Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT

Recognition of pseudolesions of the liver at computed tomography (CT) is important because of their close resemblance to primary liver cancers or metastases. Two types of pseudolesion in the noncirrhotic liver include that due to transient extrinsic compression, typically caused by ribs or the diaphragm, and that due to a "third inflow" of blood from other than the usual hepatic arterial and portal venous sources: the cholecystic, parabiliary, or epigastric-paraumbilical venous system. Although the location of both types of pseudolesion are characteristic, their appearances at CT during arterial portography and CT during selective angiography vary from nonenhanced low-attenuation areas to well-enhanced high-attenuation areas, depending on the amount and timing of the inflow and presence or absence of focal metabolic alteration of the hepatocytes. Radiologists need to understand the underlying mechanism of these pseudolesions to better recognize the wide range of their appearances at CT.