Kumaresan Sandrasegaran MD, Presenter: Research grant, Siemens AG Consultant, Repligen Corporation

Kavitha Nutakki MD, Abstract Co-Author: Nothing to Disclose

Bilal Tahir MD, Abstract Co-Author: Nothing to Disclose

Aashish A. Patel MD, Abstract Co-Author: Nothing to Disclose

Fatih Mustafa Akisik MD, Abstract Co-Author: Nothing to Disclose

Glen Lehman MD, Abstract Co-Author: Nothing to Disclose

T2-hyperintensity of the pancreatic acini during MRCPS is called acinarization. We wanted to determine the clinical significance of this finding.

Retrospective review of the radiology database for search phrases “acin*” or “blush” revealed 37 cases (group A) with acinarization on MRCPS and subsequent ERCP. 67 consecutive patients who had MRI and ERCP without the finding of acinarization were evaluated as the control group (group B). The intensity of acinarization was graded as 0 = none, 1 = barely visible acinarization, 2 = visible but not as intense as pancreatic ducts (2), and 3 = similar intensity as pancreatic ducts. ERCP findings were take as gold standard for presence of chronic pancreatitis, divisum and sphincter of Oddi dysfunction (SOD – manometric basal pancreatic sphincter pressure > 40 mmHg).

There was no difference in age or sex between the groups. On multiple regression analysis, there was a higher association with divisum (p<0.01), and clinical history of recurrent acute pancreatitis (p<0.01) in the acinarization group. There was no difference in the presence of chronic pancreatitis (p=0.23) between the groups. In patients with acinarization, there was a correlation of intensity of acinarization and the presence of divisum or SOD. Ampullary tumors were found in 4 patients with acinarization.

Acinarization probably occurs in pancreas with propensity for increased pancreatic ductal pressure (divisum, SOD) and adequate exocrine function (history of prior acute pancreatitis without severe chronic pancreatitis).

In the presence of acinarization, if the main pancreatic duct appear normal on MRCPS, ERCP may be advisable to assess for SOD or potential ampullary tumor.

Sandrasegaran, K, Nutakki, K, Tahir, B, Patel, A, Akisik, F, Lehman, G, Significance of Acinarization (Parenchymal Blush) Seen during Secretin-enhanced MRCP (MRCPS).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034376.html