© 2022 Hong Kong College of Radiologists.Objective: The aim of this retrospective study was to compare the diagnostic accuracy of conventional T2-weighted images (T2WI) and diffusion-weighted imaging (DWI) to distinguish between benign and malignant liver lesions. Methods: Lesions were assessed using a 1- to 5-point (1, benign; 5, definitely malignant) scoring system based on T2WI and signal characteristics on DWI. The sensitivity, specificity, and accuracy of T2WI and DWI were calculated for benign and malignant lesions. Results: A total of 587 focal liver lesions in 561 patients were included in the study. There were 449 benign and 138 malignant lesions. The mean ± standard deviation scores of benign lesions obtained in T2WI and DWI were 1.4 ± 0.8 and 1.7 ± 1.0, respectively, while the same scores in malignant lesions were 4.5 ± 0.8 and 4.4 ± 0.9, respectively. The sensitivity, specificity, and accuracy of T2WI in distinguishing benign from malignant liver lesions was 94%, 94%, and 94%, respectively. The same values were calculated as 96%, 85% and 88% for DWI, respectively. Conclusion: Both imaging methods had high efficiency in characterisation of benign and malignant liver lesions. T2WI and DWI can be used safely in characterisation of liver lesions in individuals who cannot be given contrast agents due to reasons such as renal failure and contrast allergy.