我们进行了一项最新的荟萃分析，以确定Liver Imaging Reporting and Data System（LI-RADS，LR）5类对肝细胞癌（HCC）的诊断性能，采用LI-RADS 2018版（v2018），并评估不同影像学模态和MRI对比介质类型的差异。我们在MEDLINE和Embase数据库中搜索了使用v2018诊断HCC的LR-5的研究。使用双变量随机效应模型计算汇总的每次观察敏感性和特异性。根据影像学模态和MRI对比介质类型进行亚组分析。共有48项研究符合荟萃分析的条件，包括9031名患者、10547次观察和7216个HCC病例。对于诊断HCC，LR-5的每次观察汇总敏感性为66%（95% CI，61-70%），特异性为91%（95% CI，89-93%）。在亚组分析中，使用细胞外造影剂的MRI（ECA-MRI）的汇总敏感性（77% [95% CI，70-82%]）显著高于CT（66% [95% CI，58-73%]；p = 0.023）或使用吉多酸锰钆（Gx-MRI）的MRI（65% [95% CI，60-70%]；p = 0.001），但ECA-MRI与使用氧化铕根的MRI（gadobenate-MRI）之间没有显著差异（73% [95% CI，61-82%]；p = 0.495）。CT的汇总特异性为88%（95% CI，80-93%），ECA-MRI为92%（95% CI，86-95%），Gx-MRI为93%（95% CI，91-95%），gadobenate-MRI为91%（95% CI，84-95%），之间没有显著差异（p = 0.084-0.803）。无论影像学模态或对比介质类型如何，LI-RADS v2018 LR-5对HCC的诊断提供了高特异性，而ECA-MRI的敏感性高于CT或Gx-MRI。改善LR-5的敏感性，同时保持高特异性，可能是未来的重要发展方向。 • 使用LI-RADSv2018，LR-5对诊断HCC的每次观察汇总敏感性和特异性分别为66%和91%。 • ECA-MRI的敏感性高于CT（77% vs 66%，p = 0.023）或Gx-MRI（77% vs 65%，p = 0.001）。 • 无论影像学模态或对比介质类型如何，LI-RADSv2018 LR-5对HCC的诊断提供了高特异性（88-93%）。 © 2023. 作者（们），独家授权给欧洲放射学学会。

We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material.The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material.Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803).LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI.Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction.• The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.© 2023. The Author(s), under exclusive licence to European Society of Radiology.