为了评估Liver Imaging Reporting and Data System (LI-RADS) 2018版对基于gadoxetic acid-enhanced MRI的肝细胞癌（HCC）检测的诊断效果，比较了肝移植候选者（LT组）和接受手术切除的患者（SR组），并确定了LI-RADS v2018诊断效果的重要临床因素。回顾性纳入于2019年1月至2020年12月期间接受gadoxetic acid-enhanced MRI和随后SR或LT治疗的HCC患者。使用广义估计方程比较了LI-RADS LR-5在两组中对HCC的敏感性和特异性。计算了LT组按照米兰标准分组的诊断准确率。进行单变量和多变量 logistic 回归分析，确定与LI-RADS敏感性相关的重要临床因素。 共281位患者中，237位分配给SR组，44位分配给LT组。LT组的患者整体敏感性（48.5% vs. 79.6%，p < .001）和病灶敏感性（31.0% vs. 75.9%，p < .001）显著低于SR组，而整体特异性（100.0% vs. 91.7%，p > .99）和病灶特异性（100.0% vs. 94.1%，p > .99）之间没有显著差异。按照米兰标准进行患者分组的准确率为50.0%。小病灶大小（p < .001）、大病灶数目（p = .002）和较高的Child-Pugh评分（p = .009）的患者的敏感性显著降低。基于gadoxetic acid-enhanced MRI的LI-RADS v2018在肝移植候选者中可能不足，应考虑使用其他诊断成像检查。 对于病灶较小、病灶数目较多和Child-Pugh评分较高的肝移植候选者，应考虑使用gadoxetic acid-enhanced MRI之外的其他成像检查来确定移植合格性。 • Liver Imaging Reporting and Data System（LI-RADS）的敏感性在肝移植候选者中较低，而在接受手术切除的患者中较高。 • 使用gadoxetic acid-enhanced MRI，基于米兰标准对于肝移植的患者分组准确性不高。 • LI-RADS v2018的敏感性与病灶大小、病灶数目和Child-Pugh分类显著相关。 © 2023. 作者，授权给European Society of Radiology。

To evaluate the diagnostic performance for hepatocellular carcinoma (HCC) detection of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 on gadoxetic acid-enhanced MRI, comparing liver transplant candidates (LT group) with patients who underwent surgical resection (SR group), and to determine significant clinical factors for diagnostic performance of LI-RADS v2018.Patients who underwent gadoxetic acid-enhanced MRI and subsequent SR or LT for HCC were retrospectively included between January 2019 and December 2020. The sensitivity and specificity of LI-RADS LR-5 for HCC were compared between the two groups using generalized estimating equations. The accuracy of patient allocation according to the Milan criteria was calculated for the LT group. Univariable and multivariable logistic regression analyses were performed to determine significant clinical factors associated with the sensitivity of LI-RADS.Of the 281 patients, 237 were assigned to the SR group, and 44 were assigned to the LT group. The LT group showed significantly lower per-patient (48.5% vs. 79.6%, p < .001) and per-lesion sensitivity (31.0% vs. 75.9%, p < .001) than the SR group, whereas no significant difference in both per-patient (100.0% vs. 91.7%, p > .99) and per-lesion specificities (100.0% vs. 94.1%, p > .99). The accuracy of patient allocation was 50.0%. Sensitivity was significantly lower in patients with a smaller lesion size (p < .001), a larger lesion number (p = .002), and a higher Child-Pugh score (p = .009).LI-RADS v2018 on gadoxetic acid-enhanced MRI might be insufficient in liver transplant candidates and other diagnostic imaging tests should be considered in patients with these significant clinical factors.In liver transplant candidates with a smaller lesion size, a larger lesion number, and a higher Child-Pugh score, imaging tests other than gadoxetic acid-enhanced MRI may be clinically useful to determine the transplant eligibility.• The sensitivity of the Liver Imaging Reporting and Data System (LI-RADS) was lower in liver transplant candidates than in those who underwent surgical resection. • With the use of gadoxetic acid-enhanced MRI, the accuracy of patient allocation for liver transplantation on the basis of the Milan criteria was suboptimal. • The sensitivity of LI-RADS v2018 was significantly associated with lesion size, lesion number, and Child-Pugh classification.© 2023. The Author(s), under exclusive licence to European Society of Radiology.