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Radiology
Hepatology · Oncology
LI-RADS
v2018
Liver Imaging Reporting & Data System — CT/MRI Classification for Hepatocellular Carcinoma
Reference
ACR LI-RADS v2018
Radiology 2018; Chernyak et al.
Parameters
For patients with cirrhosis or chronic HBV at risk for HCC
Step 1 — Initial Assessment
Observation → Proceed to diagnostic table
Definitely benign (cyst, hemangioma, focal fat) → LR-1
Probably benign (hepatic adenoma, FNH-like, distinctive hemangioma) → LR-2
Tumor in vein (definite enhancing soft tissue in vein) → LR-TIV
Targetoid mass features (rim APHE, peripheral washout, delayed central enhancement) → LR-M
Classify LR-1, LR-2, LR-TIV, LR-M first. If none apply, proceed to table.
Arterial Phase Hyperenhancement (APHE)
Yes — Nonrim
No / Rim
Nonrim APHE greater than surrounding liver parenchyma
Observation Size
(mm)
Largest outer-edge to outer-edge dimension
Nonperipheral "Washout"
Present
Absent
Nonperipheral visually assessed temporal reduction in enhancement relative to liver (portal venous or delayed phase)
Enhancing "Capsule"
Present
Absent
Smooth, uniform, sharp border around most or all of observation in portal venous or delayed phase
Threshold Growth
Yes
No
≥50% size increase in ≤6 months, OR new observation ≥10mm
Ancillary Features
(optional, for upgrade/downgrade)
Intralesional fat (more than adjacent liver)
T2 hyperintensity (moderately, not markedly)
Restricted diffusion
Corona enhancement
Mosaic architecture
Hepatobiliary phase hypointensity
Classify
→ LI-RADS
🫀
Enter observation features
LR-1 through LR-5, LR-M, LR-TIV
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Major Features Detected
Classification Basis
Recommended Management
Ancillary Features & Adjustment