Investigation of commonly used aortic aneurysm growth rate metrics: Comparing their suitability for clinical and research applications

Kayley Abell-Hart; Janos Hajagos; Victor Garcia; James Kaan; Wei Zhu; Mary Saltz; Joel Saltz; Apostolos Tassiopoulos

doi:10.1371/journal.pone.0289078

Peer Review History

Original SubmissionDecember 16, 2022
12 May 2023 Decision Letter - Emma Rezel-Potts, Editor PONE-D-22-34426Investigation of commonly used aortic aneurysm growth rate metrics: comparing their suitability for clinical and research applicationsPLOS ONE Dear Dr. Saltz, 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 Jun 26 2023 11:59PM. 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. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 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). 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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: Thank you for giving me the chance to revise this very interesting and useful paper. Introduction: General comment: The introduction is quite long. Despite that you are analytic and provide many information, some of them should be better placed into the discussion section. Line 60: think of replacing “between” with “among” Lines 68-69: This sentence is confusing. Please consider rephrasing. Lines 100-102: You should better eliminate these lines. They seem rather like a conclusion. The aim of the study should be described at the end of the introduction. Methods Lines 117-118: Please explain your abbreviations Results Very good and analytic presentation of findings, despite that your analysis is quite complex. Discussion Really a great work, especially with the presentations of examples. It becomes quite clear even for someone with less knowledge on statistical models to understand your findings. Reviewer #2: This study examined various growth models for stability, temporal bias, prediction accuracy, and inferred risk. According to the findings of this study, exponential mixture models have less bias, stability, and risk prediction than other linear models, which has a significant impact on AAA clinical practices. Overall, the approach is solid and the results are well organized and explained. Major comments 1. The morphological features of abdominal aortic aneurysm shapes are becoming increasingly important for aneurysm growth and rupture due to the increased use of AI and semi-automatic operation (Baek and Arzani, 2022). However, this study only looked at maximum diameters, and other morphological features were not considered for prediction capabilities. Similarly, a new measurement of maximally inscribed sphere diameters was introduced and expanded its use for quantifying aneurysm growth rate and demonstrating growth prediction performance using semi-segmentation. Furthermore, Akkoyun et al. (2021) demonstrated that spherical diameter growth rates provided less bias than transverse maximum diameter measurements in terms of prediction capabilities. It would be interesting to compare it to Akkoyun et al's study in terms of bias, stability, and prediction capability, or at the very least, to discuss other 3D-based morphological features for prediction of growth and rupture risk in terms of limitations and future improvements. S. Baek and A. Arzani, Current state-of-the-art and utilities of machine learning for detection, monitoring, growth prediction, rupture risk assessment, and post-surgical management of abdominal aortic aneurysms, Applications in Engineering Science, vol. 10, article 100097, 2022 E. Akkoyun, H, Gharahi, S.T. Kwon, B.A. Zambrano, A. Rao, A.C. Acar, W. Lee, S. Baek, Defining a master curve of abdominal aortic aneurysm growth and its potential utility of clinical management, Computer Methods and Programs in Biomedicine, vol. 208, 106256, 2021 Minor comments 2. AAAs have several different maximum diameter measurements. Please specify the maximum diameter used in this study. 3. More information about the final selected data set should be provided, such as imaging modality, average durations, average number of scan imaging per patient, and so on. ****** 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. 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Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0289078.r001
Revision 1
25 Jun 2023 Author Response In response to the editors question about our ethics statement: the study was approved by the Stony Brook Internal Review Board. Because study activities were limited to records review, the review board waived consent requirements for this study. This statement now only appears in the Methods section of the manuscript. Response to reviewers: Reviewer #1: Thank you for giving me the chance to revise this very interesting and useful paper. Introduction: General comment: The introduction is quite long. Despite that you are analytic and provide many information, some of them should be better placed into the discussion section. Thank you for this feedback. We have made the introduction slightly shorter by removing lines 100-102 as suggested below, but we have kept the remaining content in the introduction because the paper’s target audience is diverse, and we want to ensure that we provide all the information necessary to understand the study and its purpose. Line 60: think of replacing “between” with “among” Thank you for this suggestion. We have changed “between” to “among.” Lines 68-69: This sentence is confusing. Please consider rephrasing. Thank you for this feedback. We have rephrased this sentence. Lines 100-102: You should better eliminate these lines. They seem rather like a conclusion. The aim of the study should be described at the end of the introduction. We have deleted these lines. Methods Lines 117-118: Please explain your abbreviations Thank you for pointing this out. We have added the expanded forms for CCS, LOINC, SNOMED, ATC, and ICD-10-PCS. Please note that the abbreviation “OMOP” also appears in these lines but is already defined above. Results Very good and analytic presentation of findings, despite that your analysis is quite complex. Discussion Really a great work, especially with the presentations of examples. It becomes quite clear even for someone with less knowledge on statistical models to understand your findings. Reviewer #2: This study examined various growth models for stability, temporal bias, prediction accuracy, and inferred risk. According to the findings of this study, exponential mixture models have less bias, stability, and risk prediction than other linear models, which has a significant impact on AAA clinical practices. Overall, the approach is solid and the results are well organized and explained. Major comments 1. The morphological features of abdominal aortic aneurysm shapes are becoming increasingly important for aneurysm growth and rupture due to the increased use of AI and semi-automatic operation (Baek and Arzani, 2022). However, this study only looked at maximum diameters, and other morphological features were not considered for prediction capabilities. Similarly, a new measurement of maximally inscribed sphere diameters was introduced and expanded its use for quantifying aneurysm growth rate and demonstrating growth prediction performance using semi-segmentation. Furthermore, Akkoyun et al. (2021) demonstrated that spherical diameter growth rates provided less bias than transverse maximum diameter measurements in terms of prediction capabilities. It would be interesting to compare it to Akkoyun et al's study in terms of bias, stability, and prediction capability, or at the very least, to discuss other 3D-based morphological features for prediction of growth and rupture risk in terms of limitations and future improvements. S. Baek and A. Arzani, Current state-of-the-art and utilities of machine learning for detection, monitoring, growth prediction, rupture risk assessment, and post-surgical management of abdominal aortic aneurysms, Applications in Engineering Science, vol. 10, article 100097, 2022 E. Akkoyun, H, Gharahi, S.T. Kwon, B.A. Zambrano, A. Rao, A.C. Acar, W. Lee, S. Baek, Defining a master curve of abdominal aortic aneurysm growth and its potential utility of clinical management, Computer Methods and Programs in Biomedicine, vol. 208, 106256, 2021 Thank you for mentioning this important topic in AAA research. We have added a section discussing the utility of other geometric properties including spherical diameter, with references to these papers. Minor comments 2. AAAs have several different maximum diameter measurements. Please specify the maximum diameter used in this study. Thank you for raising this point. We have added a sentence in the methods section providing more detail on how the aortic diameter was measured. 3. More information about the final selected data set should be provided, such as imaging modality, average durations, average number of scan imaging per patient, and so on. Thank you for this suggestion. In the methods section, we have added a summary of the types of imaging modalities used in this study (primarily CT and ultrasound). In figure 1, we have added summary information describing the average number of scans and average duration of follow-up for patients in each experiment. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0289078.r002
11 Jul 2023 Decision Letter - Emma Rezel-Potts, Editor Investigation of commonly used aortic aneurysm growth rate metrics: comparing their suitability for clinical and research applications PONE-D-22-34426R1 Dear Dr. Saltz, 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, Emma Rezel-Potts Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0289078.r003
Formally Accepted
4 Aug 2023 Acceptance Letter - Emma Rezel-Potts, Editor PONE-D-22-34426R1 Investigation of commonly used aortic aneurysm growth rate metrics: comparing their suitability for clinical and research applications Dear Dr. Saltz: 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 Dr. Emma Rezel-Potts Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289078.r004

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