Doppler US Findings of Vascular Complication after Liver Transplantation

Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombisis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and pronpt di-agnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non-invasive method of diagnosing the vascular complications which may arise from liver transplantation.

Ultrasonographic Classification of Atypical Hepatic Hemangiomas

Cavernous hemangioma is the most common benign hepatic tumor. Typically, the most common features revealed by ultrasound(US) include its small size(4cm or less in diameter), uniform hyperechogenicity, welldefined margins, position in the subcapsular region of the right lobe of the liver, and some posterior echo enhancement. In addition, follow-up scanning may reveal changes in size, though this is rare. The US findings of hepatic hemangiomas may vary, however, especially when lesions are large and/or multiple. For that reason, differential diagnosis between this condition and hepatocellular carcinomas, metastatic lesions, lymphomas and other tumors is difficult. An understanding of the various sonographic findings of hepatic hemangioma can facilitate the early detection of the condition.

Usefulness of MR Imaging for Diseases of the Small Intestine: Comparison with CT

OBJECTIVE: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. MATERIALS AND METHODS: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. RESULTS: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. CONCLUSION: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction. is a high-speed, heavily T2-weighted sequence with a great sensitivity for fluid (11). This advance may make it possible to use breath-hold turbo spin-echo MR.

Angiographic Analysis of the Circle of Willis: Comparison between Normal and Aneurysm groups

PURPOSE: To evaluate angiographic variations of the circle of Willis in a normal group, and to compare thepattern of these variations between normal and aneurysm groups. MATERIALS AND METHODS: We reviewed 220 cases inwhich subjects had undergone digital subtraction cerebral angiography which showed the circle of Willis in itsentirety. One hundred patients were diagnosed as normal, and 110 had an aneurysm. We reviewed the absence orpresence and relative size of each segment, and the configuration of the distal basilar artery. Where the circlewas complete, we evaluated whether or not the circle was balanced. And we compared the pattern of these variationsbetween the two groups. RESULTS: In the normal group, the most common pattern was a small anterior communicatingartery with symmetrically large A1 segments in the anterior circulation (27%) and symmetrically small posterior communicating arteries with large P1 segments in the posterior circulation (39%). The anterior half of the circlewas complete in 90% of cases, and the posterior half in 63%. In cases in which it was incomplete, there wasagenesis of the anterior communicating artery in 9% of cases, of the A1 segment in 1%, of the posterior communicating artery in 36%, and of the P1 segment in 3%. Unilateral absence of the posterior communicating arteryand P1 segment was noted in two cases. In the distal basilar artery, symmetric cranial fusion was most common,accounting for 77% of cases. In contrast, incomplete circles with agenesis of the A1 (1% vs 12%, p<.05) or P1segment (3% vs 10%, p<.05) were more common in the aneurysm group than among normal subjects. Unbalanced typeswith a size discrepancy between A1 segments (8% vs 18%, p<.05), or posterior communicating arteries equal to orlarger than the P1 segment (27% vs 46%, p<.05) were also more common. In the distal basilar artery, symmetriccranial fusion was most common, and accounted for 69% of cases. CONCLUSION: A complete and balanced circle wasmore common in the normal group. The most common pattern was a small anterior communicating artery withsymmetrically large A1 segments and symmetrically small posterior communicating arteries with large P1 segments.In contrast, incomplete or unbalanced circles were more common in the aneurysm group.

Intrahepatic Cholangiocarcinoma: Gross Appearance and Corresponding Pathologic and Radiologic Features

PURPOSE: To assess the clinical and pathologic features of each type of intrahepatic cholangiocarcinoma,which is divided into three types according to gross appearance, and to determine the efficacy of CT in detectingthis tumor. MATERIALS AND METHODS: The pathologic and CT features of 53 surgically proven cases of intrahepaticcholangio-carcinoma were reviewed. On the basis of their gross appearance, the tumors were divided into threetypes, as follows: mass forming (n=33), periductal infiltrating (n=6), and intraductal growth type (n=14). CTscans were analyzed for sensitivity of detection and correlation between a tumors appearance and itshistopathology. RESULTS: The most common histopathologic feature of mass forming and periductal infiltrating typewas tubu-lar adenocarcinoma, while in the intraductal growth type, papillary adenocarcinoma (100%) was common.With regard to pattern of tumor spread, intrahepatic and lymph node metastasis were more common in the massforming and periductal infiltrating type than in the intraductal growth type. CT findings including intra-hepaticmass, ductal wall thickening or intraductal mass associated with segmental dilatation of intrahepataic bile ducts,corresponded with these morphologic types. CONCLUSION: This classification according to gross appearance is ofconsiderable value when interpreting the pathologic features of intrahepatic cholangiocarcinoma. CT seems to be auseful modality for the detection of tumors and may be consistent with their gross morphologic findings.

The Imaging Findings of Small(< or =15mm) Portal Defects in the Liver on CT Arterial Portography: Evaluationwith CT Hepatic Arteriography and Lipiodol CT

PURPOSE: To assess the malignant potential of small(< or =15mm) portal defects seen on CT arterial portography,the findings of CT hepatic arteriography and lipiodol CT CT were reviewed. MATERIALS AND METHODS: In 91 patientswho underwent both CTAP and CTHA, small portal defects were re-viewed for frequency, multiplicity and location. Weprospectively evauluated changes in the size and enhance-ment pattern of malignant lesions on follow up CTaccording to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. RESULTS: Among the 91patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and ofundetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that werehyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases,respectively. Location and multiplicity did not show statistically significant variation between benign andmalignant defects. CONCLUSION: Small portal defects are common and there is a high probability that portaldefects smaller than 15mm are benign, even in patients with a known hepatic mass and defect that washyperattenuated on CTHA. If a small defect showed lipiodol deposit on lipiodol CT, malignancy must be suspected.

Zollinger-Ellison Syndrome: A Case Report

Zollinger-Ellison syndrome (ZES) involves hypergastinemia produced by a gastrin-secreting tumor. Not only can it cause an ulcer but may also behave as a malignant lesion, metastasizing to the liver or other organs. The development of potent antisecretory agents for controlling acid secretion as well as techniques for localizing these islet cell tumors, has led to greatly improved survival rates. We describe a case of Zollinger-Ellison syndrome, emphasising the radiologic findings, and including a review of the literature.

CT Findings in Abdominal Actinomycosis

Abdominal actinomycosis is a chronic, progressive, suppurative disease with a fa-vorable response tointravenous treatment with penicillin. In many instances, howev-er, its clinical and radiological findings mayoverlap with those of other inflammatory and neoplastic conditions, and the familiarity with the variousradiological features can thus avoid diagnostic delay s. The purpose of this paper is to describe and discuss theCT findings of abdominal actinomycosis.

Angiographic Analysis of the Circle of Willis: Comparison between Atherosclerosis and Normal Groups

PURPOSE: To determine differences in angiographic variations of the circle of Willis between atherosclerosis and normal groups. MATERIALS AND METHODS: In 289 patients we reviewed complete cerebral angiograms obtained using biplane digital subtraction angiography. Atherosclerosis was diagnosed in 189 patients, while 100 were normal. Patients were divided into four subgroups according to the relative size of each segment and the presence of cross-filling of opposite-sided vessels. When the circle was completely present, we determined whether or not it was balanced, and statistically compared variation patterns between the two groups. RESULTS: In the atherosclerosis group, the anterior half of the circle was complete in 74% of cases(139/189), and the posterior half in 38% (72/189). In the normal group, the anterior half was complete in 90% of cases, and the posterior half in 63%. An incomplete circle was more common in the atherosclerosis group than among normal subjects (26% vs 10%, p.05) and agenesis of the P1 segment (7% vs 3%, p>.05). CONCLUSION: An incomplete and unbalanced circle of Willis was more common in the atherosclerosis group than in the normal group. Agenesis of the anterior communicating artery, the A1 segment, or the posterior communicating artery was common in the atherosclerosis group, as was size discrepancy between A1 segments.

Abdominal MR Imaging Using a HASTE Sequence: Image Comparison on the Different Echo Times

PURPOSE: To determine the optimal parameters of abdominal HASTE imaging by means of a comparison of intermediate and long TE (echo time). MATERIALS AND METHODS: We evaluated 30 consecutive patients who had undergone liver MR during a three-month period. Twelve patients were diagnosed as normal, four as having liver cirrhosis, and 14 were found to be suffering form hepatic hemangioma. On the basis of measured signal intensity of the liver, spleen, pancreas and gallbladder, and of fat, muscle, hemangioma, and background, we calculated the ratios of signal to noise (S/N), signal difference to noise (SD/N), and signal intensity (SI). Image quality was compared using these three ratios, and using two HASTE sequences with TEs of 90 msec and 134 msec, images were qualitatively evaluated. RESULTS: S/N ratio of the liver was higher when TE was 90 msec(p<.05), though S/N, SD/N and SI rations of the spleen, gallbladder, and pancreas -and of hemangiom- were higher when TE was 134 msec (p<.05). However, in muscle, all these three ratios were higher at a TE of 90 msec. SD/N ratio and SI of fat were higher at a TE of 134 msec. Overall image quality was better at a TE of 134mesc than at one of 90msec. CONCLUSION: A HASTE sequence with a TE of 134msec showed greater tissue contrast and stronger T2-weighted images than one with a TE of 90msec.

Mass - Forming Chronic Pancreatitis: CT and ERCP Features

PURPOSE: To describe the CT and ERCP findings of mass-forming chronic pancreatitis. MATERIALS AND METHODS: CT and ERCP features were assessed in 13 patients suffering from mass-forming chronic pancreatitis. Diagnosis was on the basis of surgery (n=5), percutaneous needle biopsy (n=3), and clinical follow-up (n=5). Contrast-enhanced CT was available for all patients: five underwent dynamic study and ERCP was performed in 12. On CT and ERCP, both groups were evaluated with regard to the presence and degree of pancreatic ductal dilatation (greater or less than 50 % of total gland width), double duct sign, enhancement pattern, pancreatic parenchymal calcification (site and distribution pattern), mass identification, the direction of infiltration, pancreatic parenchymal atrophy, configuration at the site of obstruction in the pancreatic and common bile duct, lymphadenopathy, vascular encasement, and vascular engorgement or increased collateral vessels in the peripancreatic space. RESULTS: Seven of 13 patients had suffered chronic alcoholism. Serum CA19-9 levels were normal in all patients except one. Common CT and ERCP findings of mass-forming chronic pancreatitis included pancreatic duct dilatation (92.3%), double duct sign(69.2%), inhomogeneous enhancement of the mass (69.2%), and the presence of calcification (61.5%). Patterns of pancreatic duct dilation were irregular in five patients (38.4%) and smooth in three (23.1 %).In all patients, duct dilatation was less than 50 % of total gland width. Enhancement patterns of the pancreatic mass were inhomogeneous (69.2%), a nonenhancing low attenuation mass (15.3%), and homogeneous enhancement (15.3 %). Configuration at the site of obstruction in the pancreatic duct was abrupt termination in two patients (15.4 %) and smooth termination in two (15.4 %). The common bile duct teminated abruptly in three patients (23.1%), and in four (30.8 %) smooth narrowing was abserved. CONCLUSION: Common findings of mass-forming chronic pancreatitis were duct dilatation of less than 50 % of total gland width, double duct sign, inhomogeneous enhancement of the mass, and the presence of calcification. These were combined with observation of clinical findings such as chronic alcoholism and CA19-9 levels, which are useful indicators for differentiating mass-forming chronic pancreatitis from pancreatic cancer.

Effects of Intrahepatic Blood Vessels on Size and Shape of Microwave Coagulation

PURPOSE: To determine the effects of blood vessels on the size and shape of microwave coagulation. MATERIALS AND METHODS: Microwave coagulation was performed with 60 W output and 60 second duration. In the first experiment five exvivo porcine livers were used to determine the size of the coagulation area and its reproducibility. The second experiment involved the used of two in-vivo porcine livers to determine how adjacent vessels affect the size and shape of coagulation. RESULTS: The result of the first experiment was that the maximum mean diameter of lesions was 1.4 cm +/- 0.1 , reproducible in the range of 1.3 c m -1 .5 cm. In the second experiment, maximum mean diameter was found to be 1.5cm +/- 0.1, reproducible in the range of 1.3 cm - 1.7cm, and the size and shape of the lesion was affected by nearby blood vessels. The shape factor of the lesion, defined as roundness of sphere, was 0.8, but the r a n g e ( 0 . 5 8 -0.92) was wide due to the effect of vascular cooling. This was more prominent in the portal vein than in the hepatic vein, and the minimum diameter of the portal vein which deformed the lesion by more than 1 mm was 0.1 mm. CONCLUSION: Microwave coagulation gives a well-defined lesion, the size of which can be reproduced, but size variation and nonuniformity can be caused by nearby blood vessels.

Effects of Intrahepatic Blood Vessels on Size and Shape of Microwave Coagulation

PURPOSE: To determine the effects of blood vessels on the size and shape of microwave coagulation. MATERIALS AND METHODS: Microwave coagulation was performed with 60 W output and 60 second duration. In the first experiment five exvivo porcine livers were used to determine the size of the coagulation area and its reproducibility. The second experiment involved the used of two in-vivo porcine livers to determine how adjacent vessels affect the size and shape of coagulation. RESULTS: The result of the first experiment was that the maximum mean diameter of lesions was 1.4 cm +/- 0.1 , reproducible in the range of 1.3 c m -1 .5 cm. In the second experiment, maximum mean diameter was found to be 1.5cm +/- 0.1, reproducible in the range of 1.3 cm - 1.7cm, and the size and shape of the lesion was affected by nearby blood vessels. The shape factor of the lesion, defined as roundness of sphere, was 0.8, but the r a n g e ( 0 . 5 8 -0.92) was wide due to the effect of vascular cooling. This was more prominent in the portal vein than in the hepatic vein, and the minimum diameter of the portal vein which deformed the lesion by more than 1 mm was 0.1 mm. CONCLUSION: Microwave coagulation gives a well-defined lesion, the size of which can be reproduced, but size variation and nonuniformity can be caused by nearby blood vessels.

Value of a Bolus-Tagging Method on Contrast-Enhanced Abdominal MR Angiography

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.

Value of a Bolus-Tagging Method on Contrast-Enhanced Abdominal MR Angiography

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.

Post-operative Imaging of Living Related Liver Transplantation in Pediatric Patients

PURPOSE: The purpose of this study was to evaluate the findings and significance of postoperative imaging after living related liver transplantation (LRLT) in pediatric patients. MATERIALS AND METHODS: We retrospectively reviewed all imaging findings, including those of post-LRLT ultra-sonography (US) and computed tomography (CT), in 20 children who had undergone LRLT at our institute. RESULTS: Postoperative findings on US and CT were perihepatic or subcapsular fluid collection (60%), periportal edema (35%), anastomotic narrowing of the IVC (10%), biliary stricture (5%), and focal hepatic infarction (5%). Liver biopsy was performed in nine patients in whom rejection was clinically suspected, and pathologic examination revealed acute rejection in five. US and CT revealed perihepatic fluid collection in one of these, periportal edema and fluid collection in two, and normal findings in two. CONCLUSION: An understanding of the various postoperative findings after LRLT is helpful for accurate diagnosis and appropriate decisions regarding the preservation of normal graft function.

Post-operative Imaging of Living Related Liver Transplantation in Pediatric Patients

PURPOSE: The purpose of this study was to evaluate the findings and significance of postoperative imaging after living related liver transplantation (LRLT) in pediatric patients. MATERIALS AND METHODS: We retrospectively reviewed all imaging findings, including those of post-LRLT ultra-sonography (US) and computed tomography (CT), in 20 children who had undergone LRLT at our institute. RESULTS: Postoperative findings on US and CT were perihepatic or subcapsular fluid collection (60%), periportal edema (35%), anastomotic narrowing of the IVC (10%), biliary stricture (5%), and focal hepatic infarction (5%). Liver biopsy was performed in nine patients in whom rejection was clinically suspected, and pathologic examination revealed acute rejection in five. US and CT revealed perihepatic fluid collection in one of these, periportal edema and fluid collection in two, and normal findings in two. CONCLUSION: An understanding of the various postoperative findings after LRLT is helpful for accurate diagnosis and appropriate decisions regarding the preservation of normal graft function.

Kimura's Disease: CT Features of Abdominal Involement in a Case

Kimura's disease is a benign chronic inflammatory condition with good prognosis, commonly involving the headand neck area. With regard to abdominal manifestat ions, howeve r, the information contained in the literature islimited. Diagnosis on the basis of imaging is difficult, especially in abdominal cases manifesting aslymphadenopathy. The purpose of this report is to illustrate and discuss an abdominal case of the diseasemanifesting as lymphadenopathy.

Intraperitoneal Ectopic Infestation of Pa rasites Invading through Gastrointestinal Tract: CT Findings

PURPOSE: The purpose of this study was to evaluate the CT findings of parasitic ectopic infestation in theperitoneal cavity, a transitional route for parasites invading the gastrointestinal tract, to migrate to varioustarget organs. MATERIALS AND METHODS: CT scans of nine patients with pathologically(n=8) or serologically(n=1)proven intraperitoneal involvement of parasitic infestation were retrospectively reviewed. The primary causes ofparasitic infestation in nine patients were Paragonimus westermani(n=5), Sparganosis(n=2), and hepaticfascioliasis(n=2). We analyzed the CT findings with regard to the sites and patterns of lesions in the peritonealcavity and gastrointestinal track, as well as in other solid organs. The clinical features of these patients werealso evaluated. RESULTS: The clinical symptoms and signs were chronic abdominal pain and general weakness inseven patients, while peripheral blood eosinophilia was observed in four. The CT features of these nine patientsincluded multiseptated cystic masses of 2 -6cm, diameter (mean 4.1 +/-1.7cm) in the omentum or mesentery insix(67%), omental or mesenteric infiltration in seven(78%), focal peritoneal thickening in seven(78%),lymphadenopathy in five(56%), and ascites in four(44%). In six of the nine patients, the gastrointestinaltract(stomach in four, colon in one, both stomach and colon in one) was concomitantly involved with focal wallthickening. Branching patterns of hypoattenuating lesions were noted in the liver of three patients ; two of thesehad hepatic fascioliasis and one had paragonimiasis. CONCLUSION: Ectopic parasitic infestation in the peritonealcavity manifests as mass formation, adjacent gastrointestinal wall thickening, and focal peritonitis. Anunderstanding of these image features is important for both early diagnosis and adequate treatment.

Inflammatory Pseudotumor of the Liver: CT Findings

PURPOSE: To evaluate the CT features of inflammatory pseudotumor of the liver with histopathologiccorrelation. MATERIALS AND METHODS: The CT features of 14 cases (ten patients) with pathologically proveninflammatory hepatic pseudotumor were retrospectively analyzed and correlated with resected and biopsy specimens. RESULTS: The size of lesions ranged between 2.0 and 7.0cm (mean, 3.7cm); On unenhanced CT, the masses were seenas ill-defined hypodense lesions, while on contrast-enhanced CT they were heterogeneous and multiseptated, withenhancement of internal septa and peripheral wall (n=10). In four lesions, central low density and peripheralhomogeneous enhancement were seen. On histopathological correlation, the central hypoattenuated area correspondedto chronic inflammalory cell infiltrates with foamy histiocytes, plasmacytes, and lymphocytes, while thehyperattenuated peripheral wall and internal septa represented dense fibrosis. CONCLUSION: In patients in whon CTshows a heterogeneous enhancing mass, inflammatory pseudotumor of the liver should be included in differentialdiagnosis.