Background: Radiomics is a promising tool that may increase the value of magnetic resonance imaging (MRI) for different tasks related to the management of patients with hepatocellular carcinoma (HCC). However, its implementation in clinical practice is still far, with many issues related to the methodological quality of radiomic studies.

Aim: To systematically review the current status of MRI radiomic studies concerning HCC using the Radiomics Quality Score (RQS).

Methods: A systematic literature search of PubMed, Google Scholar, and Web of Science databases was performed to identify original articles focusing on the use of MRI radiomics for HCC management published between 2017 and 2023. The methodological quality of radiomic studies was assessed using the RQS tool. Spearman's correlation (ρ) analysis was performed to explore if RQS was correlated with journal metrics and characteristics of the studies. The level of statistical signi-ficance was set at P < 0.05.

Results: One hundred and twenty-seven articles were included, of which 43 focused on HCC prognosis, 39 on prediction of pathological findings, 16 on prediction of the expression of molecular markers outcomes, 18 had a diagnostic purpose, and 11 had multiple purposes. The mean RQS was 8 ± 6.22, and the corresponding percentage was 24.15% ± 15.25% (ranging from 0.0% to 58.33%). RQS was positively correlated with journal impact factor (IF; ρ = 0.36, P = 2.98 × 10^-5), 5-years IF (ρ = 0.33, P = 1.56 × 10^-4), number of patients included in the study (ρ = 0.51, P < 9.37 × 10^-10) and number of radiomics features extracted in the study (ρ = 0.59, P < 4.59 × 10^-13), and time of publication (ρ = -0.23, P < 0.0072).

Conclusion: Although MRI radiomics in HCC represents a promising tool to develop adequate personalized treatment as a noninvasive approach in HCC patients, our study revealed that studies in this field still lack the quality required to allow its introduction into clinical practice.