European Radiology

, Volume 29, Issue 3, pp 1124–1132 | Cite as

Pitfalls and problems to be solved in the diagnostic CT/MRI Liver Imaging Reporting and Data System (LI-RADS)

  • Yeun-Yoon Kim
  • Jin-Young ChoiEmail author
  • Claude B. Sirlin
  • Chansik An
  • Myeong-Jin Kim


The 2017 Core of the computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) provides clear definitions and concise explanations of the CT/MRI diagnostic algorithm. Nevertheless, there remain some practical and controversial issues that radiologists should be aware of when using the system. This article discusses pitfalls and problems which may be encountered when the version 2017 diagnostic algorithm is used for CT and MRI. The pitfalls include challenges in applying major features and assigning the LR-M category, as well as categorisation discrepancy between CT and MRI. The problems include imprecision of category codes, application of ancillary features, and regional practice variations in hepatocellular carcinoma (HCC) diagnosis. Potential solutions are presented along with these pitfalls and problems.

Key Points

• Although the diagnostic algorithm provides clear and detailed explanations, major feature evaluation can be subject to pitfalls and differentiation of HCC and non-HCC malignancy remains challenging.

• Ancillary features are optional and equally weighted. However, features such as hepatobiliary phase hypointensity and restricted diffusion have greater impact on HCC diagnosis than other ancillary features and may merit greater emphasis or weighting.

• LI-RADS was initially developed from a Western paradigm, which may limit its applicability in the East due to regional practice variations. In Eastern Asia, high sensitivity is prioritised over near-perfect specificity for HCC diagnosis in order to detect tumours at early stages.


Algorithms Diagnosis Liver cancer Tomography Magnetic resonance imaging 



Arterial phase hyperenhancement


Extracellular contrast agent


Hepatobiliary phase


Hepatocellular carcinoma




Intrahepatic cholangiocarcinoma


Liver Imaging Reporting and Data System


Portal venous phase


Treshold growth


Transitional phase



The authors state that this work has not received any funding.

Compliance with ethical standards:


The scientific guarantor of this publication is Jin-Young Choi in Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required because this review article does not include analysis of patient data.

Ethical approval

Institutional Review Board approval was not required because this review article does not include analysis of patient data.


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Yeun-Yoon Kim
    • 1
  • Jin-Young Choi
    • 1
    Email author
  • Claude B. Sirlin
    • 2
  • Chansik An
    • 1
  • Myeong-Jin Kim
    • 1
  1. 1.Department of Radiology, Severance Hospital, Research Institute of Radiological ScienceYonsei University College of MedicineSeoulKorea
  2. 2.Liver Imaging Group, Department of RadiologyUniversity of California–San Diego Medical CenterSan DiegoUSA

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