In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imaging techniques in the detection and the characterization of focal liver lesions. Since the publication of these guidelines in 2008, several studies relating to this topic have been published. Thus, we felt the need to assess whether interval research and new advancements in diagnostic imaging have yielded new evidence that should modify the recommendations that were previously issued. The literature search confirmed the appropriateness of the current guidelines. Although most modalities did not show substantial changes, interval introduction of DW-MRI is a valuable technique with a high diagnostic accuracy in the detection and characterization of FLLs, and its sensitivity is higher when combined with MRI. Abbreviations: AASLD: American Association for the Study of Liver Disease; CE-IOUS: contrast-enhanced intraoperative US; CEUS: contrast-enhanced ultrasound; CRLM: colorectal liver metastasis; DW-MRI: diffusion weighted MRI; EOB-MRI: gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid MRI; FLLs: focal liver lesions; HCC: hepatocellular carcinoma; LR+: positive likelihood ratio; LR-: negative likelihood ratio; NPV: negative predictive value; PET: positron emission tomography; PPV: positive predictive value; RF: radiofrequency; TACE: transarterial chemoembolization