Objective To explore the MRI imaging findings of hepatic angiomyolipoma (HAML) and the correlation with pathology. Methods The clinical data of 70 patients with HAML were analyzed retrospectively, and all of them received MRI examination, and the relationship between MRI imaging findings and pathology were analyzed. Results Among the 70 patients with HAML, there were more women (51 cases, 72.86%) than men (19 cases, 27.14%), and they were 22-78 (43.79±6.45) years old. And 54 cases (77.14%) were asymptomaticand the tumor diameter range from 2-18 cm with average of (6.47±1.84)cm. There were 5 cases of positive carcinoembryonic antigen, and there was no abnormality in blood routine, alpha fetoprotein and CA19-9, and there were 7 cases of high hepatobilirubin. There were 8 cases of positive HBsAg, and 32 cases of positive anti-HBs antibody. Pathological examination revealed there were 77 HAML lesions, 31 mixed types (40.26%), 20 lipoma types (25.97%), 15 myoma types (19.48%), and 11 angiomatous types (14.29%). MRI showed that 54 were high-low mixed signal on T1WI and T2WI,and 17 were relatively low signal on T1WI and high signal on T2WI, and 6 were high signal on T1WI and low signal on T2WI. 45 lesions showed patchy or spotty fat signals, and 32 lesions showed no fat signal. There were 73 heterogeneous enhancement in arterial phase, and 49 lesions in portal phase and delayed phase showed continuous enhancement of high signal, and another 28 lesions showed a heterogeneous reduction of "fast wash in and fast wash out". 57 lesions showed drainage veins, and 20 lesions inside showed large malformations of vascular shadow. Conclusion MRI examination can clearly show the fat and vascular signal of the HAML, which help the diagnosis of the disease.