Title: Imaging Features of Intrahepatic Cholangiocarcinoma Mimicking a Liver Abscess: An
Analysis of 8 Cases
Version: 0 Date: 21 Sep 2021
Reviewer's report:
This manuscript aims to provide clarity on a frequently encountered clinical conundrum in the
practice of hepatobiliary Oncology, which is to accurately differentiate between a pyogenic liver
abscess and intrahepatic cholangiocarcinoma.
Three cases were discussed with excellent quality images from diagnostic ultrasound, CT scan
and an MRI. Based on these cases certain unique radiologic features were defined that could help
identify intrahepatic cholangiocarcinoma mimicking a liver abscess.  These features include lack
of prominent blood supply to the lesion, associated lymphadenopathy, a single hepatic artery
supplying the wall of the lesion and the marginal parenchyma, a rough and irregular inner wall of
the lesion, and rapid increase and then decrease in enhancement of the wall with phase contrast.
Notably, none of the lesions had the classic double target sign associated with liver abscesses.
Potential limitations of this study include a very small number of patients and lack of inclusion
of lesions that were atypical presentation of liver abscesses. Furthermore, the reviewer would
recommend inclusion of cases  where the lesion in question was smaller in size than the ones
presented on the manuscript.
Title: Imaging Features of Intrahepatic Cholangiocarcinoma Mimicking a Liver Abscess: An
Analysis of 8 Cases
Version: 0 Date: 21 Sep 2021
Reviewer's report:
This manuscript aims to provide clarity on a frequently encountered clinical conundrum in the
practice of hepatobiliary Oncology, which is to accurately differentiate between a pyogenic liver
abscess and intrahepatic cholangiocarcinoma.
Three cases were discussed with excellent quality images from diagnostic ultrasound, CT scan
and an MRI. Based on these cases certain unique radiologic features were defined that could help
identify intrahepatic cholangiocarcinoma mimicking a liver abscess.  These features include lack
of prominent blood supply to the lesion, associated lymphadenopathy, a single hepatic artery
supplying the wall of the lesion and the marginal parenchyma, a rough and irregular inner wall of
the lesion, and rapid increase and then decrease in enhancement of the wall with phase contrast.
Notably, none of the lesions had the classic double target sign associated with liver abscesses.
Potential limitations of this study include a very small number of patients and lack of inclusion
of lesions that were atypical presentation of liver abscesses. Furthermore, the reviewer would
recommend inclusion of cases  where the lesion in question was smaller in size than the ones
presented on the manuscript.
Please review this paper.
user
Title: Imaging Features of Intrahepatic Cholangiocarcinoma Mimicking a Liver Abscess: An
Analysis of 8 Cases
Version: 0 Date: 21 Sep 2021
Reviewer's report:
This manuscript aims to provide clarity on a frequently encountered clinical conundrum in the
practice of hepatobiliary Oncology, which is to accurately differentiate between a pyogenic liver
abscess and intrahepatic cholangiocarcinoma.
Three cases were discussed with excellent quality images from diagnostic ultrasound, CT scan
and an MRI. Based on these cases certain unique radiologic features were defined that could help
identify intrahepatic cholangiocarcinoma mimicking a liver abscess.  These features include lack
of prominent blood supply to the lesion, associated lymphadenopathy, a single hepatic artery
supplying the wall of the lesion and the marginal parenchyma, a rough and irregular inner wall of
the lesion, and rapid increase and then decrease in enhancement of the wall with phase contrast.
Notably, none of the lesions had the classic double target sign associated with liver abscesses.
Potential limitations of this study include a very small number of patients and lack of inclusion
of lesions that were atypical presentation of liver abscesses. Furthermore, the reviewer would
recommend inclusion of cases  where the lesion in question was smaller in size than the ones
presented on the manuscript.
assistant