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Liver Lesion Characterization (LI-RADS v2018)

Liver Lesion Characterization (LI-RADS v2018): Liver Observation on CT/MRI → At Risk for HCC? → Definitely Benign? → LR-1: Definitely Benign.

Pathway Overview

12 steps

Algorithm Steps

12 total

  1. 01Start

    Liver Observation on CT/MRI

    Patient at risk for HCC

  2. 02Decision

    At Risk for HCC?

    • Cirrhosis
    • Chronic HBV
    • Prior HCC
  3. 03Decision

    Definitely Benign?

    • Cyst
    • Hemangioma
    • Focal fat
  4. 04End

    LR-1: Definitely Benign

    100% certainty benign

  5. 05End

    LR-2: Probably Benign

  6. 06Action

    Assess Major Features

    Size, APHE, washout, capsule, threshold growth

  7. 07Decision

    Arterial Phase Hyperenhancement?

    • Non-rim APHE
    • No APHE
    • Rim APHE (targetoid)
  8. 08End

    LR-3: Intermediate

    Follow-up or biopsy

  9. 09Decision

    Washout and/or Capsule?

  10. Path rejoins step 08Shared downstream outcome
  11. 10End

    LR-4: Probably HCC

  12. 11End

    LR-5: Definitely HCC

    Can treat without biopsy

  13. 12End

    LR-M: Malignant, Not HCC Specific

    May be ICC or metastasis

Guideline Source

ACR LI-RADS CT/MRI v2018

DOI: 10.1148/radiol.2018181494View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Only applies to patients at risk for HCC
  • Does not apply to patients <18 years
  • Different versions for CT/MRI vs CEUS

Contraindicated Populations

Pediatric patientsNon-HCC risk patients

Applicable Regions

USAUEUAPAC

EU: EASL guidelines compatible

US: ACR LI-RADS standard, AASLD endorses

APAC: APASL with regional HBV modifications

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Liver Lesion Characterization (LI-RADS v2018)?

The Liver Lesion Characterization (LI-RADS v2018) is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on ACR LI-RADS CT/MRI v2018.

What guideline is the Liver Lesion Characterization (LI-RADS v2018) based on?

This algorithm is based on ACR LI-RADS CT/MRI v2018 (DOI: 10.1148/radiol.2018181494).

What are the limitations of the Liver Lesion Characterization (LI-RADS v2018)?

Known limitations include: Only applies to patients at risk for HCC; Does not apply to patients <18 years; Different versions for CT/MRI vs CEUS. Individual patient factors may require deviation from these recommendations.

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