Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors

Abstract

ObjectivesCurrent literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast‐enhanced ultrasound (CEUS) features in HIPT and compare them with contrast‐enhanced computed tomography (CECT) and contrast‐enhanced magnetic resonance imaging (CEMRI).MethodsA total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B‐mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi‐square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.ResultsOn the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper‐ or iso‐enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash‐out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash‐out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).ConclusionsThe CEUS features of HIPT lesions typically include mildly hyper‐enhanced or iso‐enhanced in AP, rapid wash‐out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash‐out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.