Objective To perform a meta-analysis of Diffusion-Weighted Imaging as a diagnostic tool for small hepatocellular carcinoma(HCC) in patients with cirrhosis. Methods A computer-based retrieval system was first used to identify reports on the diagnostic efficacy of Diffusion-Weighted Imaging for small HCC in patients with cirrhosis that were published between May 1990 and May 2015 in the following literature databases, including PubMed, EMBASE, Web of science, The Cochrane Library, China National Knowledge Infrastructure(CNKI), VIP Journal Integration Platform(VJIP), Wanfang Chinese Periodical Database, and Chinese Biomedicine Database(CBM). Two investigators, working independently, then selected cases from the relevant based on specific inclusion and exclusion criteria. The extracted data was subjected to quality assessment of diagnostic accuracy studies (QUADAS-2). The MetaDisc version 1.4 software was used to conduct meta-analyses, and subgroup analyses were performed. Results 5 studies were included in this meta-analysis with a total of 359 patients and 444 lesions. Diagnosis of small HCC in patients with cirrhosis By DWI had pooled sensitivity of 0.91 (95%CI:0.89-0.93), pooled specificity of 0.91 (95%CI:0.87-0.94), pooled positive likelihood ratios of 8.39 (95%CI:5.59-12.61), pooled negative likelihood ratios of 0.07 (95%CI:0.04-0.15), respectively. The area under the curve of the summary receiving operating characteristic (SROC) of DWI was 0.9631 (Q*=0.9091). In the subgroup analysis, the sensitivity of less than 2cm for small hepatocellular carcinoma combined was 89%, the specificity was 91%, AUC was 0.9565 (Q*=0.8995). Conclusion Combined use of DWl with conventional MRI could be valuable diagnostic tool for small HCC in cirrhotic patients.Furthermore, DWI could provide additional valuable information for small HCC(≤2.0cm)．