PURPOSE: To assess the feasibility of sequentially administering Gd-DTPA and Mn-DPDP for the MR imaging of focal hepatic lesions, and to investigate whether the procedures involved led to any adverse effects. MATERIALS AND METHODS: Forty-two patients (M:F=25:17) with suspected hepatic lesions underwent T1-weighted MR imaging procedures before and after Gd-DTPA enhancement, and after sequential Mn-DPDP administration. Two investigators reviewed the findings in terms of the size, number, morphology, and enhancement patterns of the lesions. Any adverse actions resulting from the procedures were noted. RESULTS: Fifteen patients had hepatocellular carcinoma (HCC, n=35), 13 showed liver metastases (n=40), nine had hemangioma (n=13), two had cholangiocarcinoma (CC, n=2), two had a liver abscess (n=2), and one had focal nodular hyperplasia (FNH, n=2). All focal hepatic lesions were clearly visible, with no difference in conspicuity between T1-weighted images obtained after Gd-DTPA administration and those obtained after Gd- DTPA plus Mn-DPDP administration. After the latter procedure, 12 HCCs showed high or iso- signal intensity to liver parenchyma and 23 showed no contrast enhancement. Thirty-eight liver metastases showed no contrast enhancement, but in two cases ring enhancement was observeed. In both cases of FNH, homogeneous enhancement was noted. No hemangiomas, CCs or abscesses demonstrated contrast enhancement. The only adverse reaction was five instances of facial flushing. CONCLUSION: Hepatic MR imaging after sequential Gd-DTPA plus Mn-DPDP administration may be selectively useful in differentiating between hepatocellular and non-hepatocellular tumor. No technical difficulties or severe adverse reactions were encountered.