Hepatocellular carcinoma (HCC) is one of the most leading causes of cancer death worldwide. Guidelines support the use of imaging to establish the noninvasive diagnosis of HCC without confirmatory biopsy if imaging is definitive. Therefore, accurate imaging is vital in HCC patient management. The American College of Radiology (ACR) endorsed the Liver Imaging Reporting and Data System (LI-RADS) for standardized reporting and data collection of computed tomography (CT) and magnetic resonance (MR) imaging for hepatocellular carcinoma (HCC) in high-risk patients. Originally developed only for CT and MRI, LI-RADS was expanded in 2016 to include CEUS (1) coincident with the pediatric approval in the United States of a microbubble contrast agent for liver imaging (LumasonÆ, known as SonoVueÆ in Europe and elsewhere). CEUS LI-RADS currently includes categories to codify the probability of HCC based on imaging. The categories range from definitely benign (LR-1) to definitely HCC (LR-5). Observations categorized as LR-5 can be managed as HCC without histological confirmation. CEUS LI-RADS also includes a separate category (LR-M) for observations that are definitely or probably malignant, but with imaging features not specific for HCC (2-4). The differential diagnosis for such lesions includes atypical HCC and intrahepatic cholangiocarcinoma (ICC); biopsy may be needed to distinguish these possibilities. LR-TIV (tumor in vein) is assigned for observations with definite tumor in vein, even if a parenchymal component is not identified at imaging; biopsy is not needed to confirm the vascular invasion but may be needed to determine the underlying tumor type. The presentation will summarize the updated version of CEUS-LI-RADS (v2018).