There have been major changes in the management and reporting of hepatocellular carcinoma (HCC) in the last decade. Cross-sectional imaging is now pivotal in the management of cirrhotic patients, in particular in the diagnosis and staging of HCC. Although diagnostic systems have become relatively well developed, approximately one-third of HCC nodules may have an atypical appearance, necessitating ancillary testing, close follow-up, or biopsy. The introduction of standardized diagnostic and reporting systems has improved communication between radiologists and clinicians, but there remains substantial disagreement between radiologists in feature assignment and nodule characterization.