Title: Diagnostic performances of adding transition and hepatobiliary phase to washout in
gadoxetic acid-enhanced MRI for subcentimeter hepatocellular carcinoma
Version: 7 Date: 21 May 2025
Reviewer's report:
This study evaluated 200 subcentimeter-sized hepatic lesions surgically obtained from high-
risk patients for HCC. It compared the diagnostic performance of gadoxetic acid-enhanced MRI
when washout was assessed in the portal phase (PP) versus the transitional phase (TP) and
hepatobiliary phase (HBP).
The results showed that using TP to assess washout led to increased sensitivity without a
significant loss of specificity compared to PP. Furthermore, the addition of AFP levels improved
overall diagnostic accuracy.
However, the study has several limitations that should be addressed.
First, there are cases in which subcentimeter lesions were accompanied by additional lesions
larger than 10 mm. It would be helpful if the histopathological findings of these larger lesions
could also be presented, perhaps in a supplementary table.
Second, including other imaging features of the subcentimeter lesions in a supplementary table
would enhance the comprehensiveness of the study’s imaging analysis.
Third, as noted by the authors, histopathological confirmation was only available for surgically
resected cases. This selection bias may have contributed to an overestimation of diagnostic
accuracy, especially in terms of specificity. Typical hemangiomas, which could have presented
as false positives when washout was assessed in the TP or HBP, may have been underrepresented
due to the exclusion of non-surgical cases. This issue warrants further discussion.
Addressing these points would improve the interpretability and generalizability of the study’s
findings.
Title: Diagnostic performances of adding transition and hepatobiliary phase to washout in
gadoxetic acid-enhanced MRI for subcentimeter hepatocellular carcinoma
Version: 7 Date: 21 May 2025
Reviewer's report:
This study evaluated 200 subcentimeter-sized hepatic lesions surgically obtained from high-
risk patients for HCC. It compared the diagnostic performance of gadoxetic acid-enhanced MRI
when washout was assessed in the portal phase (PP) versus the transitional phase (TP) and
hepatobiliary phase (HBP).
The results showed that using TP to assess washout led to increased sensitivity without a
significant loss of specificity compared to PP. Furthermore, the addition of AFP levels improved
overall diagnostic accuracy.
However, the study has several limitations that should be addressed.
First, there are cases in which subcentimeter lesions were accompanied by additional lesions
larger than 10 mm. It would be helpful if the histopathological findings of these larger lesions
could also be presented, perhaps in a supplementary table.
Second, including other imaging features of the subcentimeter lesions in a supplementary table
would enhance the comprehensiveness of the study’s imaging analysis.
Third, as noted by the authors, histopathological confirmation was only available for surgically
resected cases. This selection bias may have contributed to an overestimation of diagnostic
accuracy, especially in terms of specificity. Typical hemangiomas, which could have presented
as false positives when washout was assessed in the TP or HBP, may have been underrepresented
due to the exclusion of non-surgical cases. This issue warrants further discussion.
Addressing these points would improve the interpretability and generalizability of the study’s
findings.
Please review this paper.
user
Title: Diagnostic performances of adding transition and hepatobiliary phase to washout in
gadoxetic acid-enhanced MRI for subcentimeter hepatocellular carcinoma
Version: 7 Date: 21 May 2025
Reviewer's report:
This study evaluated 200 subcentimeter-sized hepatic lesions surgically obtained from high-
risk patients for HCC. It compared the diagnostic performance of gadoxetic acid-enhanced MRI
when washout was assessed in the portal phase (PP) versus the transitional phase (TP) and
hepatobiliary phase (HBP).
The results showed that using TP to assess washout led to increased sensitivity without a
significant loss of specificity compared to PP. Furthermore, the addition of AFP levels improved
overall diagnostic accuracy.
However, the study has several limitations that should be addressed.
First, there are cases in which subcentimeter lesions were accompanied by additional lesions
larger than 10 mm. It would be helpful if the histopathological findings of these larger lesions
could also be presented, perhaps in a supplementary table.
Second, including other imaging features of the subcentimeter lesions in a supplementary table
would enhance the comprehensiveness of the study’s imaging analysis.
Third, as noted by the authors, histopathological confirmation was only available for surgically
resected cases. This selection bias may have contributed to an overestimation of diagnostic
accuracy, especially in terms of specificity. Typical hemangiomas, which could have presented
as false positives when washout was assessed in the TP or HBP, may have been underrepresented
due to the exclusion of non-surgical cases. This issue warrants further discussion.
Addressing these points would improve the interpretability and generalizability of the study’s
findings.
assistant