Liver Imaging Reporting and Data System (LI-RADS): A Comprehensive Review

Hepatocellular carcinoma (HCC) is a clinically significant primary liver malignancy that predominantly occurs in patients with cirrhosis and chronic liver disease. Early detection and accurate, non-invasive diagnosis are critical for improving survival outcomes, guiding therapeutic decision-making, and determining eligibility for liver transplantation. Imaging plays a central role in this process and frequently allows definitive diagnosis without the need for biopsy. The Liver Imaging Reporting and Data System (LI-RADS), developed by the American College of Radiology (ACR), was created to standardize liver imaging acquisition, interpretation, categorization, and reporting in populations at risk for HCC. Since its introduction, LI-RADS has evolved to encompass ultrasound surveillance, contrast-enhanced ultrasound, multiphase computed tomography, magnetic resonance imaging, and treatment response assessment algorithms, including nonradiation and radiation-based therapies. This narrative review provides a comprehensive overview of LI-RADS, encompassing its evolution and the latest developments in its diagnostic, surveillance, and treatment response algorithms.