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Background:We evaluated the ability of diffusion-weighted (DW) magnetic resonance (MR) imaging to differentiate between hepatic abscess and cystic or necrotic liver tumor. Methods:DW MR imaging was performed in 18 patients who had liver masses with large cystic or necrotic cavities detected by computed tomography or ultrasonography. The final diagnoses were pyogenic abscess (five cases), fungal abscess (one), hepatocellular carcinoma (five), cystic metastasis (four), and hepatic cyst (three). Signal intensities on the DW images and apparent diffusion coefficient (ADC) maps were noted. ADCs in all lesions were calculated and compared with Student's ttest. Results:All lesions, except hepatic cysts, showed either heterogeneous or homogeneous rim enhancement on postgadolinium images. All abscess cavities showed hyperintensity on DW images and hypointensity on ADC maps. Conversely, the cystic or necrotic portions of all tumors showed hypointensity on DW images and hyperintensity on ADC maps. The mean ADCs (mm2/s) were 0.67 ± 0.35 × 10−3in hepatic abscess, 2.65 ± 0.49 × 10−3in cystic or necrotic tumor, 2.93 ± 0.52 × 10−3in hepatic cyst, and 1.98 ± 0.37 × 10−3in normal liver parenchyma. Conclusion:DW MR imaging, with the help of ADCs, may be a useful noninvasive imaging technique in differentiating hepatic abscess from cystic or necrotic tumor.

Abstract: Background: We investigated the feasibility of using intravenous magnetic resonance (MR) contrast agent as a gastrointestinal oral negative contrast agent to null the bowel signal during MR cholangiopancreatography (MRCP). Methods: In the first part of the study, a phantom study was performed to select the optimal concentration of MR contrast agent to be used as an oral negative contrast agent in MRCP. In the second part of the study, 23 consecutive patients suffering from different pancreaticobiliary diseases were imaged with a single-shot fast spin-echo pulse sequence. The data acquisition was started without oral contrast agent and then repeated with oral contrast agent. From the MR images taken with and without oral contrast agent, the gallbladder, cystic duct, common bile duct, and pancreatic duct were assessed and graded by two radiologists. Results: The oral contrast agent was tolerated well by all patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the gallbladder and cystic duct were slightly and moderately improved, respectively, whereas the depictions of the common bile duct and pancreatic duct were markedly improved by the oral contrast agent administration. Conclusion: Diluted intravenous MR contrast agent can be an effective and safe oral negative contrast agent in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in MRCP.

<it>Objectives</it>. To report the efficacy of prednisolone and azathioprine (AZA) in the treatment of systemic lupus erythematosus (SLE)-related protein-losing gastroenteropathy (PLGE). <it>Methods</it>. Between 1995 and 2002, 16 consecutive patients with SLE-related PLGE were treated with a regimen consisting of high-dose prednisolone (0.8–1 mg/kg/day for 6 weeks, then tapered to ≤10 mg/day) and AZA (2 mg/kg/day). Protein leakage from the gastrointestinal tract was confirmed by 99mTc-labelled human serum albumin scintigraphy and significant urinary loss of protein was excluded. Clinical response at 6 months of therapy was assessed and patients were followed for relapse of PLGE. <it>Results</it>. Clinical characteristics of our patients at the time of PLGE were: age 36.2 ± 8.7 (<scp>s</scp>.<scp>d</scp>.) yr; female:male ratio 15 : 1; mean SLE duration 29.6 ± 65 months. Twelve patients had PLGE as the initial presentation of SLE. Fifteen (94%) patients had concomitant activity in other organs. All patients presented with oedema and eight patients (50%) had non-bloody diarrhoea. The mean serum albumin level was 22.8 ± 5.7 g/dl. Protein leakage was at the small bowel in 11 (69%) patients and the large bowel in 5 (31%) patients. At 6 months of therapy, 14 (88%) patients had complete clinical response, 1 (6%) patient responded partially and 1 patient (6%) was treatment-refractory. Patients who responded were maintained on low-dose prednisolone (7.8 ± 6.1 mg/day) and AZA (56.3 ± 37 mg/day). Over a mean follow-up of 57.5 months, 1 (6%) patient had relapse of PLGE which responded to augmentation of prednisolone dosage. No patients developed alternative gastrointestinal diagnoses. Corticosteroid-induced psychosis, AZA-induced pancytopenia and herpes zoster occurred in three patients. <it>Conclusion</it>. PLGE is an uncommon manifestation of SLE. Treatment with a combination of prednisolone and AZA is effective and well tolerated.