Diagnosis of Hepatic Granulomas Liver tests Imaging Biopsy Hepatic granulomas are suspected in patients with Conditions that commonly cause granulomas Unexplained hepatic masses found during imaging tests Abnormalities detected by an imaging test that is done to evaluate asymptomatic elevations in liver enzymes, particularly alkaline phosphatase When granulomas are suspected, liver tests are usually done, but results are nonspecific and are rarely helpful in diagnosis.