The aim was to investigate the differential diagnostic potential of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) features and establish a nomogram model for distinguishing hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH) presenting with hyperintensity on the hepatobiliary phase (HBP). This retrospective study enrolled 80 patients with pathologically confirmed HCC or FNH who underwent Gd-EOB-DTPA-enhanced MRI between January 2017 and December 2020. All lesions exhibited hyperintensity on HBP. Morphological characteristics, signal patterns, and apparent diffusion coefficient (ADC) values were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of HCC, adjusting for age and sex. A diagnostic nomogram was subsequently constructed. After adjusting for age and sex, the study showed that nodule-in-nodule hyperintensity on HPB (odds ratio [OR] = 36.46, 95% confidence interval [CI]: 4.01-331.13), an ADC value ≤1.087 × 10-3 mm2/s (OR = 0.004, 95% CI: 0.00-0.06), and the absence of a central scar (OR = 0.04, 95% CI: 0.003-0.40) were independent predictors of HCC. The nomogram incorporating these predictors demonstrated excellent diagnostic performance, with an area under the receiver operating characteristic curve of 0.933 (95% CI: 0.874-0.991). The calibration curve showed optimal agreement between predicted and observed probabilities. Gd-EOB-DTPA-enhanced MRI characteristics combined with ADC values enable reliable differentiation between HBP-hyperintense HCC and FNH. The proposed nomogram model provides a clinically applicable tool for improving diagnostic accuracy in challenging cases.