Review for 10.1186/s12876-021-01608-9 (2021)

Reviewer’s report
Title: 
Characteristics of hepatic solitary necrotic nodules on contrast-enhanced
ultrasonography
Version: 
1 
Date: 
28 Aug 2020
Reviewer's report:
In the manuscript BMGE-D-20-00826R1 "Characteristics of hepatic solitary
necrotic nodules on contrast-enhanced ultrasonography" the authors aim to
describe the characteristics of solitary necrotic nodules (SNN) using contrast
enhanced ultrasound (CEUS) and also, they aim to improve the differential
diagnoses value of CEUS on liver focal lesions.
The authors retrospectively collected 24 patients with one or more pathology-
proven SNN (total= 41 nodules) who underwent CEUS. 
For each patient, they
provided the contrast enhancement (CE) features of the largest lesion and they
correlated two different CE pattern with lesion size.
The authors deal with a topic poorly investigate as, to date, this is the largest case
series with proven SNN described in literature. 
However, there are still some
concerns about the design of the study and the method described. Moreover, the
results and the conclusion provide will not bring significant contribution or
modifications to the clinical management of patients with suspected SNN, as
CEUS patter still overlap with other malignant lesion such as metastasis,
intrahepatic cholangiocarcinoma and hypovascular hepatocellular carcinoma.
In addition and extensive revision of English grammar along all the manuscript
is needed.
Other comment are below:
Title
Ok
Abstract
The second aim is not fulfilled in the results, mainly it is discussed in the
discussion. Please consider removing it or to add the pertinent part in the results
section. 
In the results section please, specify that for each patients the largest lesion have
been selected.
Keyword
Please add "contrast enhanced ultrasound" 
Introduction
Please add more information about SNN (for example you can move the first
paragraph of the discussion section in the introduction).
As stated before, please consider to remove the second aim which is not
complied in the results, or to add in the results section the pertinent data.
Materials and methods
Page 5 line 28: you stated that "2 patients were complicated". By what?
Results
Page 7 line 74: you stated "two lesion or more". Please provide the exact number
of lesion for each patient.
It would be interesting to compare not only the lesion size but also the lesion
shape with the contrast enhancement type.
Discussion
This section is too long. Please consider to shorten it.
In the differential diagnosis add also hypovascular HCC.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes