计算机断层扫描 (CT)/磁共振成像 (MRI) 肝脏成像报告和数据系统 (LI-RADS，LR) 5 类对于诊断肝细胞癌 (HCC) 具有高特异性和适度的敏感性。本研究的目的是比较 LR-5 与 LR-4 和 LR-5 组合 (LR-4/5) 诊断 HCC 的诊断性能。检索了截至 2023 年 1 月 3 日的 MEDLINE 和 EMBASE 数据库，以查找报告使用 CT/MRI LI-RADS 2014、2017 或 2018 版，评估 LR-5 和组合 LR-4/5 在 HCC 诊断中的性能。使用双变量随机效应模型来计算汇总的每次观察诊断性能。根据成像方式和 MRI 对比材料类型进行亚组分析。纳入了 69 项研究（15,108 个观察结果，9928 个（65.7%）HCC）。与 LR-5 相比，组合 LR-4/5 显示出显着更高的汇总敏感性（83.0% (95% CI [80.3-85.8%]) vs 65.7% (95% CI [62.4-69.1%])；p < 0.001） ，较低的汇总特异性 (75.0% (95% CI [70.5-79.6%]) vs 91.7% (95% CI [90.2-93.1%])；p < 0.001)，较低的汇总阳性似然比 (3.60 (95% CI [95% CI [90.2-93.1%]) 3.06-4.23]) vs 6.18 (95% CI [5.35-7.14])；p < 0.001)，合并阴性似然比较低 (0.22 (95% CI [0.19-0.25]) vs 0.38 (95% CI [0.35- 0.41]）与；p < 0.001）。所有亚组中都出现了类似的结果。我们的荟萃分析表明，结合 LR-4 和 LR-5 会提高敏感性，但会降低特异性、阳性似然比和阴性似然比。这些发现可能会为管理指南和个体化管理提供信息。这项荟萃分析估计了当 LI-RADS 类别 4 和类别 5 合并时影像学标准的敏感性和特异性的变化幅度；这些发现可以为管理指南和个体化管理提供信息。全球范围内没有单一的肝脏成像报告系统，部分原因是区域需求。结合 LI-RADS 类别 4 和 5 可提高敏感性并降低特异性以及阳性和阴性似然比。成像标准的敏感性和特异性的变化可以为管理指南和个体化管理提供信息。© 2024。作者，获得欧洲放射学会的独家许可。

Computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 has high specificity and modest sensitivity for diagnosis of hepatocellular carcinoma (HCC). The purpose of this study was to compare the diagnostic performance of LR-5 vs combined LR-4 and LR-5 (LR-4/5) for HCC diagnosis.MEDLINE and EMBASE databases through January 03, 2023 were searched for studies reporting the performance of LR-5 and combined LR-4/5 for HCC diagnosis, using CT/MRI LI-RADS version 2014, 2017, or 2018. A bivariate random-effects model was used to calculate the pooled per-observation diagnostic performance. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material.Sixty-nine studies (15,108 observations, 9928 (65.7%) HCCs) were included. Compared to LR-5, combined LR-4/5 showed significantly higher pooled sensitivity (83.0% (95% CI [80.3-85.8%]) vs 65.7% (95% CI [62.4-69.1%]); p < 0.001), lower pooled specificity (75.0% (95% CI [70.5-79.6%]) vs 91.7% (95% CI [90.2-93.1%]); p < 0.001), lower pooled positive likelihood ratio (3.60 (95% CI [3.06-4.23]) vs 6.18 (95% CI [5.35-7.14]); p < 0.001), and lower pooled negative likelihood ratio (0.22 (95% CI [0.19-0.25]) vs 0.38 (95% CI [0.35-0.41]) vs; p < 0.001). Similar results were seen in all subgroups.Our meta-analysis showed that combining LR-4 and LR-5 would increase sensitivity but decrease specificity, positive likelihood ratio, and negative likelihood ratio. These findings may inform management guidelines and individualized management.This meta-analysis estimated the magnitude of changes in the sensitivity and specificity of imaging criteria when LI-RADS categories 4 and 5 were combined; these findings can inform management guidelines and individualized management.There is no single worldwide reporting system for liver imaging, partly due to regional needs. Combining LI-RADS categories 4 and 5 increased sensitivity and decreased specificity and positive and negative likelihood ratios. Changes in the sensitivity and specificity of imaging criteria can inform management guidelines and individualized management.© 2024. The Author(s), under exclusive licence to European Society of Radiology.