Abstract: Objective:To analyze the imaging features of focal sparing in fatty liver caused by abnormal gastric venous drainage and its formation mechanism. Methods:The imaging features of pseudolesion caused by abnormal gastric venous drainage in 15 cases were analyzed retrospectively. Results:All the 15 cases had clear boundary, and the diameter of abnormal gastric vein ranged from 1.5 to 6 mm. In 14 cases, the right gastric vein was used to drain the liver, among which 3 cases were located in segment Ⅰ, 4 cases were located in segment Ⅲ, 6 cases were located in segment Ⅳ dorsal, and 1 case occupied the left liver. The left gastric vein was draining in 1 case, and the focal sparing was located in segment Ⅲ. Among the 15 cases, 11 cases had the appearance of mass(5 cases were round and 6 cases were wedge-shaped). The 2 cases located in segment Ⅰ were almost identical with caudate lobe, and were accompanied by different degrees of caudate lobe hypertrophy. One case occupied the left liver; one case presented irregular "claw-like" changes along the draining vein. Conclusion:The formation of focal sparing in fatty liver is related to abnormal gastric venous drainage, the correct diagnosis can be made by fully grasping the imaging characteristics.