Domain	Participant selection	Index test	Reference standard	Flow and timing
Description	Describe methods of participant selection Describe included participants (prior testing, presentation, intended use of index test, and setting) Studies that meet the inclusion criteria of this meta‐analysis should have a population of adults (18 years or older) with chronic liver disease or cirrhosis. The participants have clinical suspicion of HCC (defined broadly as elevated alpha‐fetoprotein (AFP), discovery on surveillance imaging or on nonsurveillance imaging). Participants must undergo MRI performed with gadoxetate disodium for diagnosis of HCC We will exclude studies with fewer than 10 participants, MRI field strength lower than 1.5 T, if they include animals, and if MRI is both part of the index test and the composite reference standard	Describe the index test and how it was conducted and interpreted MRI performed with gadoxetate disodium, conducted with field strength of 1.5 or 3.0 T and interpreted by at least one radiologist	Describe the reference standard and how it was conducted and interpreted Reference standard: either pathology based on biopsy of focal liver lesion, surgical resection, explant; or a composite reference standard that also includes typical imaging findings with a follow‐up period of ≥ 6 months to confirm a negative result	Describe any people who did not receive the index test(s) or reference standard (or both) or who were excluded from the 2 x 2 table (refer to flow diagram) Describe the time interval and any interventions between index test(s) and reference standard. If pathology is the reference standard, it should be performed within ≤ 3 months the index test If imaging is the reference standard, follow‐up period should be ≥ 6 months to confirm a negative result
Signalling questions: yes/no/unclear	Was a consecutive or random sample of participants enrolled? Yes: all consecutive participants or a random sample of people with clinical suspicion of HCC were enrolled in the study No: inclusion of normal volunteers or exclusion of eligible participants Unclear: insufficient data were reported to permit a judgement	Were the index test results interpreted without knowledge of the results of the reference standard? Yes: MRI results were interpreted without knowledge of the pathology results No: MRI results were interpreted with knowledge of the results of pathology results Unclear: insufficient data were reported to permit a judgement	Is the reference standard likely to classify the target condition correctly? Yes: if participants have undergone pathology analysis of tissue specimen or if follow‐up imaging was at least ≥ 6 months after index test to permit confirmation of negative diagnosis No: pathology was not deemed adequate for HCC diagnosis or if follow‐up imaging was performed too soon (< 6 months) to confirm a true negative Unclear: insufficient data were reported to permit a judgement	Was there an appropriate interval between index test(s) and reference standard? Yes: If pathology is the reference standard, the interval between pathology and MRI was ≤ 6 months If imaging is the reference standard, follow‐up period was ≥ 6 months. No: If pathology is the reference standard, the interval between pathology and MRI was > 6 months If imaging is the reference standard, follow‐up period was < 6 months Unclear: insufficient data were reported to permit a judgement
	Was a patient‐control design avoided? This question is not relevant because we exclude studies using patient‐control design. Hence, none of the included studies will have this design	If a threshold was used, was it prespecified? Yes: sets of imaging criteria for diagnosis of HCC were prespecified No: sets of imaging criteria for diagnosis of HCC were not prespecified Unclear: it is not reported or not clearly described	Were the reference standard results interpreted without knowledge of the results of the index test? Yes: the reference standard (pathology or follow‐up imaging) were interpreted without knowledge of the results of the MRI No: the reference standard (pathology or follow‐up imaging) were interpreted with knowledge of the results of the MRI Unclear: insufficient data were reported to permit a judgement	Did all participants receive the reference standard? Yes: all participants underwent the reference standard (pathology or follow‐up imaging) No: not all participants underwent pathology or follow‐up imaging Unclear: insufficient data were reported to permit a judgement
	Did the study avoid inappropriate exclusions? Yes: the study avoided inappropriate exclusions (e.g. small tumours, large number of tumours, infiltrative HCC, MRI difficult to interpret) No: the study excluded participants inappropriately Unclear: insufficient data were reported to permit a judgement			Did all participants receive the same reference standard? Yes: all participants received the same reference standard, i.e. pathology or follow‐up imaging No: not all participants received the same reference standard, i.e. pathology or follow‐up imaging Unclear: insufficient data were reported to permit a judgement
				Were all participants included in the analysis? Yes: all participants meeting the selection criteria (selected participants) were included in the analysis, or data on all the selected participants were available so that a 2 x 2 table including all selected participants could be constructed No: not all participants meeting the selection criteria were included in the analysis, or the 2 x 2 table could not be constructed using data on all selected participants Unclear: insufficient data were reported to permit a judgement
Risk of bias: high/low/unclear	Could the selection of participants have introduced bias? High risk of bias: yes, if the selection of participants could have introduced bias Low risk of bias: no, if the selection of participants would not have introduced bias Unclear risk of bias: insufficient data on participants selection were reported to permit a judgement on the risk of bias	Could the conduct or interpretation of the index test have introduced bias? High risk of bias: if the answer to the signalling questions on the conduct or interpretation of the index test is 'no' Low risk of bias: if the answer to the signalling questions on the conduct or interpretation of the index test is 'yes' Unclear risk of bias: if the answers to the 2 signalling questions on the conduct or interpretation of the index test is either 'unclear' or any combination of 'unclear' with 'yes' or 'no'	Could the reference standard, its conduct, or its interpretation have introduced bias? High risk of bias: if the answer to the signalling questions on the reference standard, its conduct, or its interpretation is 'no' Low risk of bias: if the answer to the signalling questions on the reference standard, its conduct, or its interpretation is 'yes' Unclear risk of bias: if the answers to the 3 signalling questions on the reference standard, its conduct, or its interpretation is either 'unclear' or any combination of 'unclear' with 'yes' or 'no'	Could the participant flow have introduced bias? High risk of bias: if the answer to the signalling questions on flow and timing is 'no' Low risk of bias: if the answer to the signalling questions on flow and timing is 'yes' Unclear risk of bias: if the answers to the 4 signalling questions on flow and timing is either 'unclear' or any combination of 'unclear' with 'yes' or 'no'
Concerns regarding applicability: high/low/unclear	Are there concerns that the included participants do not match the review question? High concern: there is high concern that the included participants do not match the review question Low concern: there is low concern that the included participants do not match the review question Unclear concern: if it is unclear	Are there concerns that the index test, its conduct, or interpretation differ from the review question? High concern: there is high concern that the conduct or interpretation of the MRI test differs from the way it is likely to be used in clinical practice Low concern: there is low concern that the conduct or interpretation of the MRI test differs from the way it is likely to be used in clinical practice Unclear concern: if it is unclear	Are there concerns that the target condition as defined by the reference standard does not match the review question? High concern: Not all participants underwent pathology or follow‐up imaging for diagnosis of HCC Low concern: all participants underwent pathology or follow‐up imaging for diagnosis of HCC	‐‐