Title: Predictive value of preoperative CT enhancement rate and CT perfusion parameters in
colorectal cancer
Version: 1 Date: 27 Dec 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The manuscript has limited novelty. Role of MVD and blood
markers in colorectal cancer is already well established, CT perfusion is also a long standing
imaging modality with supporting literature on its role to evaluate tumor aggressiveness. Authors
have compiled the results very nicely and has followed the good standard of practice with
statistical analysis. The number of patients also to be noted is very low.
REQUESTED REVISIONS:
The manuscript has clear objective to evaluate the role of CTP parameters (surrogate
markers and quantitative markers) for aggressiveness of colorectal cancer. However, there are
methodological issues that need clarity. What algorithm was used for CTP quantitative analysis,
PS is permeability measure which is a two compartment model parameter, whereas MTT is a
single compartment model parameter. Authors have attempted to create models using various
perfusion parameters showing AUC of 0.9 characterizing high vs low density group; whereas
blood biomarkers has also shown similar values in characterization. Authors must consider
evaluating a model, NCCT+blood biomarker, NCCT can pick up colorectal lesion and high
blood markers have high sensitivity for characterizing. Low specificity of blood biomarkers will
be reduced by a NCCT by identification of lesion. This model could be easy to implement and
have no high dose CT as well contrast injection requirement.
ADDITIONAL REQUESTS/SUGGESTIONS:
Authors have not studied the metastatic potential of cancer with respect to MVD or perfusion
parameters, this a discussion on this correlation is speculative. I suggest author be objective in
discussion based on results presented in this study. Authors must also discuss the high dose of
CT exposed to patients for perfusion study, its effects and effects of Iodine contrast agent use,
its limitation in patients with compromised kidney functions.
Title: Predictive value of preoperative CT enhancement rate and CT perfusion parameters in
colorectal cancer
Version: 1 Date: 27 Dec 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The manuscript has limited novelty. Role of MVD and blood
markers in colorectal cancer is already well established, CT perfusion is also a long standing
imaging modality with supporting literature on its role to evaluate tumor aggressiveness. Authors
have compiled the results very nicely and has followed the good standard of practice with
statistical analysis. The number of patients also to be noted is very low.
REQUESTED REVISIONS:
The manuscript has clear objective to evaluate the role of CTP parameters (surrogate
markers and quantitative markers) for aggressiveness of colorectal cancer. However, there are
methodological issues that need clarity. What algorithm was used for CTP quantitative analysis,
PS is permeability measure which is a two compartment model parameter, whereas MTT is a
single compartment model parameter. Authors have attempted to create models using various
perfusion parameters showing AUC of 0.9 characterizing high vs low density group; whereas
blood biomarkers has also shown similar values in characterization. Authors must consider
evaluating a model, NCCT+blood biomarker, NCCT can pick up colorectal lesion and high
blood markers have high sensitivity for characterizing. Low specificity of blood biomarkers will
be reduced by a NCCT by identification of lesion. This model could be easy to implement and
have no high dose CT as well contrast injection requirement.
ADDITIONAL REQUESTS/SUGGESTIONS:
Authors have not studied the metastatic potential of cancer with respect to MVD or perfusion
parameters, this a discussion on this correlation is speculative. I suggest author be objective in
discussion based on results presented in this study. Authors must also discuss the high dose of
CT exposed to patients for perfusion study, its effects and effects of Iodine contrast agent use,
its limitation in patients with compromised kidney functions.
Please review this paper.
user
Title: Predictive value of preoperative CT enhancement rate and CT perfusion parameters in
colorectal cancer
Version: 1 Date: 27 Dec 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The manuscript has limited novelty. Role of MVD and blood
markers in colorectal cancer is already well established, CT perfusion is also a long standing
imaging modality with supporting literature on its role to evaluate tumor aggressiveness. Authors
have compiled the results very nicely and has followed the good standard of practice with
statistical analysis. The number of patients also to be noted is very low.
REQUESTED REVISIONS:
The manuscript has clear objective to evaluate the role of CTP parameters (surrogate
markers and quantitative markers) for aggressiveness of colorectal cancer. However, there are
methodological issues that need clarity. What algorithm was used for CTP quantitative analysis,
PS is permeability measure which is a two compartment model parameter, whereas MTT is a
single compartment model parameter. Authors have attempted to create models using various
perfusion parameters showing AUC of 0.9 characterizing high vs low density group; whereas
blood biomarkers has also shown similar values in characterization. Authors must consider
evaluating a model, NCCT+blood biomarker, NCCT can pick up colorectal lesion and high
blood markers have high sensitivity for characterizing. Low specificity of blood biomarkers will
be reduced by a NCCT by identification of lesion. This model could be easy to implement and
have no high dose CT as well contrast injection requirement.
ADDITIONAL REQUESTS/SUGGESTIONS:
Authors have not studied the metastatic potential of cancer with respect to MVD or perfusion
parameters, this a discussion on this correlation is speculative. I suggest author be objective in
discussion based on results presented in this study. Authors must also discuss the high dose of
CT exposed to patients for perfusion study, its effects and effects of Iodine contrast agent use,
its limitation in patients with compromised kidney functions.
assistant