PURPOSE: To compare breath-hold T1-weighted magnetization-prep ared gradient-echo (MP-GRE) imaging with conventional T2-weighted spin-echo (SE) imaging in evaluation of focal liver disease. MATERIALS AND METHODS: Images of 68 patients evaluated for focal liver disease were reviewed. Five sets of images were analyzed: axial, sagittal, and coronal breath-hold T1-weighted MP-GRE images, axial T2-weighted SE images, and a compilation of axial, sagittal, and coronal (three-plane) T1-weighted ME-GEE images. Lesion signal intensity (SI) and signal difference-to-noise (SD/N) ratios were calculated. RESULTS: Lesions were detected, localized, and characterized more accurately (P <.05-.001) and with greater confidence on three-plane T1-weighted ME-GEE images than on almost all single-plane images. Mean SI ratios of nonsolid and solid lesions on MP-GRE and SE images were significantly different at all lesion sizes; mean SD/N ratio was significantly different only for large lesions. CONCLUSION: Lesion detection, localization, and characterization can be accurately and confidently performed with three-plane T1-weighted MP-GRE breath-hold imaging, potentially obviating conventional T2-weighted SE imaging.