Reviewer’s report
Title: 
Characteristics of hepatic solitary necrotic nodules on contrast-enhanced
ultrasonography
Version: 
1 
Date: 
28 Aug 2020
Reviewer's report:
In the manuscript BMGE-D-20-00826R1 "Characteristics of hepatic solitary
necrotic nodules on contrast-enhanced ultrasonography" the authors aim to
describe the characteristics of solitary necrotic nodules (SNN) using contrast
enhanced ultrasound (CEUS) and also, they aim to improve the differential
diagnoses value of CEUS on liver focal lesions.
The authors retrospectively collected 24 patients with one or more pathology-
proven SNN (total= 41 nodules) who underwent CEUS. 
For each patient, they
provided the contrast enhancement (CE) features of the largest lesion and they
correlated two different CE pattern with lesion size.
The authors deal with a topic poorly investigate as, to date, this is the largest case
series with proven SNN described in literature. 
However, there are still some
concerns about the design of the study and the method described. Moreover, the
results and the conclusion provide will not bring significant contribution or
modifications to the clinical management of patients with suspected SNN, as
CEUS patter still overlap with other malignant lesion such as metastasis,
intrahepatic cholangiocarcinoma and hypovascular hepatocellular carcinoma.
In addition and extensive revision of English grammar along all the manuscript
is needed.
Other comment are below:
Title
Ok
Abstract
The second aim is not fulfilled in the results, mainly it is discussed in the
discussion. Please consider removing it or to add the pertinent part in the results
section. 
In the results section please, specify that for each patients the largest lesion have
been selected.
Keyword
Please add "contrast enhanced ultrasound" 
Introduction
Please add more information about SNN (for example you can move the first
paragraph of the discussion section in the introduction).
As stated before, please consider to remove the second aim which is not
complied in the results, or to add in the results section the pertinent data.
Materials and methods
Page 5 line 28: you stated that "2 patients were complicated". By what?
Results
Page 7 line 74: you stated "two lesion or more". Please provide the exact number
of lesion for each patient.
It would be interesting to compare not only the lesion size but also the lesion
shape with the contrast enhancement type.
Discussion
This section is too long. Please consider to shorten it.
In the differential diagnosis add also hypovascular HCC.
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Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
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No
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 or 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Characteristics of hepatic solitary necrotic nodules on contrast-enhanced
ultrasonography
Version: 
1 
Date: 
28 Aug 2020
Reviewer's report:
In the manuscript BMGE-D-20-00826R1 "Characteristics of hepatic solitary
necrotic nodules on contrast-enhanced ultrasonography" the authors aim to
describe the characteristics of solitary necrotic nodules (SNN) using contrast
enhanced ultrasound (CEUS) and also, they aim to improve the differential
diagnoses value of CEUS on liver focal lesions.
The authors retrospectively collected 24 patients with one or more pathology-
proven SNN (total= 41 nodules) who underwent CEUS. 
For each patient, they
provided the contrast enhancement (CE) features of the largest lesion and they
correlated two different CE pattern with lesion size.
The authors deal with a topic poorly investigate as, to date, this is the largest case
series with proven SNN described in literature. 
However, there are still some
concerns about the design of the study and the method described. Moreover, the
results and the conclusion provide will not bring significant contribution or
modifications to the clinical management of patients with suspected SNN, as
CEUS patter still overlap with other malignant lesion such as metastasis,
intrahepatic cholangiocarcinoma and hypovascular hepatocellular carcinoma.
In addition and extensive revision of English grammar along all the manuscript
is needed.
Other comment are below:
Title
Ok
Abstract
The second aim is not fulfilled in the results, mainly it is discussed in the
discussion. Please consider removing it or to add the pertinent part in the results
section. 
In the results section please, specify that for each patients the largest lesion have
been selected.
Keyword
Please add "contrast enhanced ultrasound" 
Introduction
Please add more information about SNN (for example you can move the first
paragraph of the discussion section in the introduction).
As stated before, please consider to remove the second aim which is not
complied in the results, or to add in the results section the pertinent data.
Materials and methods
Page 5 line 28: you stated that "2 patients were complicated". By what?
Results
Page 7 line 74: you stated "two lesion or more". Please provide the exact number
of lesion for each patient.
It would be interesting to compare not only the lesion size but also the lesion
shape with the contrast enhancement type.
Discussion
This section is too long. Please consider to shorten it.
In the differential diagnosis add also hypovascular HCC.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 or 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Characteristics of hepatic solitary necrotic nodules on contrast-enhanced
ultrasonography
Version: 
1 
Date: 
28 Aug 2020
Reviewer's report:
In the manuscript BMGE-D-20-00826R1 "Characteristics of hepatic solitary
necrotic nodules on contrast-enhanced ultrasonography" the authors aim to
describe the characteristics of solitary necrotic nodules (SNN) using contrast
enhanced ultrasound (CEUS) and also, they aim to improve the differential
diagnoses value of CEUS on liver focal lesions.
The authors retrospectively collected 24 patients with one or more pathology-
proven SNN (total= 41 nodules) who underwent CEUS. 
For each patient, they
provided the contrast enhancement (CE) features of the largest lesion and they
correlated two different CE pattern with lesion size.
The authors deal with a topic poorly investigate as, to date, this is the largest case
series with proven SNN described in literature. 
However, there are still some
concerns about the design of the study and the method described. Moreover, the
results and the conclusion provide will not bring significant contribution or
modifications to the clinical management of patients with suspected SNN, as
CEUS patter still overlap with other malignant lesion such as metastasis,
intrahepatic cholangiocarcinoma and hypovascular hepatocellular carcinoma.
In addition and extensive revision of English grammar along all the manuscript
is needed.
Other comment are below:
Title
Ok
Abstract
The second aim is not fulfilled in the results, mainly it is discussed in the
discussion. Please consider removing it or to add the pertinent part in the results
section. 
In the results section please, specify that for each patients the largest lesion have
been selected.
Keyword
Please add "contrast enhanced ultrasound" 
Introduction
Please add more information about SNN (for example you can move the first
paragraph of the discussion section in the introduction).
As stated before, please consider to remove the second aim which is not
complied in the results, or to add in the results section the pertinent data.
Materials and methods
Page 5 line 28: you stated that "2 patients were complicated". By what?
Results
Page 7 line 74: you stated "two lesion or more". Please provide the exact number
of lesion for each patient.
It would be interesting to compare not only the lesion size but also the lesion
shape with the contrast enhancement type.
Discussion
This section is too long. Please consider to shorten it.
In the differential diagnosis add also hypovascular HCC.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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 or 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
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant