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目的:探讨2018版MRI肝脏影像报告和数据系统（LI-RADS v2018）对≤3 cm肝细胞癌（HCC）与其他肝脏原发恶性肿瘤（OM）的鉴别诊断价值。方法:回顾性分析2014年9月至2019年9月间浙江省丽水市中心医院、丽水市遂昌人民医院经手术病理证实且病灶长径≤3 cm的95例原发肝癌患者资料，根据病理结果分别归入HCC组（53例）和OM组（42例，其中肿块型肝内胆管细胞癌31例、混合型肝癌11例）。分析病灶的MRI征象，并依据LI-RADS v2018标准对病灶进行分类。两组间MRI征象比较采用χ2检验。以病理结果为金标准，计算LI-RADS v2018分类标准诊断HCC或OM的灵敏度和特异度。结果:HCC组和OM组间动脉期强化表现、廓清表现、假包膜征、脂肪变性、出血、填充强化的差异有统计学意义（n P<0.05）。HCC组LI-RADS v2018分类结果归类为LR-M、LR-3、LR-4、LR-5的例数分别为7、1、11、34例，OM组分别为15、1、15、11例。以LR-5标准诊断HCC的灵敏度为64.2%（34/53）、特异度为73.8%（31/42）；以LR-4联合LR-5标准诊断HCC的灵敏度为84.9%（45/53）、特异度为38.1%（16/42）；以LR-M标准诊断OM的灵敏度为35.7%（15/42）、特异度为86.8%（46/53）。n 结论:当肝内病灶长径≤3 cm时，以LR-4联合LR-5、LR-5为标准诊断HCC的特异度较低，以LR-M为标准诊断OM有较高的特异度。“,”Objective:To investigate the value of liver reporting and data system version 2018 (LI-RADS v2018) in the differential diagnosis between hepatocellular carcinoma (HCC) and other primary hepatic malignancy (OM) less than 3 cm.Methods:The data of total 95 patients with primary liver cancer confirmed by pathology from September 2014 to September 2019 in Central Hospital of Lishui City and Suichang People′s Hospital of Lishui City were retrospectively analyzed. The length of all the lesions were less than 3 cm. The patients were distributed into HCC group (53 cases) and OM group (42 cases, consisting of 31 cases of massive intrahepatic cholangiocarcinoma and 11 cases of combined hepatocellular-cholangiocarcinoma) according to the pathological results. Then the lesions were classified based on the MRI features according to the LI-RADS v2018 guidelines. The χn 2test was used to compare the MRI characteristics between the two groups. The sensitivity and specificity of LI-RADS v2018 in the diagnosis of HCC and OM were calculated based on pathology.n Results:There were statistically significant differences in arterial enhancement, clearance, pseudocapsule sign, steatosis, hemorrhage and filling enhancement between the HCC group and OM group (n P<0.05). In HCC group, the number of lesions classified as LR-M, LR-3, LR-4 and LR-5 were 7, 1, 11 and 34, respectively. Meanwhile in OM group, the number of lesions were 15, 1, 15 and 11, respectively. Taking LR-5 as the criterion to predict HCC, the sensitivity was 64.2% (34/53) and the specificity was 73.8% (31/42). Taking LR-4/5 as the criterion to predict HCC, the sensitivity was 84.9% (45/53) and the specificity was 38.1 % (16/42). Taking LR-M as the criterion to predict OM, the sensitivity was 35.7% (15/42) and the specificity was 86.8% (46/53).n Conclusion:On the condition that the length of intrahepatic lesions are less than 3.0 cm, the specificities of LR-4/5 and LR-5 criteria in the diagnosis of HCC are relatively low, meanwhile the specificity of LR-M criterion in the diagnosis of OM is high.