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Fig. 6C —Misdiagnosis with algorithm of focal nodular hyperplasia as malignant lesion in 46-year-old asymptomatic woman. Portal venous phase sonogram shows hypoechoic mass (arrow) relative to enhancement of background liver. This negative enhancement with washout incorrectly suggests malignant lesion. In portal venous phase, all reviewers interpreted sonogram as showing negative enhancement with washout. Algorithm diagnosis is wrong, as it suggests hepatocellular carcinoma. Biopsy showed focal nodular hyperplasia (FNH). In our experience, only two FNHs have shown negative portal venous phase enhancement on contrast-enhanced sonography. We do not have an explanation for this.