PONE-D-20-25875

Validation of color Doppler ultrasound and computed tomography in the radiologic assessment of non-malignant acute splanchnic vein thrombosis

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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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: I apologize for the delay in advising you on the progress on the paper that you submitted to the PLOS ONE.

This is well written and illustrated paper. I suggest you make minor revision.

1.Is CT more reliable than CDUS if the evaluator is not an experienced interventional hepatologists/radiologists?

2.Were the CT and CDUS purchased at about the same time and with the same high performance?　 Is the CT the old one and the US the newest one?

Reviewer #2: The authors compared CDUS or CT to direct transjugular spleno-portography about detectable ability for acute splanchnic vein thrombosis. Their results is that CDUS and CT were consistent with portography in 76.6% and 78.4% compared to direct transjugular spleno-portography. They claimed that CDUS and CT are equally reliable tools in the radiologic assessment of non-malignant acute splanchnic vein thrombosis.

I think the work is well written.

However, I think the authors should consider several problems.

Major

#1. The number of enrollment was only 49 patients. I think this is too small.

#2. In clinical, CDUS and enhanced-CT are useful and often performed for diagnosis of portal or splanchnic vein thrombosis. We often perform direct transjugular spleno-portography after being diagnosed in order to intervention therapy.

So, this conclusion seems to be low impact.

#3. Concerns to patient characters, 35 patients have non-cirrhotic thrombosis. What were their detail cause ? What number was due to surgery?

Minor

#1. Images of CDUS and CT as figures should be added.

Reviewer #3: The authors present a retrospective cohort study comparing portography versus CT or CDUS for the diagnosis of splanchnic vein thromboses. Overall, the study adds new data in an area with very little information. In general, the study is well done but it could use some improvement.

Please consider a subanalysis comparing the 26 patients who had all 3 imaging modalities. Compare CT and US versus portography and also US vs CT. This also may be of value as CT and US are used interchangeably when they may be not.

It is possible that among those patients in whom there was a discrepancy between portography and the other imaging modalities the time lapse between imaging modalities might have been longer (i.e. the CDUS or CT were done first – failing to detect a thrombus, that subsequently developed and was later found by portography). Please clarify this.

Please make sure that the study adheres to STROBE guidelines.

Figure 2 could use a single panel with 5 100%-stacked columns, one per vessel. Would make it much clearer.

The manuscript needs a thorough revision of the English language. A few examples are shown below but there are many more.

Page 4. Should read “mesenteric”

Page 6. Should read “confluence”

Page 9: please rephrase the following: “In the evaluation of CDUS results complete and partial thrombosis was erroneously graded as patent in only one and two cases of the entirety of splanchnic venous regions assessed, respectively. In the evaluation of CT misjudgment of complete and partial thrombosis as patent occurred in only two and three cases, respectively”. It is not clear in its current form

Page 13. The use of the word “subsuming” is not correct

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Validation of color Doppler ultrasound and computed tomography in the radiologic assessment of non-malignant acute splanchnic vein thrombosis

PONE-D-20-25875R1

Dear Dr. Sturm,

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,

Roza Chaireti

Academic Editor

PLOS ONE