Can ultrasound parameters predict the diagnostic yield of diuretic renal scintigraphy in pediatric hydronephrosis?

Dheeratama Siripongsatian; Nipaporn Tewattanarat; Nantaporn Wongsurawat; Suwannee Wisanuyotin; Daris Theerakulpisut

doi:10.1371/journal.pone.0324446

Peer Review History

Original SubmissionJanuary 9, 2025
9 Jan 2025 Author Response https://doi.org/10.1371/journal.pone.0324446.r001
14 Mar 2025 Decision Letter - Ahmet Çağlar, Editor PONE-D-25-01165Can ultrasound parameters predict the diagnostic yield of diuretic renal scintigraphy in pediatric hydronephrosis?PLOS ONE Dear Dr. Theerakulpisut, 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 Apr 28 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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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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). 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 ****** 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 ****** 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 manuscript technically sound, and do the data support the conclusions.It has the statistical analysis been performed appropriately and rigorously. The authors made all data underlying the findings in their manuscript fully available.the manuscript presented in an intelligible fashion and written in standard English Reviewer #2: In the current work, authors performed a retrospective study to study the ability of kidney ultrasound and its paramters to distinguish between diagnostic and non-diagnostic DRS so that people who dont qualify for diagnostic DRS can avoid DRS. The study found that kidney ultasound canot predict DRS with significance. The manuscript is well written and the data supports the conclusions. Statistical analysis is well done. There are a few minor comments if authors can address. 1) Can some anotomical changes occur in the 6 month time gap between kidney US and DRS? What if the exclusion criteria is more tight (3 months or lower)? Will that make any difference in the results? 2) are there any previous studies that have similarly explored the predictive ability of Kidney US? The authors have not mentioed about them. It would be intersting to know what is the outcome in the previous studies. 3) Authors can mention any limiations in the current study. Also, mention the future directions for the researchers reading the manuscript. ****** 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 Reviewer #2: 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.0324446.r002
Revision 1
30 Mar 2025 Author Response ### Comments from the Editorial office: #Comment: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. # Response: File names are renamed to comply with PLOS ONE's style requirements. (Fig1.tif, Fig2.tif, Fig3.tif, Fig4.tif, S1_Dataset.csv) ------------------------------- # Comment: 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. # Response: A caption for the Supporting Information file is included at the end of the revised manuscript. # Revised text: "Supporting information S1 Dataset. Anonymized patient-level dataset" ------------------------------- # Comment: 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. # Response: • The references were checked and revised to comply with the Vancouver style. • An additional reference is added as per recommendation from the reviewer (reference number 10) with the references that follow renumbered accordingly. # Revised text: 10. Jacobson DL, Flink CC, Johnson EK, Maizels M, Yerkes EB, Lindgren BW, et al. The correlation between serial ultrasound and diuretic renography in children with severe unilateral hydronephrosis. J Urol. 2018 Aug;200(2):440–7. ------------------------------- ### Comments from Reviewer 2: # Comment: 1) Can some anotomical changes occur in the 6 month time gap between kidney US and DRS? What if the exclusion criteria is more tight (3 months or lower)? Will that make any difference in the results? # Response: We agree that this is an important point, and it is one that we have considered when initiating the study. We believe that anatomical changes that could occur is possible, but should not be so pronounced as to invalidate the results of the study. This is because according to the “Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide” (reference 5), children with hydronephrosis are initially managed medically with serial ultrasound follow-up every 3-6 months, which suggests that significant changes in the kidney anatomy would not occur in a short time frame. However, to explore if including only those that underwent DRS and US within 3 months (90 days) of each other, we did a subgroup analysis to find the ROCs of US parameters in 44 patients whose imaging tests were done within a 3-month window. The results are presented in a new table (Table 6). The AUCs are still poor, so we believe that the time window did not have a significant effect on the outcome and the key message of this study. # Revised text: "The median time window between DRS and US was 44 days. To further examine if the time window between DRS and US could have affected the predictiveness of US parameters, a subgroup analysis was done in 44 of 67 patients (65.7%) who underwent both modalities within =< 90 days of each other. The results are presented in table 6. The AUCs of the US parameters did not improve, ranging from 0.46 – 0.56, with all having 95% confidence intervals crossing 0.5. This suggests that the time window is not an effect modifier on the predictiveness of US parameters." ------------------------------- # Comment: 2) are there any previous studies that have similarly explored the predictive ability of Kidney US? The authors have not mentioed about them. It would be intersting to know what is the outcome in the previous studies. # Response: There have been several studies which explored the predictiveness of US on predicting the “obstruction pattern” on DRS (reference numbers 11 - 15). However, there have not been studies that explored the predictiveness of US in predicting “non-diagnostic” DRS. We did additional searching and the closest we could find is a study by Jacobson et al. (reference 10) which analyzed the correlation between US and DRS, but did not analyze the ROC. We added this reference and added this discussion point. # Revised text: "A previous study by Jacobson et al. found a poor correlation between DRS and US findings in children with hydronephrosis with a Spearman correlation coefficient of only 0.24 [10]. However, to our knowledge, this current study is the first to examine the predictiveness of US parameters in relation to diagnostic vs. non-diagnostic DRS results." ------------------------------- # Comment: 3) Authors can mention any limiations in the current study. Also, mention the future directions for the researchers reading the manuscript. # Response: We added a paragraph about the limitations and future directions at the end of the discussion section. # Revised text: "The main limitation of this study is its retrospective nature. Although all US studies were done by pediatric radiologists, since US is a highly operator-dependent modality, variations at the time the US studies were done are difficult to avoid. To address this issue, in this study, all US parameters were remeasured by one experienced pediatric radiologist (N.T.). Future prospective studies should aim to integrate multiple clinical, functional, and anatomical parameters to enhance prediction accuracy and improve patient selection for DRS." ------------------------------- # Comment: While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool # Response: I uploaded the figure file to PACE as instructed, and downloaded the PACE-adjusted version, and reuploaded them to the Editorial Manager submission system. ------------------------------- Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0324446.r003
25 Apr 2025 Decision Letter - Ahmet Çağlar, Editor <p>Can ultrasound parameters predict the diagnostic yield of diuretic renal scintigraphy in pediatric hydronephrosis? PONE-D-25-01165R1 Dear Dr. Theerakulpisut, 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, Ahmet Çağlar, M.D. 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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 #2: Yes ****** 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 #2: 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 #2: The authors have appropriately addressed all the comments. The manuscript is suitable for publishing. ****** 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 #2: No ******** https://doi.org/10.1371/journal.pone.0324446.r004
Formally Accepted
Acceptance Letter - Ahmet Çağlar, Editor PONE-D-25-01165R1 PLOS ONE Dear Dr. Theerakulpisut, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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 Dr. Ahmet Çağlar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0324446.r005

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