Dual-Energy CT Applications in Urological Diseases

Round 1

Reviewer 1 Report

 

 

 

Abstract

Ok

I suggest to include the possibility of diagnosing urine extravasation by using iodine maps.

 

KEY WORDS

DECT is redundand; add kidney or urinary stones; add urotelial tumors

 

INTRODUCTION

Briefly explain how DECT works in differentiating stones and detecting tumors; add if possible regarding urinary leaks; also the possibility to detect more secondary hypervascular lesions could be described here

I suggest to include more references here

 

 

PAG 10 line 278   indicate the figure number

Paper is well written

Author Response

The authors thank the reviewer for the work and precious suggestions.

 

We performed the requested changes as follows:

 

Abstract

Ok

I suggest to include the possibility of diagnosing urine extravasation by using iodine maps.

 

Thank you for the suggestion.

We added a section on urinary leaks

 

KEY WORDS

DECT is redundand; add kidney or urinary stones; add urotelial tumors

 

Thank you for the suggestion. We have changed the key words

 

INTRODUCTION

Briefly explain how DECT works in differentiating stones and detecting tumors; add if possible regarding urinary leaks; also the possibility to detect more secondary hypervascular lesions could be described here

I suggest to include more references here

Thank you for the suggestion, we modified the manuscript accordingly

 

 

PAG 10 line 278   indicate the figure number

 

We apologize for the mistake and add the Figure number

 

 

Thank you very much

 

The authors

Reviewer 2 Report

In this manuscript, a comprehensive overview of Dual-energy computed tomography (DECT) applications for the diagnosis and treatment of urological diseases has been presented. The manuscript is well-structured and provides valuable insights into the potential applications of DECT in urology. However, there appear to be some crucial areas that require further clarification. The authors should address the following concerns for the manuscript to be considered for publication.

1. Please add colormaps for the iodine map shown in Fig.9. Please add “legend” for all the spectral curve graphs in the article.

2. In Section 3.4, the author states that observing a specific curve pattern in the ROI of specific tissue helps the diagnosis of fat-containing diseases. Please clarify whether there is any variation or overlap in these curve patterns, and if so, how is differential diagnosis achieved?

 

3. In Section 4.1, the author states that there is an overlap in the HU values of different stone types when conventional CT is used. Please provide more details on how significant the overlap is along with its implications on diagnostic accuracy. Also please elaborate on the dual energy index mentioned. What does this index represent? How is it calculated?

 

 

4. In Section 4.1, please add some introductory sentences or transitions prior to the presentation of the outcomes of different studies. This will improve the flow and readability of the manuscript.

 

5. In Section 4.1, the author says the DECT accuracy can be confounded by the stents and nephrostomy tubes. Please discuss the other possible factors that can influence the accuracy of DECT such as the presence of contrast media, hydration status, etc. 

 

6. The author states that the DECT is beneficial for patients having difficulty with MRI such as breath-holding etc. (Section 4.2). Are there any conditions under which DECT might not be suitable for a patient? Please discuss it in the limitations section. 

 

7. Please clarify the benefits and challenges of using iodine maps in DECT for the diagnosis of renal lesions (Section 4.2). 

 

8. Please provide more details on the split-bolus protocol and its implementation. Furthermore, the author states that urothelial tumors show moderate enhancement during the nephrographic phase. Is there a specific reason for this moderate enhancement?

 

 

 

 

 

 

 

 

Comments for author File: Comments.pdf

The writing of the manuscript can be improved.

Author Response

The authors thank the reviewer for the work and precious suggestions

We performed all required changes as follows:

In this manuscript, a comprehensive overview of Dual-energy computed tomography (DECT) applications for the diagnosis and treatment of urological diseases has been presented. The manuscript is well-structured and provides valuable insights into the potential applications of DECT in urology. However, there appear to be some crucial areas that require further clarification. The authors should address the following concerns for the manuscript to be considered for publication.

1. Please add colormaps for the iodine map shown in Fig.9. Please add “legend” for all the spectral curve graphs in the article.

Thank you for the suggestion. We modified the figure and the captions accordingly

1. In Section 3.4, the author states that observing a specific curve pattern in the ROI of specific tissue helps the diagnosis of fat-containing diseases. Please clarify whether there is any variation or overlap in these curve patterns, and if so, how is differential diagnosis achieved?

Thank you for the suggestion. We add a section to better explain this aspect

3. In Section 4.1, the author states that there is an overlap in the HU values of different stone types when conventional CT is used. Please provide more details on how significant the overlap is along with its implications on diagnostic accuracy. Also please elaborate on the dual energy index mentioned. What does this index represent? How is it calculated?

Thank you for the suggestion,

we deepened these aspects in urinary stones in the corresponding section

4. In Section 4.1, please add some introductory sentences or transitions prior to the presentation of the outcomes of different studies. This will improve the flow and readability of the manuscript

Thank you for this comment. We modified this section accordingly

5. In Section 4.1, the author says the DECT accuracy can be confounded by the stents and nephrostomy tubes. Please discuss the other possible factors that can influence the accuracy of DECT such as the presence of contrast media, hydration status, etc. 

Thank you for the comment, we modified section 4.1 accordingly

6. The author states that the DECT is beneficial for patients having difficulty with MRI such as breath-holding etc. (Section 4.2). Are there any conditions under which DECT might not be suitable for a patient? Please discuss it in the limitations section. 

We deepened the limitations section adding some consideration of these aspects

7. Please clarify the benefits and challenges of using iodine maps in DECT for the diagnosis of renal lesions (Section 4.2). 

Thank you for this comment, we add some considerations on the iodine maps in renal lesions characterization, as suggested

8. Please provide more details on the split-bolus protocol and its implementation. Furthermore, the author states that urothelial tumors show moderate enhancement during the nephrographic phase. Is there a specific reason for this moderate enhancement?

We added considerations on the suggested aspects

 

Thank you

 

Regards

 

The authors

Round 2

Reviewer 2 Report

The author has not appropriately answered the comments and clarified my concerns.

The manuscript is well articulated, and the quality of English is good.

Author Response

I thank the reviewer for his/her work.

 

We have modified the manuscript by further deepen the previously suggested aspects, such as stones characterization, angiomyopoma, and split bolus protocol

 

Thank you very much

 

Regards 

 

The authors