Cytokeratin 19 (CK19) is well acknowledged as a biliary/progenitor cell marker and a marker of tumor stem cell. CK19-positive HCCs demonstrate more aggressive behaviors and poorer outcomes. This worked aimed at exploring the value of intravoxel incoherent motion (IVIM) diffusion-weighted (DW) magnetic resonance (MR) imaging in the diagnosis of CK19-positive HCC. The results showed that Slow ADC Mono and Slow ADC Bi were significantly different between the CK19-positive and CK19-negative HCC groups. The area under the curves (AUCs) of Slow ADC Mono, Slow ADC Bi, and combine (Slow ADC Mono & Slow ADC Bi) were 0.817, 0.988, and 0.992, respectively.