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Based on the ACR LI-RADS® v2018 CT/MRI Core. Applies only to patients at high risk for HCC.
Major features (HCC pathway)
nonrim APHE · size · additional featuresMass type — LR-M screen
non-HCC malignancy featuresAncillary features
auto-applied · ±1 category · cannot reach LR-5Reference — diagnostic table, LR-M criteria, ancillary features
CT/MRI Diagnostic Table (v2018)
| Additional major features* | No APHE | Nonrim APHE | |||
|---|---|---|---|---|---|
| <20 | ≥20 | <10 | 10–19 | ≥20 | |
| None | LR-3 | LR-3 | LR-3 | LR-3 | LR-4 |
| One | LR-3 | LR-4 | LR-4 | LR-4 / LR-5† | LR-5 |
| ≥ Two | LR-4 | LR-4 | LR-4 | LR-5 | LR-5 |
*Additional major features: nonperipheral “washout”, enhancing “capsule”, threshold growth (≥50% diameter increase in ≤6 months).
†10–19 mm + nonrim APHE + exactly one additional feature: LR-5 if nonperipheral “washout” OR threshold growth; LR-4 if enhancing “capsule” only.
LR-M criteria
Targetoid mass (rim APHE, peripheral “washout”, delayed central enhancement, targetoid diffusion, or targetoid TP/HBP), OR nontargetoid mass with ≥1 of: infiltrative appearance, marked diffusion restriction, necrosis or severe ischemia, or other feature suggesting non-HCC malignancy.
<20 mm distinctive nodule (no major or LR-M features)
No ancillary feature of malignancy → LR-2. ≥1 ancillary feature of malignancy and none favoring benignity → LR-3. Conflicting ancillary features → LR-2.
Ancillary features
Favoring malignancy: US visibility as discrete nodule, subthreshold growth, restricted diffusion, mild–moderate T2 hyperintensity, corona enhancement, fat sparing in solid mass, iron sparing in solid mass, transitional phase hypointensity, HBP hypointensity, nonenhancing “capsule”, nodule-in-nodule, mosaic architecture, blood products in mass, fat in mass (more than adjacent liver).
Favoring benignity: size stability >2 yrs, size reduction, parallels blood pool, undistorted vessels, iron in mass (more than liver), marked T2 hyperintensity, HBP isointensity.
