We aimed to develop a modified Liver Imaging Reporting and Data System (mLI-RADS) with comparisons against original LI-RADS version 2018 (v2018) for diagnosing hepatocellular carcinoma (HCC) on gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI). 1002 hepatic observations in 272 consecutive at-risk patients were prospectively included. Ancillary features were assessed based on inter-rater agreement, prevalence, diagnostic accuracy, and added value to the major features. Compared with the original LI-RADS v2018, mLI-RADS demonstrated superior simplicity, sensitivity and accuracy without substantial loss of specificity; hence should be the preferred diagnostic criteria for HCC in high-risk patients on EOB-MRI.
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