Response to Letter to the Editor Regarding the Article "Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement" by Zhou and Collaborators.

Abstract

Thanks Stefanini and your colleagues for positive comments on our recent study of applying CEUS LI-RADS in eastern countries with emphasis on diagnostic performance and interobserver agreement [1]. We agree that the specificity of CEUS LR-5 is high enough (range:92.7–100.0 % in cirrhotic patients in our study) to rule out non-hepatocellular carcinoma(HCC) lesions. And we also agree that inconsistency of interpreting objective CEUS features, especially ancillary features, significantly hinder the general application of CEUS LI-RADS in targeted high-risk population. Even after years of CEUS LI-RADS learning and training, ancillary features are still deemed as failure to make additional value in final decision. Therefore, we fully approve removing current ancillary features (mosaic and nodule-in-nodule pattern) from CEUS LI-RADS workup as Stefanini demonstrated.