Title: Reliability Assessment of CT Enhancement Rate and Extracellular Volume in Liver
Fibrosis Prediction
Version: 2 Date: 20 Dec 2024
Reviewer's report:
1.This study mainly focuses on the reliability evaluation of CT Enhancement Rate and
Extracellular Volume in evaluating liver fibrosis. However, the authors did not conduct
reliability analysis of the data.  Test-retest variability and inter-observer agreement are required.
2.Abstract: The description of the abstract part is too redundant and has too many words, please
rewrite it to ensure that the summary is concise and increase readability.
3.Line 60-61 “Results VP-ER and ECV fraction showed significant positive correlations with
fibrosis grade (r#=#0.363, p#=#0.0003; r#=#0.531, p#<#0.0001, respectively)...”this is not correct,
r=0.363/0.531 can only indicate that there is a weak or moderate correlation between the two,
and it does not reach a significant correlation, please correct. And synchronize in the results
section of the text.
4.Line 72-73, it was mentioned that “Incorporating both parameters enhances predictive
accuracy for liver fibrosis,.....” but no corresponding results were presented in the results section.
How did come to this conclusion?  Please explain and correct.
Materials and Methods
1.please provide a diagram to show how to draw ROI for data measurement.
Statistics#
1.To ensure the reliability of data measurements, please include intra-reader and inter-reader
consistency analyses.
2.In correlation analysis, is liver fibrosis staging a binary classification (fibrosis/no) or a graded
classification (F0, 1, 2)?  Please clarify and provide a figure and table to display the results.
Results:
1. Why did the author ignore or exclude patients with F4? Please specify this in the study design
section
2. Results need to be presented in more detail, the number of patients in each group, and basic
information is missing.
3. Line 323-325: “The accuracy of the model and the ROC were obtained to be 72.04% and 0.756
(CI: 0.688-0.863, p<0.0001).”  How was this result concluded? Is it the combination of ECV
and VR-ER to predict the stage of significant liver fibrosis? Please supplement the description
in the Methods and statistics section, and add charts for presentation.
Table : 1.please provide a more detailed explanation of Table 1 to ensure accessibility for non-
specialist readers.
3.Mention the number of excluded cases and reasons for exclusion to give readers a sense of
sample representativeness.
Figures: Ensure all figures and tables are properly cited in the text and include legends that are
standalone and detailed.
Discussion
The discussion section should add the discussion of the biological principles of VP-ER and ECV
related to fibrosis, both of which assess the mechanism of liver fibrosis, etc., and explain how
VP-ER and ECV can be incorporated into routine practice or decision-making to have clinical
impact, rather than simply repeating the description of the results.
Title: Reliability Assessment of CT Enhancement Rate and Extracellular Volume in Liver
Fibrosis Prediction
Version: 2 Date: 20 Dec 2024
Reviewer's report:
1.This study mainly focuses on the reliability evaluation of CT Enhancement Rate and
Extracellular Volume in evaluating liver fibrosis. However, the authors did not conduct
reliability analysis of the data.  Test-retest variability and inter-observer agreement are required.
2.Abstract: The description of the abstract part is too redundant and has too many words, please
rewrite it to ensure that the summary is concise and increase readability.
3.Line 60-61 “Results VP-ER and ECV fraction showed significant positive correlations with
fibrosis grade (r#=#0.363, p#=#0.0003; r#=#0.531, p#<#0.0001, respectively)...”this is not correct,
r=0.363/0.531 can only indicate that there is a weak or moderate correlation between the two,
and it does not reach a significant correlation, please correct. And synchronize in the results
section of the text.
4.Line 72-73, it was mentioned that “Incorporating both parameters enhances predictive
accuracy for liver fibrosis,.....” but no corresponding results were presented in the results section.
How did come to this conclusion?  Please explain and correct.
Materials and Methods
1.please provide a diagram to show how to draw ROI for data measurement.
Statistics#
1.To ensure the reliability of data measurements, please include intra-reader and inter-reader
consistency analyses.
2.In correlation analysis, is liver fibrosis staging a binary classification (fibrosis/no) or a graded
classification (F0, 1, 2)?  Please clarify and provide a figure and table to display the results.
Results:
1. Why did the author ignore or exclude patients with F4? Please specify this in the study design
section
2. Results need to be presented in more detail, the number of patients in each group, and basic
information is missing.
3. Line 323-325: “The accuracy of the model and the ROC were obtained to be 72.04% and 0.756
(CI: 0.688-0.863, p<0.0001).”  How was this result concluded? Is it the combination of ECV
and VR-ER to predict the stage of significant liver fibrosis? Please supplement the description
in the Methods and statistics section, and add charts for presentation.
Table : 1.please provide a more detailed explanation of Table 1 to ensure accessibility for non-
specialist readers.
3.Mention the number of excluded cases and reasons for exclusion to give readers a sense of
sample representativeness.
Figures: Ensure all figures and tables are properly cited in the text and include legends that are
standalone and detailed.
Discussion
The discussion section should add the discussion of the biological principles of VP-ER and ECV
related to fibrosis, both of which assess the mechanism of liver fibrosis, etc., and explain how
VP-ER and ECV can be incorporated into routine practice or decision-making to have clinical
impact, rather than simply repeating the description of the results.
Please review this paper.
user
Title: Reliability Assessment of CT Enhancement Rate and Extracellular Volume in Liver
Fibrosis Prediction
Version: 2 Date: 20 Dec 2024
Reviewer's report:
1.This study mainly focuses on the reliability evaluation of CT Enhancement Rate and
Extracellular Volume in evaluating liver fibrosis. However, the authors did not conduct
reliability analysis of the data.  Test-retest variability and inter-observer agreement are required.
2.Abstract: The description of the abstract part is too redundant and has too many words, please
rewrite it to ensure that the summary is concise and increase readability.
3.Line 60-61 “Results VP-ER and ECV fraction showed significant positive correlations with
fibrosis grade (r#=#0.363, p#=#0.0003; r#=#0.531, p#<#0.0001, respectively)...”this is not correct,
r=0.363/0.531 can only indicate that there is a weak or moderate correlation between the two,
and it does not reach a significant correlation, please correct. And synchronize in the results
section of the text.
4.Line 72-73, it was mentioned that “Incorporating both parameters enhances predictive
accuracy for liver fibrosis,.....” but no corresponding results were presented in the results section.
How did come to this conclusion?  Please explain and correct.
Materials and Methods
1.please provide a diagram to show how to draw ROI for data measurement.
Statistics#
1.To ensure the reliability of data measurements, please include intra-reader and inter-reader
consistency analyses.
2.In correlation analysis, is liver fibrosis staging a binary classification (fibrosis/no) or a graded
classification (F0, 1, 2)?  Please clarify and provide a figure and table to display the results.
Results:
1. Why did the author ignore or exclude patients with F4? Please specify this in the study design
section
2. Results need to be presented in more detail, the number of patients in each group, and basic
information is missing.
3. Line 323-325: “The accuracy of the model and the ROC were obtained to be 72.04% and 0.756
(CI: 0.688-0.863, p<0.0001).”  How was this result concluded? Is it the combination of ECV
and VR-ER to predict the stage of significant liver fibrosis? Please supplement the description
in the Methods and statistics section, and add charts for presentation.
Table : 1.please provide a more detailed explanation of Table 1 to ensure accessibility for non-
specialist readers.
3.Mention the number of excluded cases and reasons for exclusion to give readers a sense of
sample representativeness.
Figures: Ensure all figures and tables are properly cited in the text and include legends that are
standalone and detailed.
Discussion
The discussion section should add the discussion of the biological principles of VP-ER and ECV
related to fibrosis, both of which assess the mechanism of liver fibrosis, etc., and explain how
VP-ER and ECV can be incorporated into routine practice or decision-making to have clinical
impact, rather than simply repeating the description of the results.
assistant