Purpose <p>The purpose of the current study was to evaluate the diagnostic accuracy of FDG PET/CT radiomics in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC), and to compare it with conventional metabolic parameters of FDG PET/CT through a systematic review and meta-analysis.</p> Methods <p>The PubMed, EMBASE, and Cochrane databases were searched for studies evaluating the diagnostic performance of FDG PET/CT in predicting MVI in HCC patients. We calculated the pooled area under the curve (AUC) for predicting MVI using FDG PET/CT analyzed with radiomics methods and compared the results with those predicted through visual or semi-quantitative analysis. The study was conducted and registered in PROSPERO (International Prospective Register of Systematic Reviews) with the registration number CRD42023466842.</p> Results <p>The pooled AUC for predicting MVI from three studies (274 patients) analyzed using radiomics methods was 0.79 (95% CI; 0.75–0.84), with various model algorithms and selected features. The pooled AUC for six studies (368 patients) using visual analysis was 0.76 (95% CI; 0.73–0.80), and the pooled AUC for nine studies (661 patients) using semi-quantitative analysis was 0.80 (95% CI; 0.76–0.83). The diagnostic performance of the three analysis methods did not show a statistically significant difference.</p> Conclusion <p>FDG PET/CT radiomics for predicting MVI in HCC showed diagnostic performance similar to that of conventional visual or semi-quantitative analysis methods. Further large-scale multicenter studies are necessary to substantiate the diagnostic accuracy of FDG PET/CT radiomics for predicting MVI in HCC patients.</p>