title: Acinarization (parenchymal blush) observed during secretin-enhanced MRCP: clinical implications.
abstract: OBJECTIVE
  T2 hyperintensity of pancreatic acini during secretin-enhanced MRCP is called "acinarization." We sought to determine the clinical significance of this finding.
  
  
  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 hyperintensity; 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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: 1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202.
authors.forename: Kumaresan
authors.initials: K
authors.lastname: Sandrasegaran
authors.forename: Uttam
authors.initials: U
authors.lastname: Bodanapally
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.forename: Stephen
authors.initials: S
authors.lastname: Benzinger
authors.forename: Aashish A
authors.initials: AA
authors.lastname: Patel
authors.forename: Fatih M
authors.initials: FM
authors.lastname: Akisik
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
mesh_terms: D061354:Acinar Cells / Q000473:pathology*; D000328:Adult; D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000473:pathology*; D015203:Reproducibility of Results; D012633:Secretin; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D012633:Secretin
keywords: MRCP; acinarization; chronic pancreatitis; pancreas; secretin