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Objective To explore the CT performance ofintrahepatic focal leisions in the context of fatty liver.Methods To retrospective analysis the morphology, density and distribution of 23 cases of fatty liver patients (with 29 lesions) which had been confirmed by pathology, intervention or follow-up of 0.5 to 3years.Results There are 12 cases of hemangioma, 4 cases of HCC(8 lesions), and 7 cases of liver Island.There is no feature in morphology and distribution of hemangioma and HCC which often with mass effect.Liver Island is located in the liver margin or beside the split liver or next to the gallbladder fossa with flake or nodule-like in shape without mass effect.The density ofhemangioma and HCC on plain CT scan are depending on the extent of fatty liver.On plain CT scan, the liver Island manifested as high or slightly high density.All of the lesions still maintained their characteristic on enhanced CT: HCC performance as "filling fast and clear fast".Hepatic hemangioma performance as "nodular enhanced on the margin, centripetal filling and delayed enhancement", or even enhance on arterial phase and high-density on delayed phase.The enhancing form of liver Island is the same with the normal liver, but still can be distinguished from the normal liver by the T-D curve.We can distinguish tumor (hemangioma and HCC) or pseudotumor (liver Island) on the arterial phase of the T-D curve, and hemangioma or liver Island on the portal phase.Conclusion Fatty liver will not affect the original CT performances of the occupations(hemangioma,HCC).Misdiagnosis or missed diagnosis can be avoided with a careful analysis of the distribution of lesions, morphology, the multi-phase enhanced CT scan and for T-D curve.