Objective      To investigate the diagnostic value of Gd-EOB-DTPA-enhanced hepatobiliary phase MR imaging combined with diffusion-weighted MR imaging (DW-MRI) in the detection of hepatocellular carcinoma (HCC) with histopathology as reference standard.       Methods      A total of 60 patients who were suspected with HCC admitted in our hospital from January to November 2013 were recruited in this study and their data were collected and retrospectively reviewed. They underwent Gd-EOB-DTPA-enhanced arterial phase (HAP)

portal venous phase (PVP)

hepatobiliary phase (HP) MR and DW MRI before surgery and histopathological biopsy. Three groups of images were assigned and compared. Two radiologists graded likelihood of HCC with a five-point confidence scale. The accuracy of MR imaging protocols in detecting HCC was analyzed by the receiver operating characteristic (ROC) curve with the histopathology as reference standard.       Results      Based on the histopathological analyses

56 HCCs were demonstrated in this study and 22 HCCs less than 2 cm in diameters were observed. Combined with Gd-EOB-DTPA-enhanced hepabiliary phase MRI and DWI showed greatest ability in identification of HCC (≤2 cm) compared with conventional dynamic enhanced MRI (P=0.024 8). The accuracy of adding Gd-EOB-DTPA-enhanced hepabiliary phase MRI in diagnosis of HCC (≤2 cm) was greater than conventional dynamic enhanced MRI alone (P=0.043 2). However

combined both Gd-EOB-DTPA-enhanced hepabiliary phase MRI and DW-MRI had similar ability in detection of HCC with variable size in this cohort.       Conclusion      Combining Gd-EOB-DTPA-enhanced hepabiliary phase MRI and DW-MRI is more helpful in the diagnosis of HCC

especially early HCC less than 2 cm in diameter

than conventional dynamic enhanced MRI.