The authors evaluated the technique of magnetization transfer to determine if it could enable distinction of benign from malignant liver lesions. Thirteen patients with 27 hemangiomas or cysts and 13 patients with 31 malignant liver lesions underwent magnetic resonance imaging. Hepatic malignancies demonstrated magnetization transfer similar to that of the liver. However, hemangiomas and cysts showed significantly less magnetization transfer than malignant liver lesions. Gradient-recalled-echo imaging with the off-resonance saturation pulse showed increased lesion contrast compared with the liver for hemangiomas and cysts but not for malignancies. On the basis of signal intensity measurements alone (ie, ignoring morphologic criteria), the magnetization transfer studies showed an area under the receiver operating characteristic curve of 0.96 for distinguishing benign from malignant liver lesions. Though the separation of these two groups was imperfect, it was comparable with that achieved with qualitative analysis of signal intensity ratios at spin-echo imaging.