Abstract: Objective The purpose of this study was to investigate the impact of fatty liver on the diagnosis of contrast-enhanced ultrasound (CEUS) in patients with inflammatory pseudotumor of liver (IPL). Methods 28 patients with IPL were encountered in Kailuan General Hospital, North China University of Science and Technology between January 2016 and January 2021, and out of them, 12 patients with underlying fatty liver. The diagnosis was made by fine needle aspiration biopsies or post-operational histopathologic examination. All patients underwent CEUS, and the blood supply status, contrast-enhanced modes and quantitative parameters were compared between the two groups. Results In patients with IPL and underlying fatty liver, there were 1 cases (8.3%) with arterial blood supply, 11 cases (91.7%) with venous blood supply, 3 cases (25.0%) presenting with rich blood supply, and 9 cases (75.0%) with poor blood supply, while in patients with IPL and normal liver, there were 7 cases (43.8%) with arterial blood supply, 9 cases (56.3%, P<0.05) with venous blood supply, 5 cases (31.3%) presenting with rich blood supply and 11 cases(68.8)with poor blood supply (P>0.05); there were no significant differences in blood supply type and blood supply richness between the two groups (P>0.05); In patients with fatty liver, there were no significant enhancement of foci under CEUS in 1 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 3 cases, and low enhancement in 3 cases, while in patients with IPL, there were no significant enhancement in 2 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 7 cases, and low enhancement in 2 cases, not significantly different between the two groups in contrast enhancement mode ( P=0.661); in patients with IPL and fatty liver, the contrast agent arrival time was (8.9±1.3) s, significantly slower than [((8.0±0.9)s, P<0.05], and the peak intensity was (53.2±7.8)dB, significantly weaker than [((61.1±9.7)dB, P<0.05] in patients with IPL, while there were no significant differences as respect to the peak time, the curve sharpness and the area under curve between the two groups (P> 0.05). Conclusion The IPL foci in patients with fatty liver are mainly having venous blood supply, and the underlying fatty liver might interfere with the imaging diagnosis, which should be carefully identified.

Key words: Inflammatory pseudotumor of liver, Fatty liver, Contrast-enhanced ultrasound, Blood supply, Diagnosis