Title: Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid
lesions of gallbladder# 1 cm
Version: 4 Date: 13 May 2022
Reviewer:  Antonio Corvino
Reviewer's report:
STATUS: ACCETTABLE FOR PUBBLICATION PENDING MINOR REVISIONS
Short summary according reviewers:
Authors reported an original article to investigate the usefulness of Contrast-enhanced
ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder
(PLGs) # 1 cm.
General considerations + Study design:
This is an original article. The work is interesting and the paper is well-written. The statistical
analysis is good. I believe that the article can represent a complete overview focusing on the
usefulness of CEUS in the assessment of PLGs. I recommend its publication, pending minor
revisions.
Abstract: the abstract appropriately summarize the manuscript without discrepancies between
the abstract and the remainder of the manuscript.
Keywords: adequate.
Paper
On some aspects the authors should mostly address:
1)I would describe how may appear the normal gallbladder wall at sonography. Low-frequency
transducers may show a single or two layers of gallbladder wall. High-frequency transducers
can show three layers of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle
thin hypoechoic layer (muscular) and the outermost hyperechoic layer (serosa).
2)Please, specify that the normal cut-off value for gallbladder wall is 4 mm, which is a more
specific discriminant value in clinical practice.
3)I suggest you to read the following article:
-Diagnostic Performance and Confidence of Contrast-Enhanced Ultrasound in the Differential
Diagnosis of Cystic and Cysticlike Liver Lesions. AJR Am J Roentgenol. 2017
Sep;209(3):W119-W127. doi: 10.2214/AJR.16.17062. Epub 2017 Jun 22. PMID: 28639831.
In this paper, the authors describes the CEUS features of cystic and cystic-like liver lesions. The
article includes schematic drawings about CEUS enhancement features, which you could take
as an example to describe your case evaluated with CEUS. Furthermore, these data confirm that
the distinctive feature in the appropriate differential diagnosis is hypoenhancement in the portal
and sinusoidal phases, with or with- out arterial enhancement. I recommend that you discuss this
article because it is an international reference about CEUS approach to lesion characterization
on the basis of enhancement features.
4)Have you thought about using the new microvascularization software?
Reference: the references are adequate. Please, add those suggested.
Tables: good.
Figures:
1)Please, include US images of good quality of gallbladder wall in the normal and when there
is thickening. It would be interesting if you show that low-frequency transducers may depict a
single or two layers of gallbladder wall and high-frequency transducers can depict three layers
of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle thin hypoechoic layer
(muscular) and the outermost hyperechoic layer (serosa).
2)You could also make some schematic drawings.
Title: Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid
lesions of gallbladder# 1 cm
Version: 4 Date: 13 May 2022
Reviewer:  Antonio Corvino
Reviewer's report:
STATUS: ACCETTABLE FOR PUBBLICATION PENDING MINOR REVISIONS
Short summary according reviewers:
Authors reported an original article to investigate the usefulness of Contrast-enhanced
ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder
(PLGs) # 1 cm.
General considerations + Study design:
This is an original article. The work is interesting and the paper is well-written. The statistical
analysis is good. I believe that the article can represent a complete overview focusing on the
usefulness of CEUS in the assessment of PLGs. I recommend its publication, pending minor
revisions.
Abstract: the abstract appropriately summarize the manuscript without discrepancies between
the abstract and the remainder of the manuscript.
Keywords: adequate.
Paper
On some aspects the authors should mostly address:
1)I would describe how may appear the normal gallbladder wall at sonography. Low-frequency
transducers may show a single or two layers of gallbladder wall. High-frequency transducers
can show three layers of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle
thin hypoechoic layer (muscular) and the outermost hyperechoic layer (serosa).
2)Please, specify that the normal cut-off value for gallbladder wall is 4 mm, which is a more
specific discriminant value in clinical practice.
3)I suggest you to read the following article:
-Diagnostic Performance and Confidence of Contrast-Enhanced Ultrasound in the Differential
Diagnosis of Cystic and Cysticlike Liver Lesions. AJR Am J Roentgenol. 2017
Sep;209(3):W119-W127. doi: 10.2214/AJR.16.17062. Epub 2017 Jun 22. PMID: 28639831.
In this paper, the authors describes the CEUS features of cystic and cystic-like liver lesions. The
article includes schematic drawings about CEUS enhancement features, which you could take
as an example to describe your case evaluated with CEUS. Furthermore, these data confirm that
the distinctive feature in the appropriate differential diagnosis is hypoenhancement in the portal
and sinusoidal phases, with or with- out arterial enhancement. I recommend that you discuss this
article because it is an international reference about CEUS approach to lesion characterization
on the basis of enhancement features.
4)Have you thought about using the new microvascularization software?
Reference: the references are adequate. Please, add those suggested.
Tables: good.
Figures:
1)Please, include US images of good quality of gallbladder wall in the normal and when there
is thickening. It would be interesting if you show that low-frequency transducers may depict a
single or two layers of gallbladder wall and high-frequency transducers can depict three layers
of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle thin hypoechoic layer
(muscular) and the outermost hyperechoic layer (serosa).
2)You could also make some schematic drawings.
Please review this paper.
user
Title: Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid
lesions of gallbladder# 1 cm
Version: 4 Date: 13 May 2022
Reviewer:  Antonio Corvino
Reviewer's report:
STATUS: ACCETTABLE FOR PUBBLICATION PENDING MINOR REVISIONS
Short summary according reviewers:
Authors reported an original article to investigate the usefulness of Contrast-enhanced
ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder
(PLGs) # 1 cm.
General considerations + Study design:
This is an original article. The work is interesting and the paper is well-written. The statistical
analysis is good. I believe that the article can represent a complete overview focusing on the
usefulness of CEUS in the assessment of PLGs. I recommend its publication, pending minor
revisions.
Abstract: the abstract appropriately summarize the manuscript without discrepancies between
the abstract and the remainder of the manuscript.
Keywords: adequate.
Paper
On some aspects the authors should mostly address:
1)I would describe how may appear the normal gallbladder wall at sonography. Low-frequency
transducers may show a single or two layers of gallbladder wall. High-frequency transducers
can show three layers of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle
thin hypoechoic layer (muscular) and the outermost hyperechoic layer (serosa).
2)Please, specify that the normal cut-off value for gallbladder wall is 4 mm, which is a more
specific discriminant value in clinical practice.
3)I suggest you to read the following article:
-Diagnostic Performance and Confidence of Contrast-Enhanced Ultrasound in the Differential
Diagnosis of Cystic and Cysticlike Liver Lesions. AJR Am J Roentgenol. 2017
Sep;209(3):W119-W127. doi: 10.2214/AJR.16.17062. Epub 2017 Jun 22. PMID: 28639831.
In this paper, the authors describes the CEUS features of cystic and cystic-like liver lesions. The
article includes schematic drawings about CEUS enhancement features, which you could take
as an example to describe your case evaluated with CEUS. Furthermore, these data confirm that
the distinctive feature in the appropriate differential diagnosis is hypoenhancement in the portal
and sinusoidal phases, with or with- out arterial enhancement. I recommend that you discuss this
article because it is an international reference about CEUS approach to lesion characterization
on the basis of enhancement features.
4)Have you thought about using the new microvascularization software?
Reference: the references are adequate. Please, add those suggested.
Tables: good.
Figures:
1)Please, include US images of good quality of gallbladder wall in the normal and when there
is thickening. It would be interesting if you show that low-frequency transducers may depict a
single or two layers of gallbladder wall and high-frequency transducers can depict three layers
of gallbladder wall: the innermost hyperechoic layer (mucosa), the middle thin hypoechoic layer
(muscular) and the outermost hyperechoic layer (serosa).
2)You could also make some schematic drawings.
assistant