Advantages of Photon-Counting Detector CT in Aortic Imaging
, Filippo Cademartiri 2, Alessandro Toniolo 1, Costanza Bini 1, Alberto Clemente 2, Elda Chiara Colacchio 3, Giulio Cabrelle 1, Florinda Mastro 4, Michele Antonello 3, Emilio Quaia 1 and Alessia Pepe 1,*
James Nadel
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsI like to thank the authors for sending this interesting review article. They compared and summarized 7 current studies that analyzed the potential of photon-counting detector CT for vascular pathologies other than coronary artery disease.
They found that PCD-CT has potential advantages in cardiovascular imaging, which are discussed in detail. Overall, this review lacks studies – there are a lot more out there that need to be included. Please find my detailed comments below:
- Major: There are a large number of studies that could also be included here. What about studies on peripheral artery disease (https://pubmed.ncbi.nlm.nih.gov/36525704/), pulmonary embolism, abdominal vessels, active bleeding (https://pubmed.ncbi.nlm.nih.gov/37804649/)? There are so many that there is also another form of this article already published in another MDPI Journal (JCM) https://www.mdpi.com/2077-0383/12/11/3798 - with some of the same authors. I think this article could add to the existing literature as in the authors group studies for different advantages, which gives a great overview. However there are too many missing.
- Title: This is too general, I think. Maybe add “advantages” and maybe also already define that its vascular imaging except the coronary arteries.
- This selection should also be defined more clearly in other sections of the manuscript. In key point 1 and in the conclusion for example, there is the word “cardio”vascular, but you did not include cardiac studies. Please change to vascular.
- Also how did you deal with neurovascular applications? There are also an increasing number that may be included if you only want to exclude cardiac studies -> https://pubmed.ncbi.nlm.nih.gov/37297821/
- Overall, this manuscript lacks methodology. How did you search for these studies and how many did you exclude for which reasons (no cardiac, no neuro)? I could only find this short sentence in the abstract, nothing in the manuscript body.
- Table 2 does not fit in this context. I suggest to either remove it or use it as a supplemental table for referencing.
- The figures focus heavily on the (abdominal) aorta. Additional images of other vascular territories would be greatly appreciated.
Author Response
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Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsGENERAL COMMENTS:
- This is a review article on a promising technology which includes some revision of cohort studies.
- The review looks specifically at the application of PCCT in vascular (large artery) imaging and surveillance imaging following aortic intervention.
- The paper is relevant to the readership of the journal.
MAJOR COMMENTS:
- The grammar and prose is not as good as it could be e.g. line 65 “to obtain a good quality reports..” line 70 “…innovative technology that delivers a high image quality…” line 74 “since its introduction in 20214, PCCT has become...”; and so it continues. Additionally, there are tense changes throughout the text. I would encourage the authors to review the works themselves prior to asking a primary English speaker to review the text for grammar and flow before resubmission.
- Some discussion about the use of iodinated and non-iodinated contrast agents in PCCT would be welcome in the technical discussion on page 4. Not all readers will be aware that PCCT allows for imaging with non-iodinated contrast agents and the authors then go on to discuss studies which have applied these.
- Representative images showing PCCT vs CT would be welcomed and would strengthen the authors strong position of the paradigm-shifting importance of PCCT.
- Discussion on the limitations of PCCT should be made. E.g. the absence of its wide availability, technical difficulties and the lack of molecular imaging agents to couple with it.
MINOR COMMENTS:
- The first sentence is odd. “Vascular disease remains a global cause of death and morbidity”. This statement is benign as for example ‘golf ball injuries’ also remain a global cause of death. In this reviewers opinion it would be best to leave out the opening 3 sentences and commence with “Over the years..”.
- The closing paragraphs of the introduction read as if they are part of the conclusions. “In summary” would not be a term to use in your introductory paragraphs…you have not yet presented anything to summarise.
- Avoid using superlative language in a scientific text such as “cutting-edge”, “remarkable”.
- Line 242-243: Do the authors truly believe that PCCT “holds promise in revolutionizing the management of ELs”? This language is hyperbolic.
- You need to contextualise your references for example see Line 63 “The main CT scan requests…” From Who? When? or Line 182 “EL’s was the most common complication…” In What? Where? How many patients/centres?
- The text repeatedly emphasises the importance of PCCT in reducing contrast related nephrotoxicity (which in itself is seen as not a major clinical issue) and radiation exposure. Both these problems are overcome by MRI. The use of MRI in vascular disease and PCCTs performance in relation to it is not presented by the authors.
- Figure 2. What is “thrombotic stratification”? identify it in the image with a symbol.
- Figure 5. Describe in the legend that the arrowheads identify the aortic wall.
- The text is repetitive at times. The utility of PCCT in providing improved CNR, reduced contrast dose and enhanced image quality it laboured.
Comments on the Quality of English LanguageSee above.
Author Response
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Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThis is a very well written manuscript reviewing the utility of photon-counting detector CT imaging for vascular territories, with specific focus on AAA and endoleak after EVAR. This authors are very comprehensive in their review and explain the results of each article very clearly. I believe this article would be of great interest to this journals readers after a few minor corrections.
Page 2 Line 74: I believe there may be a typo here. “Since its introduction in 20214 …”
Page 4 Line 123: There appears to be an extra “.” Before citation 15
Page 6 Line 189: The study below does not support that endoleak detection accuracy was improved, rather you state it was equivalent. Are there other studies to suggest improved accuracy? How about comparisons of sensitivity and specificity.
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for sending the revised version of this manuscript.
However, I am quite confused with this revision.
On the one hand, the authors added a better focus on aortic applications in the title, key words, abstract and even added some sort of methods section.
In the "methods" they write: "All articles concerning coronary imaging, head and neck vessel imaging, pulmonary vessels, small vessels, experimental animals, reviews, and those unrelated to photon counting CT were excluded"
Then they added 3 new references (also with extensive discussion) [15-17] of mainly non-aortic applications. I detail, they specifically included coronary imaging and a more generalized VNC/TNC comparison manuscript, although they wrote that these were exluded?
I like the focus on aortic applications and advantages but the selection of compared manuscripts feels random to me. I suggest to really stick to aortic applications and to perform a new search with adequate comparison of a sound selection of papers.
Alternatively, if the authors want to include coronary papers, there are at least 10 papers more that should be in this review to allow for an adequate comparison.
I am aware that this was not published, when this review was drafted, but this may also be a good addition: https://journals.lww.com/investigativeradiology/fulltext/2023/11000/photon_counting_detector_ct_angiography_for.7.aspx
Author Response
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Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThe review article is improved. I would recommend its publication as suitable to the readership of Tomography. Only one minor comment remains re: Figure 2. In the Figure legend the thrombotic stratification is supposedly marked with an (* asterisks), though this is still not displayed on the images. Please correct the Figure prior to publication.
Author Response
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Author Response File: Author Response.pdf
