Review for 10.1186/s12876-024-03201-2 (2024)

Title: Optimizing LI-RADS: Ancillary features screened from LR-3/4 categories can improve
the diagnosis of HCC on MRI
Version: 3 Date: 05 Feb 2024
Reviewer:  Sidong Xie
Reviewer's report:
This revised draft has made many improvements and improvements compared to the initial draft.
The structure and logical explanation of the article are clearer than before, but there are still
some minor errors and omissions that need further improvement.
1.Is the LI-RADS evaluation method used in the article the LI-RADS 2018 version? If so, it is
recommended to express it uniformly in the text to avoid misunderstandings
2.Regarding statistical P-values, it is recommended to uniformly use capital letter P -values
3.There are still some issues with the inclusion and exclusion criteria described in Figure 1
and Materials and Methods. As mentioned earlier, 2326 patients underwent CT, MRI, or US
examinations, but the inclusion criteria did not specifically indicate that all underwent MRI
examinations. Additionally, in this study, it was not appropriate to use nodules to represent
lesions, as nodules were generally # 3cm in size. However, in this study, some lesions were larger
than 3cm in size. Also, the statement“(2) No MR enhancement scans were performed within two
months before and after clinical and pathology data collection” in the exclusion criteria may be
misleading. There may be cases who undergo MRI examination after surgery and the interval of
2 months is too long. Some malignant tumor of liver may increase significantly within 2 months,
so this inclusion and exclusion criteria need to be further revised.
4. In Figure 1, there are 872 eligible patients, but the total number of HCC patients, non HCC
malignant patients, and benign patients is 859, which is not equal to 872. Please carefully check
the number and classification of patients and lesions. In addition, 32 cases of benign lesions
were confirmed by surgical resection, including FNH: 14 nodules; IPL: 6; LGDN: 3; HGDN: 6,
but this total is not equal to 32, and these classifications are not quite consistent with the ones
mentioned in the initial draft. Please carefully check them
5. In the materials and methods, the exclusion criteria described are inconsistent with those
described in figure 1. Points (4) and (5) in the exclusion criteria do not belong to the
direct exclusion criteria, but are removed later. and here for the follow-up cases only for the
consideration of benign lesions, cases confirmed by surgery and pathology do not need to be
followed up, so it is misleading to rule out 306 cases of lost follow-up. Please carefully improve
this exclusion standard.
6.In this study, two kinds of contrast agents are used, one is non-liver-specific contrast agent, the
other is liver-specific contrast agent, the corresponding number of cases of DP or TP and HBP
is also different, but there is no distinction in the table, and the statistical analysis is confusing.
In order to make the article more convincing, it is suggested to redo statistical analysis after
removing non-liver-specific contrast agents.
7.In the department of image analysis#Page5, line 112-113#the arterial-phase
hyperenhancement (APHE) Should be changed to “nonperipheral arterial-phase
hyperenhancement (APHE)”
8.Page5, line 169-170#“...including 98 patients in the HCC group, accounting for 32.45%, and
40 patients in the Non-HCC group, accounting for 26.32%.”#What type of contrast agent is this
sentence referring to, and how are these two percentages calculated?
9.In Table 1, the P-value for each binary or multiple categories should be the column where each
sub item is placed; For example, under Child PughClass, there are three levels: A, B, and C. The
statistical result P=0.000 should be written in the column of Child Pugh
10.In Table 2, some () are incomplete and some items are incorrect, which need to be corrected.
For example, in the Non peripheral washout column, the 10.5(17/311) in Non-HCC nodules is
wrong, and so on, I hope to double check more carefully.
11.In Table 3, the P value of Mild–moderate T2 hyperintensity in Univariable analysis is 0.888,
which had no statistical difference, but the P value of Mild–moderate T2 hyperintensity in
Multivariable analysis is 0.005, which had statistical difference. This result seems contradictory,
how to understand it?#the Coronal enhancement of in Univariable analysis is <.001, which
had statistical difference, but the P value of Coronal enhancement of in Multivariable
analysis is blank, how to understand it?, and also such as “Fat in mass”#“Hepatobiliary-phase
hypointensity”#“Parallels blood pool enhancement”