Distinguishing between HCC and benign hypervascular lesions in liver cirrhosis remains a major challenge in management of patients at risk for developing hepatocellular carcinoma. The differential diagnosis of a hypervascular liver lesion in cirrhotic liver can be narrowed to a few entities, including arterioportal shunts or pseudolesions (for very small lesions), dysplastic nodules, and HCCs. Occasionally; a cirrhotic liver may have preexisting flash-filling hemangiomas that may mimic malignant lesions. Small, arterially-enhancing lesions detected with MRI have a low likelihood of representing HCC, and MRI follow-up of such lesions is a reasonable approach. Lesions that increase in size, convert to hypointense on subsequent T1W images, convert to hyperintense in T2W images, or develop rim enhancement on follow-up MRI images are concerning and should prompt consideration of intervention.