PONE-D-20-11565

Distribution and predictive performance of the temporal phase of dynamic spot sign appearance in acute intracerebral hemorrhage

PLOS ONE

Dear Dr. Chung,

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PLOS ONE

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Additional Editor Comments (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors examined 'spot sign' on dynamic CTA's (arterial vs. venous phase) ability to predict significant hematoma expansion (defined as 6mL or 33% relative volume growth). This is an important topic as clinical predictors will likely be of value when deciding on trial enrollment for potential therapeutics for ICH. The manuscript is well-written, direct, and easy to follow. The intent of the study is clearly stated and the methods for which the authors attempt to answer their hypothesis is rationale and scientifically sound.

The major limitation of the study is the sample size in each group, in particular the venous phase (n=8), which the authors explicitly mention in the discussion. With this low of a sample size it is challenging to draw a firm conclusion, however, the authors appropriately conclude that the study is 'exploratory' and 'predictability of significant HE and clinical outcome MAY differ across the timing of spot sign appearance on dCTA' and 'larger sample sizes are needed to confirm the findings of our study.' The authors collected subjects prospectively but could consider including retrospective cases if dCTA was being used at their center before they started the study to increase the number of subjects.

A few minor requests:

MEdian time of follow-up CT is listed in the Table however please comment on your sites/study's customary practice for serial neuroimaging. For example, repeat CT in all cases within xx h, repeat only if clinically worse.

Please describe method used to measure hematoma volume (automated segmentation, abc2, etc)

Reviewer #2: This article demonstrating a trend towards poor outcome in ICH patients with arterial phase spot sign on dCTA when compared to venous cohorts is well received. The small sample size is mentioned, and publication of this article will highlight the need for further study.

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Reviewer #1: No

Reviewer #2: Yes: Kathleen Burger DO

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Distribution and predictive performance of the temporal phase of dynamic spot sign appearance in acute intracerebral hemorrhage

PONE-D-20-11565R1

Dear Dr. Chung,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Jonathan H Sherman

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors addressed all questions. The reviewer acknowledges the inability of the author to gather retrospective data and does not feel this limitation hinders the work to a point that it should not be shared/published. No further remarks apart from this being a well written manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No