Background: To demonstrate the improved specificity of liver MRI in diagnosis of focal nodular hyperplasia (FNH) using liver specific contrast agents. Methods: In a patient after resected adenosarcoma of the uterus a focal nodular hyperplasia was followed. Serial MRI of the liver was performed using first Gd-DOTA, followed by superparamagnetic iron oxide (SPIO) as well as Gd-EOB-DTPA. Results: During the follow-up of FNH specificity of liver MRI improved using liver specific contrast agents. The central scar as well as the pseudocapsule showed different typical contrast uptake using all three methods. Conclusion: Serial MRI of the liver with Gd-DOTA, SPIO and Gd-EOB-DTPA can exclude a malignant liver lesion. Liver biopsy of FNH can be avoided with increased specificity of MRI for FNH.