Early detection of small hepatocellular carcinoma (HCC) lesions can improve long-term patient survival. A systematic review and meta-analysis of the diagnostic performance of gadoxetic acid disodium-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) and multidetector computed tomography (MDCT) was performed in diagnosing small HCCs measuring up to 2 cm(0.05). Area under the summary receiver operating characteristic curve was 0.9712 with Gd-EOB-DTPA-enhanced MRI and 0.8538 with MDCT. Regarding Gd-EOB-DTPA-enhanced MRI, sensitivity was significantly higher for studies from non-Asian countries than Asian countries(0.96 vs 0.93, p0.01), for retrospective studies than prospective studies(0.95 vs 0.91, p0.01), and for those with Gd-EOB-DTPA injection rate>/=1.5ml/s than that of1.5ml/s (0.97 vs 0.90, p0.01). CONCLUSIONS: Gd-EOB-DTPA-enhanced MRI demonstrated higher sensitivity and overall diagnostic accuracy than MDCT, and thus should be the preferred imaging modality for diagnosing small HCCs measuring up to 2 cm. This article is protected by copyright. All rights reserved.