The MRI findings of a liver lesion in a patient with congenital heart disease are presented and the differences between the two types of MR contrast agents, i.e., extracellular and intracellular (hepatobiliary), and their role in characterizing the imaging features of hepatocellular carcinoma are discussed. The diagnostic algorithm of LI-RADS cannot be used to characterize liver lesions in patients with cardiac cirrhosis (secondary to congestive hepatopathy following congenital heart disease). The main reason for this is the increased likelihood of the presence of confounding benign lesions resulting from chronic hepatic congestion. The only definitive way to diagnose suspicious liver lesions in these patients is the histopathological examination of these lesions. Hence, there is a need for a new diagnostic imaging algorithm in such patients, which can provide a non-invasive method to identify potentially malignant lesions. Keywords: CT/MRI LI-RADS; CEUS LI-RADS; gadolinium contrast; MRI contrast agents; congenital heart disease; contrast enhanced ultrasound.