Hepatitis B virus (HBV)-related decompensated cirrhosis is well-known risk factor for developing hepatocellular carcinoma (HCC). Therefore, it is critical to assess the risk of developing HCC in these patients. Magnetic resonance elastography (MRE) has promise in predicting future events in many chronic liver diseases, but its prognostic role in predicting HCC development of HBV-related decompensated cirrhosis remains unclear. In our study, we evaluated the performance of baseline liver stiffness measurement (LSM) by MRE in predicting HCC development in patients with HBV-related decompensated cirrhosis. Our results showed that MRE-based LSM was associated with HCC development and is independently predictive of HCC development in patients with HBV-related decompensated cirrhosis.