent ERCP were enrolled as the control group. The intensity of acinarization was classified into three groups: grade 0, no visible acinarization; grade 1, barely visible parenchymal hyperinlensity; or grade 2, easily visible parenchymal hyperintensity. ERCP findings of ductal abnormalities and basal pancreatic sphincter manometry were recorded. RESULTS. There were higher frequencies of divisum (p = 0.001) and of a clinical history of recurrent acute pancreatitis (p < 0.001) and higher basal pancreatic sphincter of Oddi manometric pressure measurements (p = 0.008) in the acinarization group. There was no difference in the frequency of ERCP-defined chronic pancreatitis (p = 0.10) between the groups. In patients with acinarization, a higher mean sphincter pressure was seen in patients with more intense acinarization than in those with faint acinarization, but this difference was not significant (p = 0.22). Ampullary tumors were found in four patients with acinarization. CONCLUSION. Acinarization probably occurs in patients with a propensity for increased pancreatic ductal pressure (i.e., patients with divisum, elevated basal pancreatic sphincter pressure, ampullary tumor) and adequate exocrine function (absence of severe chronic pancreatitis).

Original languageEnglish (US)
Pages (from-to)607-614
Number of pages8
JournalAmerican Journal of Roentgenology
Volume203
Issue number3
DOIs
StatePublished - Sep 1 2014

Keywords

  • Acinarization
  • Chronic pancreatitis
  • MRCP
  • Pancreas
  • Secretin

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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