Application of Liver Imaging Reporting and Data System version 2018 ancillary features to upgrade from LR-4 to LR-5 on gadoxetic acid-enhanced MRI.

• Independently significant AFs for HCC on gadoxetic acid-enhanced MRI were mild-moderate T2 hyperintensity, hepatobiliary phase hypointensity, nonenhancing "capsule," and mosaic architecture. • When LR-4 criteria by major features alone in combination with significant AFs were upgraded to LR-5, sensitivities were higher than the standard LR-5, without impairing specificity. • Independently significant ancillary features in Liver Imaging Reporting and Data System version 2018 may be used to upgrade from LR-4 to LR-5 to improve sensitivity without impairing specificity on gadoxetic acid-enhanced MRI.