Abstract: Objective The aim of this study was to investigate diagnostic performance of MRI scan based on liver imaging report and data system (LI-RADS) in diagnosis of patients with hepatocellular carcinoma (HCC). Methods 100 patients with intra-hepatic space-occupying lesions (IH-SOL) were encountered in our hospital between June 2021 and July 2023, all underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MR scan, and lesions were classified based on LI-RADS v2018. The main MRI features of HCC included non-circular arterial phase hyperintense (APHE), rapid clearance and enhanced capsule, and the possible auxiliary signs considered as malignant included non-enhanced capsules, mosaic structures, nodules, fat inside lesions, hemorrhage, halo enhancement, fat deficiency in lesions, iron deficiency, limited diffusion of DWI and mild and moderate T2 high signals. Results Liver histo-pathological examination showed HCC in 79 cases, including 92 lesions, dysplasia nodule (DN) in 14 cases, including 22 lesions and cirrhotic regenerative nodule (RN) in 7 cases, including 11 lesions; incidences of acyclic APHE, rapid clearance and enhanced capsule in HCC lesions were 82.6%, 80.4% and 33.7%, all much higher than 45.4%, 45.4% and 9.1% (P<0.05) in DN lesions or 36.4%, 45.4% and 0.0% (P<0.05) in RN lesions; as for auxiliary signs of HCCs lesions, the incidences of DWI diffusion limitation, mild to moderate T2 hyper-intensity, low signal at transitional phase and low signal at hepatobiliary phase were 85.9%, 88.0%, 84.8% and 91.3%, all much higher than 59.1%, 63.6%, 45.4% and 63.6% (P<0.05) in DN lesions or 45.4%, 54.5%, 45.4% and 54.5% (P<0.05) in RN lesions; the sensitivity by main and auxiliary signs in predicting HCC for LR-4/5 lesions was 95.6%, much higher than 79.3%(P<0.05) by main signs alone, while there were no significant differences as respect to specificity (51.5% vs. 42.4%) or accuracy(84.0% vs. 72.0%) by MRI main or main and auxiliary sign combination (P>0.05). Conclusion The diagnostic efficacy of MRI LI-RADS in differentiating malignant and benign IH-SOL is satisfactory, which might help clinicians make correct diagnosis early and make an appropriate measures for good outcomes.

Key words: Hepatocellular carcinoma, MRI, Liver imaging report and data system, Diagnosis