Liver Imaging Reporting and Data System
Evaluates liver observations in patients with cirrhosis or high HCC risk. Major features (APHE, washout, capsule, size, threshold growth) determine the LR-1 to LR-5 category.
APHE (Arterial phase hyperenhancement)
Size
Washout (Portal/delayed phase)
Enhancing capsule (Delayed phase)
Threshold growth (>=50% / 6 months)
Select all features
100% benign observation — cyst, hemangioma, focal steatosis, etc.
Management: Continue routine surveillance
High probability of benignity
Management: Continue routine surveillance
Intermediate probability of malignancy
Management: Follow-up in 3-6 months or multidisciplinary discussion
High probability of HCC but not definitive
Management: Multidisciplinary discussion, biopsy or treatment
Sufficient features for HCC diagnosis — diagnose without biopsy
Management: Treat as HCC (transplant, resection, ablation)
Suspicious for malignancy but not HCC-specific (ICC, metastasis, etc.)
Management: Biopsy and multidisciplinary discussion
Tumor thrombus in portal or hepatic vein
Management: Advanced HCC — systemic therapy or multidisciplinary discussion
This classification system is intended for clinical decision support. Final diagnosis and treatment decisions rest with the clinician.