Review for 10.1186/s12876-017-0719-1 (2018)

Reviewer ’s report  
 
Title:  Efficacy comparison of multi -phase CT and hepatotropic contrast -enhanced MRI in the 
differential diagnosis of focal nodular hyperplasia: a prospective cohort study.  
 
Version: 0 Date: 12 Apr 2017 
 
Reviewer:  Subramaniyan  Ramanathan  
 
Reviewer’s report:  
 
This is a well written and strongly designed study to evaluate the accuracy of CT and MRI in the 
diagnosis of FNH.  
 
1. Although the study is strongly designed with good sample size, the role of CT and MRI 
especially the hepatobiliary contrast is now well established through multiple studies in 
the recent past.  
 
2. Pg3 Ln14 - "in about 30% of cases due to atypical radiological features [4, 5]." I feel this 
is an overstatement in the e ra of MRI. 30% should be more of CT data than MRI. MRI 
has great accuracy in FNH diagnosis  
 
3. Did you encounter any problems with suboptimal hepatobiliary phase (not because of 
artifacts) due to liver dysfunction??  
 
4. It is fairly well known that MRI out performs CT in the diagnosis of focal lesions atleast 
practically. So with the addition of hepatobiliary contrast (an additional diagnsotic 
paarmeter), naturally it is going to overshadow CT. Authors could have evaluated the role 
of Gd -BOPTA like its addit ional value in the diagnosis.  
 
5. In and out phase was performed?? Any fat containing FNH?  
 
6. What do you mean 'absence of enhancement in PV phase - What about wash -out??  
 
7. Did you encounter pseudo -washout with Gd -BOPTA  
 
8. Inflammatory hepatic adenoma i s a hot topic now and mimics FNH. In your large sample 
size, any of FNH turned out to be adenoma on histopathology?  
 
9. Table 5 and 6 - Lot of repeat of the information in the text. Either keep the text or table  
 
10. Images are not adequate. More represent ative images of HBP appearance of FNH could 
be added.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the aut hors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following  questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks o r shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests  in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open pee r review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the autho rs' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal