Diagnostic Approaches to Adult-Type Diffuse Glial Tumors: Comparative Literature and Clinical Practice Study

Round 1

Reviewer 1 Report

The authors present a literature review of various imaging approaches for the diagnosis of gliomas. The review is informative as it correlates imaging features with outcomes and, as such the manuscript is likely to be of interest to clinicians in the neuro-oncology field.

 

Line 92: “Combined with….” This is an incomplete sentence. Please re-write for clarity.

Lines 125 – 126: The authors state that “CT can be used as the main imaging modality on rare occasions when MRI is contraindicated.” Please state these contraindications.

Line 128: Recommend using “architectural,” not “architonical.”

Line 136: Recommend the following: “T1 contrast-enhanced (T1CE) images…”

Line 219: The meaning of “effectuation time” is unclear. Please re-write for clarity.

Lines 224 – 226: The authors state that DCE is the preferred method for mixed type tumors. If that’s the case then why is DSC more commonly used than DCE. Please clarify.

Section 4.3.3: The explanation of arterial spin labelling is somewhat confusing. Please re-write for clarity.

Line 279: “can modify a patient’s motor or sensory…”

Line 340: The meaning of “Pataisyti Sarase” is unclear.

Line 349: What is the spatial resolution of PET and SPECT. Please include in text.

Lines 351 – 355: This section is difficult to understand. According to the authors, if uptake of the two radioisotopes is seen, it indicates either tumor recurrence or radiation-induced necrosis. How do you differentiate between the two? The authors state that the cutoff ratio value of the tumor’s uptake is around 4. What is it for radiation necrosis? Please explain.

Section 4.6.4: Authors should consider adding images illustrating radiation necrosis (and comparing them to images of pseudoprogression).

English usage is relatively poor and, in places, it is difficult to understand the main points presented by the authors. Editorial revisions will be required in order to bring the manuscript up to the standards of an English language journal.

Author Response

Thanks for your comments. Please find my reply in the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The manuscript by Veikutis et al. offers a comprehensive review of glial tumors, which are the most prevalent tumors affecting the central nervous system. The authors propose a multimodal approach to enhance the effectiveness of glial tumor treatment. To substantiate their suggestion, they compare the existing literature on radiological approaches to glioma imaging diagnostics with their own experience, which involves a cohort of patients with diffuse glioma.

While the manuscript shows potential for publication, it requires certain improvements. Firstly, it is unclear whether the manuscript is intended to be an article or a review. If it is categorized as a review, the materials and methods section should be omitted. The title could be simplified to improve clarity. Additionally, the conclusion section is concise and lacks clear descriptions of the observations made. Addressing these areas would enhance the overall quality of the manuscript.

 

Author Response

Thanks for your comments. Please find my reply in the attachment.

   

 

 

Author Response File: Author Response.docx

Reviewer 3 Report

Overall, the article draft introduces gliomas, highlights the changes brought by the 2021 WHO Classification of Central Nervous System Tumors, and mentions the importance of molecular diagnostics in the classification of gliomas. It also emphasizes the role of magnetic resonance (MR) imaging in diagnosing and monitoring treatment response in gliomas and mentions the use of functional imaging, perfusion imaging, spectroscopy, and nuclear medicine imaging for better treatment outcomes. 

 

Here are a few suggestions to enhance the clarity and structure of the article:

 

1.     Specify in the introduction that the focus will be on adult-type diffuse gliomas, as this is the most relevant group in clinical practice. This will help set the context for the subsequent discussion.

2.     Before discussing specific genetic markers, provide a brief explanation of why these markers are significant in glioma diagnosis and treatment.

3.     The information that different types of gliomas have distinct radiological features on MRI can be given as a list for easier readability. 

4.     I believe that the transition between the two paragraphs on Page 4 (Lines 149-157) could be improved to enhance the overall flow and coherence of the text.

Author Response

Thanks for your comments. Please find my reply in the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors have addressed my concerns. I have no additional comments.

Minor editorial revisions are required.

Author Response

Thanks for your comments.

Reviewer 2 Report

The manuscript by Veikutis et al. provides a comprehensive examination of the literature regarding various diagnostic methods for detecting gliomas. Gliomas are highly prevalent and aggressive tumors that primarily affect the central nervous system. Early detection and accurate grading of these tumors are crucial for making treatment decisions and assessing prognosis. Overall, the review is well-written, and the authors have effectively addressed the necessary modifications. However, one important observation is the absence of mention regarding patient consent for using the images provided by the hospital. The authors should address and clarify patient consent in their manuscript

Author Response

Thanks for your comments and we have uploaded a typical certified in our Clinical hospital patient agreement form which is mandatory in case of any visit, medical procedure, or hospitalization with the translation of specific parts. Part No.3. Do you agree that the confidential information contained in your medical records will be used in scientific research works, which will be depersonalized or changed in such a way that no identity can be determined?