No abstract

The standard treatment for autoimmune pancreatitis (AIP) is steroid therapy, although some patients improve spontaneously. Indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, back pain, and the presence of symptomatic extrapancreatic lesions. Prior to steroid therapy, obstructive jaundice should be managed by biliary drainage, and blood glucose levels should be controlled in patients with diabetes mellitus. The recommended initial oral prednisolone dose for induction of remission is 0.6 mg/kg/day, which is administered for 2-4 weeks. The dose is then tapered by 5 mg every 1-2 weeks, based on changes in clinical manifestations, biochemical blood tests (such as liver enzymes and IgG or IgG4 levels), and repeated imaging findings (US, CT, MRCP, ERCP, etc.). The dose is tapered to a maintenance dose (2.5-5 mg/day) over a period of 2-3 months. Cessation of steroid therapy should be based on the disease activity in each case. Termination of maintenance therapy should be planned within 3 years in cases with radiological and serological improvement. Re-administration or dose-up of steroid is effective for treating AIP relapse. Application of immunomodulatory drugs is considered for AIP patients who prove resistant to steroid therapy. The prognosis of AIP appears to be good over the short-term with steroid therapy. The long-term outcome is less clear, as there are many unknown factors, such as relapse, pancreatic exocrine or endocrine dysfunction, and associated malignancy.

After evaluation by the moderators, the Japanese clinical guideline for AIP has been established. Further studies for the international guideline are needed after international consensus for diagnosis and treatment.

Purpose:To elucidate whether apparent diffusion coefficient (ADC) values calculated from echo-planar diffusionweighted MR imaging (EPDWI) are useful in the differential diagnosis of ovarian cystic masses. Materials and Methods: EPDWI was performed in 131patients with ovarian cystic masses (54 mature cystic teratomas, 35 endometrial cysts, four other benign cysts, 14 benign neoplasms, and 24 malignant neoplasms). The areas of the highest signal intensity on EPDWI (b ϭ 1000 seconds/mm 2 ) and the lowest ADC values within the cystic component were evaluated. Results:On qualitative and quantitative analyses, mature cystic teratomas tended to show higher signal intensity and had areas of lower ADC values than endometrial cysts and other benign and malignant neoplasms (P Ͻ .005). In vitro scanning of the cystic contents of mature cystic teratomas confirmed that high signal on DWI or low ADC value was attributable to the keratinoid substance within the tumors. The difference in ADC between malignant and benign lesions were significant when mature cystic teratomas and endometrial cysts were included, but was not significant when they were excluded. Conclusion:The ADC value may add useful information to the differential diagnosis of ovarian cystic masses in limited populations, such as those with mature cystic teratomas with a small amount of fat. DIFFUSION-WEIGHTED IMAGING (DWI) and the calculated apparent diffusion coefficient (ADC) were originally used to demonstrate early ischemic change in brain tissue by depicting cytoplasmic edema (1). They have also been applied to differentiate brain tumors, particularly in the diagnosis of epidermoid and lymphoma (2-6). A high signal on DWI or a low ADC value of these tumors have been attributed to intratumoral keratinoid substance in the former, and high cellularity and a high nuclear-to-cytoplasm (NC) ratio without interstitial edematous change in the latter (2-6). Both of these conditions restrict Brownian movement of the free water molecules within the tumor. The ability of high-speed echo-planar imaging (EPI) to minimize artifacts due to respiratory motion has extended the application of DWI and ADC to the diagnosis of breast lesions (7-10) and prostate carcinomas (11,12), and promising preliminary results have been reported. However, there is controversy regarding the usefulness of this technique in cystic ovarian tumors (13-16), particularly as applied to differentiating benign from malignant lesions.In this study we applied echo-planar DWI (EPDWI) and ADC values to 131 cystic ovarian masses and assessed their potential usefulness in the differential diagnosis. MATERIALS AND METHODS SubjectsBetween September 2000 and December 2003, 322 consecutive women underwent MRI for evaluation of known ovarian lesions. Of these patients, 131 (11-75 years old, mean ϭ 33.9 years) underwent surgical resection within 2 weeks after the MRI was performed. Of the 131 patients, 102 had a lateral lesion and 29 had bilateral lesions. In the bilateral cases, the largest lesion was selected for...

Purpose:To elucidate the performance of apparent diffusion coefficient (ADC) map in localizing prostate carcinoma (PC) using stepwise histopathology as a reference. Materials and Methods:Preoperative MR images of 37 patients with PC who had undergone radical prostatectomy were retrospectively evaluated. First, T2-weighted images (T2WI) alone were interpreted (T2WI reading), and then T2WI along with ADC map were interpreted (T2WI/ ADC map reading). Sextant-based sensitivity and specificity, and the ratio of the detected volume to the whole tumor volume (% tumor volume) were compared between the two interpretations, and results were also correlated to Gleason's scores (GS). ADC values were correlated to histological grades.Results: Sensitivity was significantly higher in T2WI/ ADC map reading than in T2WI reading (71% vs. 51%), but specificity was similar (61% vs. 60%). By adding ADC map to T2WI, % tumor volume detected increased significantly in transitional zone (TZ) lesions, but not in peripheral zone (PZ) lesions. % tumor volume detected with T2WI/ADC map reading showed a positive correlation with GS of the specimens. Less differentiated PC were associated with lower ADC values and higher detectability.Conclusion: T2WI/ADC map reading was better than T2WI reading in PC detection and localization. This approach may be particularly useful for detecting TZ lesions and biologically aggressive lesions.