To investigate the value of enhanced MRI image features combined with apparent diffusion coefficient(ADC) in the differential diagnosis of primary hepatic mucosa-associated lymphoid tissue(MALT) lymphoma and hepatocellular carcinoma(HCC).

The clinical data of 10 patients with pathology-confirmed primary MALT lymphoma admitted in our hospital from January 1997 to May 2025 were retrospectively collected. Their enhanced MRI images were analyzed, mainly including the number of lesions, morphology, signal characteristics, enhancement methods, and presence or absence of vessel floating signs, and the ADC value was calculated in order to screen statistically significant variables. Firth regression analysis was used to screen independent predictors of primary MALT lymphoma in the liver. Receiver operating characteristic(ROC) curve was plotted, and the area under the curve(AUC) was calculated to evaluate the diagnostic efficacy.

Compared with the HCC group, the primary MALT lymphoma group had significantly higher incidence in the females(P=0.026), alpha-fetoprotein(AFP) <8 ng/mL(P<0.001), lower T2WI signal(P=0.001), lower ADC value(P<0.001), and mostly continuously enhanced lesions(P<0.001), and more vessel floating signs(P=0.008). Univariate Firth regression analysis showed that sex(95%CI: 1.36~52.10, P=0.020), T2 value(95%CI: 3.89~5 121.00, P<0.001), AFP(95%CI: 0~0.21, P<0.001), ADC value(95%CI: 0~0.21, P<0.001), and dynamic reinforcement(95%CI: 0~0.23, P<0.001), and vessel floating sign(95%CI: 0~0.40, P=0.004) were diagnostic predictors for primary MALT lymphoma of the liver. Multivariate Firth regression analysis indicated that ADC value(95%CI: 0~0.62, P=0.006), AFP(95%CI: 0~0.047, P=0.01), and dynamic reinforcement(95%CI: 0~0.39, P=0.005) were independent predictors for primary MALT in the liver. ROC curve analysis indicated that the AUC value of ADC value in diagnosing primary MALT lymphoma was 0.96, with a sensitivity of 0.8 and a specificity of 1.0, and the AUC value of AFP level in diagnosing primary MALT lymphoma was 0.85, with a sensitivity of 1.0 and a specificity of 0.7. The AUC value of dynamic reinforcement in diagnosing primary MALT lymphoma was 0.85, with a sensitivity of 0.8, and a specificity of 0.9.

Dynamic reinforcement and ADC value can be used as differential markers for primary MALT lymphoma and HCC, providing reliable reference for clinical preoperative evaluation.