Geographic and Sex Distribution of LI-RADS Research Globally: A Cross-Sectional Meta-Research Study

Background: Hepatocellular carcinoma (HCC) has an uneven global distribution and a higher incidence in males. The Liver Imaging Reporting and Data System (LI-RADS) is a standardized imaging framework for HCC diagnosis. It is unclear whether the evidence used to inform LI-RADS reflects the global burden of HCC. Purpose: To determine whether the geographic and sex distribution of studies assessing LI-RADS and those included in the LI-RADS individual participant data (IPD) database reflect the global burden of HCC. Materials and Methods: We conducted a cross-sectional meta-research study comparing the country- and sex-specific HCC prevalence from GLOBOCAN 2022 with the distribution of studies eligible for and included in the LI-RADS IPD database. Studies were identified through a systematic search of 4 databases. Study Protocol: OSF page . Results: We identified 470 eligible studies including 98 014 patients; of these, 76 studies comprising 11 924 patients were included in the IPD database. Asian and African countries, excluding Republic of Korea, were underrepresented in both the eligible and the IPD dataset. North America was overrepresented. Female patients were under-represented in LI-RADS eligible studies ( Z = −21.95, P < .0001) and in studies included in the IPD ( Z = −9.02, P < .0001) compared to the global prevalence of HCC in females. Conclusion: LI-RADS research is disproportionately reported from some countries relative to HCC burden. Asia, Africa, and female patients remain underrepresented. This may affect the generalizability and diagnostic equity of the LI-RADS system and underscore the need for improved global inclusivity in LI-RADS research.