Summary of findings 2. Diagnostic accuracy of magnetic resonance imaging for the diagnosis of resectable hepatocellular carcinoma.

Review question: what is the diagnostic accuracy of MRI for the diagnosis of resectable HCC in people with chronic liver disease?
Population: adults with chronic liver disease
Setting: clinical setting (secondary or tertiary care setting) or surveillance programmes
Study design: cross‐sectional studies
Index test: MRI
Target condition: resectable HCC
Reference standards Pathology of the explanted liver in case of transplantation Histology of resected focal liver lesion(s), or the histology of resected or biopsied focal liver lesion(s) with a follow‐up of ≥ 6 months to exclude the presence of focal lesions not detected by the index test
Limitations in the evidence: risk of bias and applicability concerns (total 16 studies which had all participants with resectable HCC) Participant selection: high/unclear risk of bias 10 studies (63%); high concern for applicability 11 studies (69%) Index tests: high/unclear risk of bias 0 studies (0%); high concern for applicability 0 studies (0%) Reference standard: high/unclear risk of bias 10 studies (63%); high concern for applicability 11 studies (69%) Flow and timing: high/unclear risk of bias 14 studies (88%) Overall: high risk of bias; all included studies; high concern for applicability 11 studies (69%)
Findings
Index test	Number of studies (participants)	Sensitivity (95% CI)	Specificity (95% CI)	Implications in a hypothetical cohort of 1000 people
				Prevalencea%	True positives will receive appropriate treatment (surgical resection)	False negatives will be misdiagnosed and not undergo surgical resection	True negatives will not undergo inappropriate further testing or surgical resection	False positives will undergo inappropriate further testing or surgical resection	Certainty of the evidence
MRI	16 (2150)	84.3% (77.6% to 89.3%)	92.9% (88.3% to 95.9%)	36	303	57	595	45	Lowb
				56	472	88	409	31
				66	556	104	316	24
CI: confidence interval; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging.

^aWe chose for exemplification three values of hepatocellular carcinoma prevalence: 36% for a population with low clinical suspicion, 56% as a median derived from our study analysis, and 66% for population with high clinical suspicion (assessment of nodules detected by ultrasound).
^bDowngraded two levels for risk of bias and indirectness.