Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography

Shingo Ohira; Naoyuki Kanayama; Kentaro Wada; Toshiki Ikawa; Takero Hirata; Noriko Kishi; Tsukasa Karino; Hayate Washio; Yoshihiro Ueda; Masayoshi Miyazaki; Masahiko Koizumi; Teruki Teshima

doi:10.1371/journal.pone.0244079

Peer Review History

Original SubmissionDecember 5, 2019
1 Sep 2020 Decision Letter - Agostino Chiaravalloti, Editor PONE-D-19-33675 Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography PLOS ONE Dear Dr. Schingo Ohira, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 30th september 2020. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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If you are prepared to undertake the work required, I could reconsider my decision. [Note: HTML markup is below. Please do not edit.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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Reviewer #1: Yes ****** 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: Overall, this research was well-designed. It suggested feasibility to used the CE-4D-DECT for better delineation of hepatocellular carcinoma with portal vein thrombosis. Authors have mentioned the limitation in phase of enhancement, which I agreed. Visibility of primary hepatocellular carcinoma and portal vein thrombosis is better in combined phases and the patterns of enhancement are various. Movement of tumor correlated with diaphragm is also point of concerned. Authors point out the discordance between diaphragm and tumor movement. I agreed but it would be better understand if authors would described more about how to measure tumor movement, eg. The definition of GTV; Primary alone or combined with PVTT? How to find the center of GTV? Was it contoured by radiation oncologist? It would be appreciate if author have described it with figure, might be in supplement data. In discussion, it would be outright if authors would add a paragraph mention about limitation of previously used or conventional technique in target delineation of hepatocellular carcinoma with some evidences. ****** 6. 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 [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0244079.r001
Revision 1
10 Sep 2020 Author Response Dear Editor and Reviewers, We would like to thank you for the insightful comments on our paper. We have revised the manuscript in the light of the comments of the editor and reviewers. The revisions have been made using the 'Edit' function of Word. We hope that the revised version of our manuscript is now suitable for publication in the PLOS ONE. Point-by-point responses according to the reviewers’ comments are as follows: Editor’s Comments Reviewers have now commented on your paper. You will see that they are advising that you revise in a minor way your manuscript. If you are prepared to undertake the work required, I could reconsider my decision. We have revised the manuscript in accordance with the reviewer’s comments. We hope that the revised version of our manuscript is now suitable for publication in the PLOS ONE. Reviewer’s Comments 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: Overall, this research was well-designed. It suggested feasibility to used the CE-4D-DECT for better delineation of hepatocellular carcinoma with portal vein thrombosis. Authors have mentioned the limitation in phase of enhancement, which I agreed. Visibility of primary hepatocellular carcinoma and portal vein thrombosis is better in combined phases and the patterns of enhancement are various. Movement of tumor correlated with diaphragm is also point of concerned. Authors point out the discordance between diaphragm and tumor movement. Thank you so much for your favorable comments. We have revised the manuscript in accordance with the reviewer’s comments. We hope that the revised version of our manuscript is now suitable for publication in the PLOS ONE. I agreed but it would be better understand if authors would described more about how to measure tumor movement, eg. The definition of GTV; Primary alone or combined with PVTT? How to find the center of GTV? Was it contoured by radiation oncologist? It would be appreciate if author have described it with figure, might be in supplement data. We agree the reviewer’s comments, and the additional Figure was described to explain the tumor/diaphragm motion measurement. The tumor and diaphragm were delineated by radiation oncologists and a medical physicist, respectively. Radiation oncologists determined the GTV as the PVTT alone or PVTT combined with the primary tumor. The center of the tumor was calculated by using a treatment planning system (Eclipse, Varian Medical Systems). We believe that the readers can understand the methodology of the tumor/diaphragm motion in the revised manuscript. Thank you for your insightful comments. In discussion, it would be outright if authors would add a paragraph mention about limitation of previously used or conventional technique in target delineation of hepatocellular carcinoma with some evidences. We agree the reviewer’s comment. Although the CE-CT has been widely used for first-line diagnostic tests in patients suspected of having HCC, many major guidelines (such as European Association for the Study of the Liver and American Association for the Study of Liver Diseases) now include gadoxetic acid-enhanced MRI (GA-MRI) as a first-line diagnostic test. The limitation of conventional CE-CT is that conventional CT can only depict PTVV in the HU values. For the detection of PVTT using the GA-MRI, Bae et al. reported that the additional information of diffusion- and T2-weighted imaging could contribute better depiction of common imaging findings, such as continuity with the tumor in the adjacent liver parenchyma than CE-CT [Bae et al., Liver Cancer, 2020]. Previous study Kim et al demonstrated that the PVTT showed the increased T2 signal intensity and diffusion restriction, and the characteristic imaging features improved diagnostic capability [Kim et al., Radiology, 2016]. Moreover, the diffusion-weighted imaging has advantage for distinguishing bland thrombus from neoplastic thrombus in the portal vein in patients with HCC [Catalano et al., Radiology, 2010]. The evidences in detecting PVTT using MR imaging are added in the paragraph mentioned about limitation of previously used or conventional technique. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0244079.r002
3 Dec 2020 Decision Letter - Dong-Hoon Lee, Editor Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography PONE-D-19-33675R1 Dear Dr. Ohira, 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Dong-Hoon Lee, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers have now commented on your paper. You will see that they are advising that you revise in a minor way your manuscript. If you are prepared to undertake the work required, I could reconsider my decision. Reviewers' comments: https://doi.org/10.1371/journal.pone.0244079.r003
Formally Accepted
22 Dec 2020 Acceptance Letter - Dong-Hoon Lee, Editor PONE-D-19-33675R1 Improvement of image quality and assessment of respiratory motion for hepatocellular carcinoma with portal vein tumor thrombosis using contrast-enhanced four-dimensional dual-energy computed tomography Dear Dr. Ohira: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Dong-Hoon Lee Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244079.r004

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