We aimed to propose a revised LI-RADS (rLI-RADS) for hepatocellular carcinoma (HCC) based on the LI-RADS version 2018 (v2018) major feature system on gadoxetate disodium (EOB)-enhanced MRI. We retrieved 224 consecutive at-risk patients with 742 LR-3 to LR-5 hepatic observations from a prospectively-collected database. In the training set, LI-RADS v2018 major features evaluated by three independent radiologists were used to develop rLI-RADS according to the likelihood of HCC. Compared with LI-RADS v2018, rLI-RADS was completely data-driven, remarkably simpler, and demonstrated significantly optimized diagnostic sensitivity and accuracy while maintaining reasonable specificity for HCC.
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