Liver parenchyma could develop primary tumours or be involved by secondary metastases. Hepatocellular carcinoma (HCC) is the most frequently encountered primary tumour of the liver; intra-hepatic cholangiocarcinoma represents the second most common tumour which develops from the liver, less reported than HCC. Secondary involvement of hepatic parenchyma could be observed in several tumours, namely in case of colonic, pulmonary, breast, gastric, oesophageal, pancreatic or genitourinary cancer.

Management of oncological patients requires the highest diagnostic accuracy, in order to obtain the most correct “oncological stage of disease”, to adopt the optimal treatment and to identify ­– in case of non-surgical therapies – the early responder patients.

MRI fuelled high expectations in the evaluation of oncological liver, due to its high contrast resolution. The new recent advantages of liver MRI, predominantly represented by diffusion weighted imaging (DWI) and hepatospecific contrast agent are discussed in this paper, in order to help clinicians, oncologists and radiotherapists in the management of hepatic oncological disease.

Namely, we focused on main features of a liver MRI protocol in oncological patients: 1) dual-echo chemical shift gradient-echo sequences; 2) Gadoxetic-acid liver MRI and HCC; 3) Hepatocyte-specific contrast agents MRI in detection of liver metastases; 4) DWI for malignant lesions detection and response to treatments.