Abstract: Objectives: To evaluate the diagnostic performance of the 2018 version of liver reporting and date system (LI-RADS v2018) for hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging (MRI) in high-risk patients. Methods: The data from 69 patients with HCC confirmed by pathology from 2017 and 2022 were retrospectively analyzed. The MRI features of the HCC lesions were analyzed and categorized according to LI-RADS v2018. The efficacy of LI-RADS v2018 in the diagnosis of HCC was calculated based on pathology. The intraclass correlation coefficient (ICC) test was used for consistency analysis. Results: The ICC value of the LI-RADS categories was 0.782 (95%CI: 0.713 to 0.841) across three readers based on the Liver Imaging Reporting and Data System (LI-RADS) criteria. When using LR-5 as the criterion to predict HCCs, the sensitivity, specificity and accuracy for each reader were 83.9%, 70.4%, and 79.8%; 80.6%, 74.1%, and 78.7%; and 80.6%, 77.8%, and 79.8%, respectively. When using LR-4/5 as the criterion to predict HCCs, these measures for each reader were 93.5%, 63.0%, and 84.3%; 90.3%, 66.7%, and 83.1%; and 91.9%, 66.7%, and 84.3%, respectively. Conclusion: Based on LI-RADS v2018, the enhanced MRI demonstrated high diagnostic efficacy for HCC in high-risk patients.