Hepatocellular carcinoma (HCC) is the second most cause of cancer death worldwide. Early detection of small HCC can prolong patient survival. Recent updates have changed diagnostic criteria for LI-RADS v2018 for 10-19 mm HCC, and the impact on accuracy has not yet been studied. We found that LI-RADS v2018 provides 68.2% sensitivity, 91.7% specificity, and 71.8% accuracy for 10-19 mm HCC diagnosis in a Chinese population with chronic liver disease. Several modifications of LI-RADS were explored (e.g., pooling LR-4 and LR-5; allowing ancillary features favoring HCC to upgrade LR-4 to LR-5 and/or convert LR-M to LR-5), some sensitivities were mild improved without specificities increase.