Practical guide: LI-RADS v2024 updates every radiologist should know

The Liver Imaging Reporting and Data System (LI-RADS) v2024, released by the American College of Radiology, introduces several clinically significant updates that affect daily liver imaging practice.

The most impactful changes include refined criteria for LR-5 (definitely HCC) that now incorporate a revised threshold growth definition, updated ancillary features that can upgrade observations from LR-4 to LR-5, and a completely restructured treatment response algorithm.

For Indian radiologists, these updates are particularly relevant given the rising incidence of hepatocellular carcinoma associated with non-alcoholic steatohepatitis (NASH) in the Indian population — a demographic shift that is bringing more liver MRI studies into daily workflow.

Key practical takeaways:

• Threshold growth now requires a minimum 50% size increase in 6 months or less (previously any measurable growth)
• Capsule appearance and mosaic architecture have been elevated as ancillary features that can upgrade LR-4 to LR-5
• The treatment response categories now explicitly address immunotherapy-related pseudoprogression