BackgroundThe Liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing liver imaging in patients at risk for hepatocellular carcinoma (HCC).PurposeTo systematically compare the performance of computed tomography (CT)/MRI LI‐RADS category 5 (LR‐5) for diagnosing HCC between versions 2017 and 2018.Study TypeSystematic review and meta‐analysis.SubjectsSix articles with 1181 lesions.Field Strength/Sequence1.5 T and 3.0 T.AssessmentData extraction was independently performed by two reviewers who identified and reviewed articles comparing the performance of LR‐5 for diagnosing HCC between CT/MRI LI‐RADS versions 2017 and 2018. Study and patient characteristics, index test characteristics, reference standards, and study outcomes were extracted from included studies. Risk of bias and concerns regarding applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool.Statistical TestsBivariate random‐effects models were used to calculate the pooled per‐observation sensitivity and specificity of LR‐5 using both versions. The summary receiver operating characteristic curves were plotted. Meta‐regression analysis was performed to explore heterogeneity. A P‐value <0.05 was considered to be statistically significant for all analyses other than heterogeneity, where the significance threshold was 0.1.ResultsThe pooled per‐observation sensitivity of LR‐5 for diagnosing HCC did not show statistically significant difference between versions 2017 (60%; 95% confidence interval [CI], 49%–70%) and 2018 (67%; 95% CI, 56%–76%; P = 0.381). The pooled per‐observation specificities of LR‐5 were not significantly different between versions 2017 (92%; 95% CI, 90%–95%) and 2018 (91%; 95% CI, 88%–93%; P = 0.332). Meta‐regression analyses revealed that the most common underlying liver disease (hepatitis B or hepatitis C) was a significant factor contributing to the heterogeneity of sensitivities among studies for both versions.Data ConclusionIn this meta‐analysis using intraindividual paired comparisons, the pooled sensitivity and pooled specificity of LR‐5 were not significantly different between 2017 and 2018 LI‐RADS versions.Level of Evidence3Technical EfficacyStage 2