Teefey 2003.

Study characteristics
Patient Sampling	Between August 1996 and December 1998, authors examined 37 patients with end‐stage liver disease who had been listed for hepatic transplantation. Only patients with an elevated serum alpha‐fetoprotein level (30 g/L) or with primary sclerosing cholangitis were eligible. All patients underwent CT, MR imaging, US, and PET. 2 patients whose names had been on the transplant list for > 2 years were not included in the study because of an inability to obtain follow‐up images – inappropriate exclusion.
Patient characteristics and setting	All participants underwent OLT, therefore only people with advanced liver disease were included.
Index tests	Positivity criteria: a focal area of increased enhancement on arterial phase images was considered suggestive of HCC. An additional criterion for diagnosing HCC was mild lesion hyperintensity on T2W images. Radiologists were unaware of the final diagnosis. Aim: to determine and compare the diagnostic performance of CT, MRI, US, and PET against the standard of histological examination of the resected liver specimen to assess which single test or combination of tests was most accurate in the detection of HCC in listed liver transplant candidates.
Target condition and reference standard(s)	Reference standards: liver transplantation, biopsy, and follow‐up with imaging. The presence or absence of all lesions identified with ≥ 1 of the imaging tests (CT, MRI, US, or PET) was determined histologically on a lesion‐by‐lesion basis.
Flow and timing	Time between index test and reference standard > 90 days.
Comparative
Notes	Information regarding COI and 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?			High
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