Title: Clinical significance of contrast extravasation on computed tomography immediately after
thermal ablation for hepatic tumors
Version: 2 Date: 29 Mar 2025
Reviewer:  Jin Chen
Reviewer's report:
The paper is well-written by authors. The paper focused on clinical significance of contrast
extravasation on computed tomography immediately after thermal ablation for hepatic tumors
and made the conclusion that "The presence of contrast extravasation on post-ablation CT
was not clinically significant. However, transarterial embolization is required if contrast
extravasation is detected in the extrahepatic arteries." The paper still has some major problems.
1# The flow chart is needed to explain the enrollment of the study.
2# Please add the standard of endpoint of ablation based on the US-guided and CT enhancement.
3# As you used US-guided ablation in most cases in this study, why do not you use contrast-
enhanced ultrasound to evaluate the efficacy and assess the complication such as bleeding
immediately after the ablation?  And the difference between these two methods. Please discuss
in detail.
4# Did the authors use the contrast-enhance CT in all patients after liver ablation? Whether
allergic reactions and contrast media nephropathy happened in the study?
5# What is the manifestation of bleeding in the study before contrast-enhance CT assessment?
Whether there are patients with intrahepatic hematoma#Most patients with intrahepatic
hematoma are caused by hepatic artery injury, and the hematoma is easy to progress and break
into the abdominal cavity leading to shock, so embolization intervention is needed as soon as
possible.
6# Can you further locate target vascular injury, artery or vein in contrast extravasation
patients with immediate postoperative CT enhancement? To further guide whether to embolize
decisions?
7# Consider whether to try ablation to stop bleeding#Thermal ablation is a method for
hemostasis.
8# Whether follow-up bleeding needs drainage and other treatment?
9# In our center, intrahepatic artery injuries, especially those associated with intrahepatic
hematoma, generally require further embolization. Hemothorax or abdominal hemorrhage
caused by phrenic artery injury generally requires active embolization or surgical intervention.
Most conservative treatment of intercostal artery injury can stop bleeding. There is some
discrepancy with the conclusion of the study, please explain further.
Title: Clinical significance of contrast extravasation on computed tomography immediately after
thermal ablation for hepatic tumors
Version: 2 Date: 29 Mar 2025
Reviewer:  Jin Chen
Reviewer's report:
The paper is well-written by authors. The paper focused on clinical significance of contrast
extravasation on computed tomography immediately after thermal ablation for hepatic tumors
and made the conclusion that "The presence of contrast extravasation on post-ablation CT
was not clinically significant. However, transarterial embolization is required if contrast
extravasation is detected in the extrahepatic arteries." The paper still has some major problems.
1# The flow chart is needed to explain the enrollment of the study.
2# Please add the standard of endpoint of ablation based on the US-guided and CT enhancement.
3# As you used US-guided ablation in most cases in this study, why do not you use contrast-
enhanced ultrasound to evaluate the efficacy and assess the complication such as bleeding
immediately after the ablation?  And the difference between these two methods. Please discuss
in detail.
4# Did the authors use the contrast-enhance CT in all patients after liver ablation? Whether
allergic reactions and contrast media nephropathy happened in the study?
5# What is the manifestation of bleeding in the study before contrast-enhance CT assessment?
Whether there are patients with intrahepatic hematoma#Most patients with intrahepatic
hematoma are caused by hepatic artery injury, and the hematoma is easy to progress and break
into the abdominal cavity leading to shock, so embolization intervention is needed as soon as
possible.
6# Can you further locate target vascular injury, artery or vein in contrast extravasation
patients with immediate postoperative CT enhancement? To further guide whether to embolize
decisions?
7# Consider whether to try ablation to stop bleeding#Thermal ablation is a method for
hemostasis.
8# Whether follow-up bleeding needs drainage and other treatment?
9# In our center, intrahepatic artery injuries, especially those associated with intrahepatic
hematoma, generally require further embolization. Hemothorax or abdominal hemorrhage
caused by phrenic artery injury generally requires active embolization or surgical intervention.
Most conservative treatment of intercostal artery injury can stop bleeding. There is some
discrepancy with the conclusion of the study, please explain further.
Please review this paper.
user
Title: Clinical significance of contrast extravasation on computed tomography immediately after
thermal ablation for hepatic tumors
Version: 2 Date: 29 Mar 2025
Reviewer:  Jin Chen
Reviewer's report:
The paper is well-written by authors. The paper focused on clinical significance of contrast
extravasation on computed tomography immediately after thermal ablation for hepatic tumors
and made the conclusion that "The presence of contrast extravasation on post-ablation CT
was not clinically significant. However, transarterial embolization is required if contrast
extravasation is detected in the extrahepatic arteries." The paper still has some major problems.
1# The flow chart is needed to explain the enrollment of the study.
2# Please add the standard of endpoint of ablation based on the US-guided and CT enhancement.
3# As you used US-guided ablation in most cases in this study, why do not you use contrast-
enhanced ultrasound to evaluate the efficacy and assess the complication such as bleeding
immediately after the ablation?  And the difference between these two methods. Please discuss
in detail.
4# Did the authors use the contrast-enhance CT in all patients after liver ablation? Whether
allergic reactions and contrast media nephropathy happened in the study?
5# What is the manifestation of bleeding in the study before contrast-enhance CT assessment?
Whether there are patients with intrahepatic hematoma#Most patients with intrahepatic
hematoma are caused by hepatic artery injury, and the hematoma is easy to progress and break
into the abdominal cavity leading to shock, so embolization intervention is needed as soon as
possible.
6# Can you further locate target vascular injury, artery or vein in contrast extravasation
patients with immediate postoperative CT enhancement? To further guide whether to embolize
decisions?
7# Consider whether to try ablation to stop bleeding#Thermal ablation is a method for
hemostasis.
8# Whether follow-up bleeding needs drainage and other treatment?
9# In our center, intrahepatic artery injuries, especially those associated with intrahepatic
hematoma, generally require further embolization. Hemothorax or abdominal hemorrhage
caused by phrenic artery injury generally requires active embolization or surgical intervention.
Most conservative treatment of intercostal artery injury can stop bleeding. There is some
discrepancy with the conclusion of the study, please explain further.
assistant