Abstract: Objective The aim of this study was to investigate differential diagnosis of dysplastic nodule (DN) and small hepatocellular carcinoma (sHCC) under background of liver cirrhosis (LC) by enhanced magnetic resonance imaging (MRI). Methods A total of 104 patients with LC and intrahepatic nodular lesions were encountered in our hospital between July 2022 and July 2025, and all underwent Gd-EOB-DTPA enhancement of 3.0 T MR. The diagnosis was proven by histo-pathological examination. Results The histo-pathological examination diagnosed DN with dimeter of (0.9±0.2)cm in 46 cases and sHCC with diameter of (1.1±0.2)cm in 58 cases in our series; DN lesions presented with high or equal signals on T1WI mostly, and with low signals on T2WI and DWI mostly, while sHCC lesions showed with low or equal signals on T1WI mostly, and with high signals on T2WI and DWI mostly; sHCC lesions demonstrated with enhancement at arterial phase, clearance at portal vein phase, low signals at hepatobiliary phase and "fast-in and fast-out" mode, and their relative apparent diffusion coefficient (ADC)was much lower than ADC lesions; the differential diagnosis by MRI was excellent with sensitivity of 89.7%, the specificity of 91.3% and the accuracy of 90.4%, and the Kappa was 0.81 as compared to histo-pathological diagnosis. Conclusion MRI by Gd-EOB-DTPA enhancement could provide differential diagnosis of DN and sHCC, and the signal intensity and enhancement mode between the two lesions were mostly different.

Key words: Hepatoma, Liver cirrhosis, Enhanced magnetic resonance imaging, Gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid, Dysplastic nodule, Differential diagnosis