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AIM: To compare the gadolinium-enhanced multiphase dynamic magnetic resonance imaging (MRI) and multiphase multirow-detector helical CT (MDCT) scanning for detection of small hepatocellular carcinoma (HCC). METHODS: MDCT scanning and baseline MRI with SE T1-WI and T2-WI sequence combined with FMPSPGR sequence were performed in 37 patients with 43 small HCCs. Receiver operating characteristic (ROC) curves were plotted to analyze the results for modality. RESULTS: The areas below ROC curve (Az) were calculated. There was no statistical difference in dynamic enhancement MDCT and MRI. The detection rate of small HCC was 97.5%-97.6% on multiphase MDCT scanning and 90.7%-94.7% on MRI, respectively. The sensitivity of detection for small HCC on MDCT scanning was higher than that on dynamic enhancement MRI. The sensitivity of detection for minute HCC (tumor diameter ≤ 1 cm) was 90.0%-95.0% on MDCT scanning and 70.0%-85.0% on MRI, respectively. CONCLUSION: MDCT scanning should be performed for early detection and effective treatment of small HCC in patients with chronic hepatitis and cirrhosis during follow-up.