Title: Optimizing LI-RADS: Ancillary features screened from LR-3/4 categories can improve
the diagnosis of HCC on MRI
Version: 1 Date: 09 Jan 2024
Reviewer's report:
This study tried to screen out the favorable AFs to upgrade a LR-3/4 observation, intending to
improve the sensitivity for HCC. This is a good idea because until now, the use of AFs is on
the radiologists' bias and LI-RADS has not clearly illustrate which AFs are more important for
upgrading an observation.
However, there were some problems as follows:
1. Manuscript needs a language revision, a lot of sentences were difficult to understand. auxiliary
should be ancillary.
2. The inclusion and exclusion criteria were not clear. Are all of the patients underwent
MRI? What contrast-enhanced agent was used (extracellular or hepatobilliary contrast-enhanced
agent)? What interval between MRI and pathology can be included/excluded? What is the least
follow-up time can be included/excluded? Can an observation treated before MRI be included?...
3. The upgraded and downgraded argorithm were not clear. Is it allow for a LR-4 observation
upgrade to LR-5? Is it allow for a LR-3 observation upgrade to LR-5? In what situation is a
LR-3  observation upgraded to LR-4, and in what situation it is upgraded to LR-5?
4. The presentation of the manuscript was a bit in chaos. Some parts in the "Reference standard
should move to "Results". Some parts in the "Discussion" should move to "Results".
5. Table 5 is difficult to understand.
Title: Optimizing LI-RADS: Ancillary features screened from LR-3/4 categories can improve
the diagnosis of HCC on MRI
Version: 1 Date: 09 Jan 2024
Reviewer's report:
This study tried to screen out the favorable AFs to upgrade a LR-3/4 observation, intending to
improve the sensitivity for HCC. This is a good idea because until now, the use of AFs is on
the radiologists' bias and LI-RADS has not clearly illustrate which AFs are more important for
upgrading an observation.
However, there were some problems as follows:
1. Manuscript needs a language revision, a lot of sentences were difficult to understand. auxiliary
should be ancillary.
2. The inclusion and exclusion criteria were not clear. Are all of the patients underwent
MRI? What contrast-enhanced agent was used (extracellular or hepatobilliary contrast-enhanced
agent)? What interval between MRI and pathology can be included/excluded? What is the least
follow-up time can be included/excluded? Can an observation treated before MRI be included?...
3. The upgraded and downgraded argorithm were not clear. Is it allow for a LR-4 observation
upgrade to LR-5? Is it allow for a LR-3 observation upgrade to LR-5? In what situation is a
LR-3  observation upgraded to LR-4, and in what situation it is upgraded to LR-5?
4. The presentation of the manuscript was a bit in chaos. Some parts in the "Reference standard
should move to "Results". Some parts in the "Discussion" should move to "Results".
5. Table 5 is difficult to understand.
Please review this paper.
user
Title: Optimizing LI-RADS: Ancillary features screened from LR-3/4 categories can improve
the diagnosis of HCC on MRI
Version: 1 Date: 09 Jan 2024
Reviewer's report:
This study tried to screen out the favorable AFs to upgrade a LR-3/4 observation, intending to
improve the sensitivity for HCC. This is a good idea because until now, the use of AFs is on
the radiologists' bias and LI-RADS has not clearly illustrate which AFs are more important for
upgrading an observation.
However, there were some problems as follows:
1. Manuscript needs a language revision, a lot of sentences were difficult to understand. auxiliary
should be ancillary.
2. The inclusion and exclusion criteria were not clear. Are all of the patients underwent
MRI? What contrast-enhanced agent was used (extracellular or hepatobilliary contrast-enhanced
agent)? What interval between MRI and pathology can be included/excluded? What is the least
follow-up time can be included/excluded? Can an observation treated before MRI be included?...
3. The upgraded and downgraded argorithm were not clear. Is it allow for a LR-4 observation
upgrade to LR-5? Is it allow for a LR-3 observation upgrade to LR-5? In what situation is a
LR-3  observation upgraded to LR-4, and in what situation it is upgraded to LR-5?
4. The presentation of the manuscript was a bit in chaos. Some parts in the "Reference standard
should move to "Results". Some parts in the "Discussion" should move to "Results".
5. Table 5 is difficult to understand.
assistant