Background Current imaging guidelines do not specify the preferred hepatobiliary contrast agent when differentiating hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH) on MRI. Purpose To analyze intrapatient differences in the hepatobiliary phase (HBP) after use of both gadobenate dimeglumine (Gd‐BOPTA) and gadoxetic acid (Gd‐EOB‐DTPA)‐enhanced MRI to differentiate HCA from FNH. Study Type Retrospective. Population Patients who underwent both Gd‐BOPTA and Gd‐EOB‐DTPA‐enhanced MRI, including 33 patients with 82 lesions (67 HCA; 15 FNH), with a step‐down reference standard of pathology, 20% regression, identical appearance to earlier biopsied lesions, and stringent imaging findings. Field Strength/Sequence 1.5T and 3T HBP of Gd‐BOPTA and Gd‐EOB‐DTPA‐enhanced MRI, precontrast fat‐suppressed T1‐weighted sequence. Assessment Signal intensities relative to the surrounding liver in the HBP were assessed by two observers. Statistical Tests Sensitivity and specificity of HCA diagnosis were calculated for both contrast agents. Interobserver agreement was evaluated using Cohen's kappa; differences in degree of certainty for scoring a lesion were calculated by means of the Wilcoxon signed rank test. Differences in signal intensity between Gd‐BOPTA and Gd‐EOB‐DTPA were calculated using McNemar's test. Results Almost perfect agreement was found between observers for scored signal intensities with both contrast agents. In 30 of the 82 lesions (37%) a difference was observed between contrast agents in the HBP, with Gd‐EOB‐DTPA proving correct in all but one of the discordant lesions. When distinguishing HCA from FNH, Gd‐BOPTA showed a sensitivity of 46% (31/67) and a specificity of 87% (13/15), while the sensitivity and specificity of Gd‐EOB‐DTPA was 85% (57/67) and 100% (15/15), respectively. A risk of misclassifying HCA as FNH typically occurs for Gd‐BOPTA when lesions are intrinsically hyperintense (P < 0.005). Data Conclusion The HBP of Gd‐EOB‐DTPA shows superior accuracy in ruling out HCA in comparison with Gd‐BOPTA, especially when the lesion is intrinsically hyperintense on T1‐weighted imaging. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:700–710.

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Level of Evidence 5 Technical Efficacy Stage 3 J. Magn. Reson. Imaging 2020;52:1281–1282.