Focal lesions in the cirrhotic liver: an update on LI-RADS classification and clinical implications

Hepatocellular carcinoma (HCC) is a major global health burden, and imaging is crucial for its detection, characterization, and post-treatment assessment. The Liver Imaging Reporting and Data System (LI-RADS) was developed to standardize terminology, interpretation, and reporting in at-risk patients, reducing variability and improving communication in clinical practice. This review outlines the spectrum of focal liver lesions in cirrhosis and provides a comprehensive overview of LI-RADS across surveillance, diagnostic, and treatment response algorithms, with particular focus on the most recent updates, including the 2024 versions. Evidence from recent literature and current guidelines integration is summarized, and future perspectives are discussed, highlighting ongoing needs for wide adoption, simplification, and incorporation of novel imaging strategies.