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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.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Liver Observation on CT/MRI

    Patient at risk for HCC

    1. ◆
      Decision

      At Risk for HCC?

      • Cirrhosis
      • Chronic HBV
      • Prior HCC
      1. ◆
        Decision

        Definitely Benign?

        • Cyst
        • Hemangioma
        • Focal fat
        1. ■
          End

          LR-1: Definitely Benign

          100% certainty benign

        2. ■
          End

          LR-2: Probably Benign

        3. ●
          Action

          Assess Major Features

          Size, APHE, washout, capsule, threshold growth

          1. ◆
            Decision

            Arterial Phase Hyperenhancement?

            • Non-rim APHE
            • No APHE
            • Rim APHE (targetoid)
            1. ■
              End

              LR-3: Intermediate

              Follow-up or biopsy

            2. ◆
              Decision

              Washout and/or Capsule?

              1. ■
                End

                LR-4: Probably HCC

              2. ■
                End

                LR-5: Definitely HCC

                Can treat without biopsy

            3. ■
              End

              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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