Impact of double-bolus tracking to individualize scan timing of the portal venous phase in preoperative computed tomography colonography angiography for right-sided colon cancer

Yoshiya Ohashi; Masaaki Miyo; Koichi Okuya; Emi Akizuki; Atsushi Hamabe; Ai Noda; Masayuki Ishii; Ryo Miura; Momoko Ichihara; Maho Toyota; Kohei Okamoto; Shun Hayasaka; Takeo Tanaka; Hiroyuki Takashima; Kohei Harada; Keishi Ogura; Ichiro Takemasa

doi:10.1371/journal.pone.0320630

Peer Review History

Original SubmissionNovember 4, 2024
4 Nov 2024 Author Response https://doi.org/10.1371/journal.pone.0320630.r001
23 Jan 2025 Decision Letter - Tsutomu Kumamoto, Editor PONE-D-24-39564Impact of double-bolus tracking to individualize scan timing of the portal venous phase in preoperative computed tomography colonography angiography for right-sided colon cancerPLOS ONE Dear Dr. Miyo, 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 Mar 09 2025 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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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments : Thank you for submitting your manuscript titled "Impact of double-bolus tracking to individualize scan timing of the portal venous phase in preoperative computed tomography colonography angiography for right-sided colon cancer." I found your study to be both innovative and clinically relevant. However, I would like to provide some comments and suggestions for further improving the manuscript: 1. Evaluation of ARCV I suggest including the accessory right colic vein (ARCV) as part of the venous evaluations performed using the DBT method. The ARCV is a crucial anatomical structure in right-sided colon cancer surgeries, and its clear delineation during preoperative planning may help reduce the risk of surgical complications, such as unplanned conversions to open surgery. 2. 3D Reconstruction of Arterial Structures Please clarify whether arterial 3D-VR reconstructions were performed using the DBT method and if there were any notable differences compared to the conventional method. 3. Comparison of Clinical Outcomes It would be valuable to assess whether the DBT method influenced clinical outcomes compared to the conventional method. For example, were there any differences in conversion rates to open surgery, operative time, blood loss, complications, or length of hospital stay? Including data on these short-term outcomes could provide more practical insights into the clinical impact of your findings. 4. Generalizability, Cost, and Patient Burden Please include a discussion about the feasibility of implementing the DBT method in general facilities, considering workflow changes, costs, and required resources. Additionally, mention potential patient burden, such as increased radiation exposure due to low-dose monitoring, as part of the "Limitations" section, which could enhance the manuscript's practical relevance. [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. 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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 ****** 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: This is a well written article covering an interesting topic: the use of bolus tracking techniques for improving venous phase imaging. I hove some suggestions for further improving your manuscript: - Abstract: in the "aim" section there is some information that should be moved in the "method" one - Page 6 line 81: another recently published article evaluated the use of bolus tracking technique for PVP CT (doi: 10.1007/s00330-024-11009-7). I suggest you to add it as a reference. - Page 7, lines 97-103: move this information to the beginning of the subheading - Page 97, lines 104-108: please better explain the preparation with dosages - Page 8, lines 121-123: please clarify ho CM was dosed and which injection flow was used - Page 9, lines 128-129: was there any delay between aortic peak and scanning start? ****** 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: Yes: Matteo Bonatti ******** [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. 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Revision 1
20 Feb 2025 Author Response We thank the Editor and reviewers for the fair comments and useful suggestions to improve our manuscript. As indicated below, we have taken the comments and suggestions into consideration, and we made corrections on a proof in red for the revised part of the manuscript. And the number of decimal places for the p-values has been unified throughout. Additional Editor Comments: 1. Evaluation of ARCV I suggest including the accessory right colic vein (ARCV) as part of the venous evaluations performed using the DBT method. The ARCV is a crucial anatomical structure in right-sided colon cancer surgeries, and its clear delineation during preoperative planning may help reduce the risk of surgical complications, such as unplanned conversions to open surgery. Thank you for your helpful suggestion. We evaluated the enhancement of the accessory right colic vein (ARCV) by measuring its CT values. Identification of the ARCV was difficult in 13.3% of cases (4/30) in the fixed-delay group compared to 3.3% (1/30) in the DBT group, and excluding these cases, the mean CT values were 144.2 ± 9.3 HU in the DBT group and 135.1 ± 6.7 HU in the fixed-delay group. Both imaging performance and enhancement of ARCV tended to be better with the DBT method compared to the fixed delay method, but the difference was not significant. These results might be due in part to the small sample size in our study. We described these findings on page 15 lines 219-223 of the “Results” section and added S1 Table about these as supporting information. 2. 3D Reconstruction of Arterial Structures Please clarify whether arterial 3D-VR reconstructions were performed using the DBT method and if there were any notable differences compared to the conventional method. In the DBT method, 3D volume-rendered (VR) images of the arteries were also reconstructed in as well as the fixed-delay method. Since both the DBT and conventional methods rely on the same arterial enhancement phase, there is no substantial difference in arterial visualization between the two approaches. We have modified the description about this to make it clearer on page 9 lines 129~130 of “Materials and methods” section. 3. Comparison of Clinical Outcomes It would be valuable to assess whether the DBT method influenced clinical outcomes compared to the conventional method. For example, were there any differences in conversion rates to open surgery, operative time, blood loss, complications, or length of hospital stay? Including data on these short-term outcomes could provide more practical insights into the clinical impact of your findings. We appreciate your insightful comments. The mean operative time was 312.2 ± 20.4 minutes in the DBT group and 361.0 ± 25.7 minutes in the fixed-delay group (p = 0.135), blood loss was 40.1 ± 27.5 mL and 51.8 ± 33.4 mL (p = 0.787), and conversion to open surgery was required in 3.6% and 0% of cases (p = 1.000). Postoperative complications occurred in 7.1% of cases in the DBT group and 5.3% in the fixed-delay group (p = 1.000), and the mean length of stay was 8.4 ± 1.2 days and 7.9 ± 1.5 days (p = 0.780), with no significant differences between the groups. Limitations such as case selection bias and small sample size should be considered when discussing these clinical outcomes. We added the comments about these on page 18 lines 266-271 of the “Results” section. 4. Generalizability, Cost, and Patient Burden Please include a discussion about the feasibility of implementing the DBT method in general facilities, considering workflow changes, costs, and required resources. Additionally, mention potential patient burden, such as increased radiation exposure due to low-dose monitoring, as part of the "Limitations" section, which could enhance the manuscript's practical relevance. We appreciate your helpful advice. While initial costs and workflow adjustments, such as staff training and equipment upgrades, are required, the DBT method’s potential to improve diagnostic accuracy justifies these investments in well-equipped facilities, which could enhance its generalizability in the future. The slight increase in radiation exposure due to additional low-dose scans is another limitation. Although optimized protocols minimized radiation exposure, this remains a concern, especially for patients requiring repeated imaging. Future improvements in low-dose techniques are essential to address this issue and enhance patient safety. We added the comments about these in lines 356-359 and lines 363-367 of the “Discussion” section. Reviewer #1: This is a well written article covering an interesting topic: the use of bolus tracking techniques for improving venous phase imaging. I hove some suggestions for further improving your manuscript: - Abstract: in the "aim" section there is some information that should be moved in the "method" one Thank you for your helpful comments. We have revised the abstract by moving the information from the “Aim” section to lines 30-32 of the “Method” section. - Page 6 line 81: another recently published article evaluated the use of bolus tracking technique for PVP CT (doi: 10.1007/s00330-024-11009-7). I suggest you to add it as a reference. We appreciate your suggestion. We added the recommended paper as a reference on page 6 line 81 of the “Introduction” section. - Page 7, lines 97-103: move this information to the beginning of the subheading According to your advice, we moved this information to lines 91-96 in the “Materials and methods” section. - Page 97, lines 104-108: please better explain the preparation with dosages According to your advice, the dosage and administration of drugs for preparation were specified as 24 mg of Sennoside A‧B Calcium (Sennoside Tablets, Nichi-Iko Pharmaceutical Co., Ltd.), 1 mg of glucagon (Glucagon G Novo Injection, Novo Nordisk Pharma Ltd.), and 20 mg of Scopolamine Butylbromide (Buscopan Injection, Sanofi K.K.) on page 7-8 lines 106-111 in the “Materials and Methods” section. - Page 8, lines 121-123: please clarify how CM was dosed and which injection flow was used We appreciate your valuable comments. The contrast injection protocol was based on the study by Ichikawa T, et al, in which a total dose of 600 mgI/kg injected at 3.6-5.4 mL/s over 25 seconds (1). These details have been included on page 8-9 lines 123-127 of the “Materials and methods” section. - Page 9, lines 128-129: was there any delay between aortic peak and scanning start? In our study, the arterial phase imaging method was the same between the DBT and fixed-delay methods, with no significant delay observed in both the DBT group (30 patients) and the fixed-delay group (30 patients). References 1. Ichikawa T, Erturk SM, Araki T. Multiphasic contrast-enhanced multidetector-row CT of liver: contrast-enhancement theory and practical scan protocol with a combination of fixed injection duration and patients' body-weight-tailored dose of contrast material. Eur J Radiol. 2006;58(2):165-76. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0320630.r003
23 Feb 2025 Decision Letter - Tsutomu Kumamoto, Editor Impact of double-bolus tracking to individualize scan timing of the portal venous phase in preoperative computed tomography colonography angiography for right-sided colon cancer PONE-D-24-39564R1 Dear Dr. Masaaki Miyo, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Tsutomu Kumamoto Academic Editor PLOS ONE Additional Editor Comments: Congratulations on the acceptance of your manuscript! Your careful revisions and thoughtful responses have further strengthened this valuable study. The additional analyses and clarifications enhance its scientific impact and clinical relevance. It has been a pleasure to review your work, and I look forward to its publication. https://doi.org/10.1371/journal.pone.0320630.r004
Formally Accepted
Acceptance Letter - Tsutomu Kumamoto, Editor PONE-D-24-39564R1 PLOS ONE Dear Dr. Miyo, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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 M.D., Ph.D. Tsutomu Kumamoto Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0320630.r005

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