Besa 2017.

Study characteristics
Patient Sampling	Included: people who underwent gadoxetic acid‐enhanced liver MRI between 1 January 2011 to 31 December 2011 for HCC screening/surveillance or diagnosis/follow‐up post‐therapy. Final cohort consisted of 174 consecutive participants, 62 had HCC, 112 were HCC free. Excluded: people with HCC sized < 1 cm.
Patient characteristics and setting	Consecutive participants at risk of HCC underwent MRI.
Index tests	MRI positivity criteria: HCC was diagnosed on CE‐set when a nodule showed arterial hyperenhancement followed by washout or capsule/pseudocapsule (or both) on PVP images, according to the AASLD 2011 criteria (Bruix 2011). MRI observers were blinded to clinical MRI reports and pathological results.
Target condition and reference standard(s)	Aim: to assess the diagnostic performance of a simulated AMRI protocol using DWI and T1W‐HBP after gadoxetic acid injection alone and in combination for HCC detection in comparison with dynamic CE‐T1W imaging, using histopathology (resection, OLT, biopsy) and follow‐up as the reference standard. Pathology reports were matched with imaging findings to ensure observers analysed the correct lesions.
Flow and timing	Time between index test and reference standard 12–270 days.
Comparative
Notes	Study reported COI. Funding not reported.
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Did the study avoid inappropriate exclusions?	No
Could the selection of patients have introduced bias?		High risk
Are there concerns that the included patients and setting do not match the review question?			Low concern
DOMAIN 2: Index Test (All tests)
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
Were positivity criteria clearly defined?	Yes
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	No
Could the reference standard, its conduct, or its interpretation have introduced bias?		High risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Low concern
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	No
Did all patients receive the same reference standard?	No
Were all patients included in the analysis?	Yes
Could the patient flow have introduced bias?		High risk