Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 24 May 2018  
 
Reviewer : Phillippe A. Soyer  
 
Reviewer's report:  
 
This is an interesting study. The design is appropriate wit h an acceptable standard of reference.  
 
I suggest a few amendments  
In general, please add the diagnostic presentation of the bleeding (acute, chronic, occult, overt, 
obscure)  
It would be interesting to state if the patients had CT examination.  
 
Title  
SPEC T/CT fusion imaging in the diagnosis of  gastrointestinal bleeding: A retrospective analysis  
 
Abstract  
Please consider the following purpose  
The purpose of this study was  to retrospectively assess the capabilities of SPECT/CT in the 
diagnosis of gastroi ntestinal bleeding by comparison to planar imaging  alone and SPECT alone.  
 
Introduction  
The authors should indicate that gastrointestinal bleeding can be overt, ocult or obscure. The 
diagnostic approach depends on the clinical presentation. The use of capsule endoscopy is 
usually restricted to patients with obscure occult gastrointestinal ble eding. This should be stated 
with more détails.  
Please spell out all acronyms at first use  
Please use the same goal in the Intro and the Abstract  
 
Methods  
Please give gender distribution, mean age, SD and range  
Please avoid colloquial sentnece such as "F ive patients (5 scintigraphy examinations) were 
diagnosed by planar imaging (planar  group)." Please consider, "In five patients,  
Please state clearly what a "bleeding scintigraphy" is.  Please consider " Twenty patients who 
underwent a total of 21 scinti graphic examinations because of gastrointestinal bleeding     (give 
dates of inclusion)  were retrospectively included in the study. The bleeding site was identified 
by endoscopy (n = patients (give number of patients) or capsule endoscopy (n = give number  of 
patients) or no evidence of gastrointestinal bleeding was identified during the clinical course (n = 
give number of patients).  
Please change "The 21 scintigraphy images" for "The 21 scintigraphy examinations"  
Please change "The parameters were express ed as the mean ± SD." for "The quantitative 
variables were expressed as  mean ± standard deviation [SD] and add ranges .  
 
Results  
Please avoid the use of "exams" which is colloquial and use "examinations"  
Please consider using proportions x/y instead of  x of the y examinations and add corresponding 
percentages  
Please indicate the location of ulcer  
The terminal ileum is part of small bowel.  
 
Discussion  
Please do not use "case". Case is misleading. Use "patient" or "examination".  
Please rewrite "In the three groups (planar group, planar + SPECT group, planar + SPECT/CT 
group) examinations showed high degrees of  accuracy in detecting the presence of 
gastro intestinal bleeding"  
Please add the following limitation" A fourth limitation relates to the absence  of comparison 
with CT angiography that has demonstrated high degrees of accuracy for the diagnosis of active 
gastrointestinal bleeding and with CT -enteroclysis which has emonstrated high degrees of 
accuracy for the diagnosis of obscure gastrointestinal bl eeding." Add the following references  
Jaeckle T, Stuber G, Hoffmann MH, Jeltsch M, Schmitz BL, Aschoff AJ. Detection and 
localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi -
detector row helical CT. Eur Radiol 200 8;18(7):1406 -13. 
Shotar E, Soyer P, Barat M, Dautry R, Pocard M, Placé V, Camus M, Eveno C, Barret M, Dohan 
A.Diagnosis of acute overt gastrointestinal bleeding with CT -angiography: Comparison of the 
diagnostic performance of individual acquisition phases. Diagn Interv Ima ging 2017;98(12):857 -
863 
García -Blázquez V, Vicente -Bártulos A, Olavarria -Delgado A, Plana MN, van der Winden D, 
Zamora J; EBM -Connect Collaboration.Accuracy of CT angiography in the diagnosis of acute 
gastrointestinal bleeding: systematic review and meta -analysis.Eur Radiol 2013;23(5):1181 -90. 
Khalife S, Soyer P, Alatawi A, Vahedi K, Hamzi L, Dray X, Placé V, Marteau P, Boudiaf 
M.Obscure gastrointestinal bleeding: preliminary comparison of 64 -section CT enteroclysis with 
video capsule endoscopy. Eur Radi ol 2011;21(1):79 -86. 
 
Figures  
I suggest adding an illustrative patient.  
 
Table 2  
Please for typos (Rupture instead of rapture)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 24 May 2018  
 
Reviewer : Phillippe A. Soyer  
 
Reviewer's report:  
 
This is an interesting study. The design is appropriate wit h an acceptable standard of reference.  
 
I suggest a few amendments  
In general, please add the diagnostic presentation of the bleeding (acute, chronic, occult, overt, 
obscure)  
It would be interesting to state if the patients had CT examination.  
 
Title  
SPEC T/CT fusion imaging in the diagnosis of  gastrointestinal bleeding: A retrospective analysis  
 
Abstract  
Please consider the following purpose  
The purpose of this study was  to retrospectively assess the capabilities of SPECT/CT in the 
diagnosis of gastroi ntestinal bleeding by comparison to planar imaging  alone and SPECT alone.  
 
Introduction  
The authors should indicate that gastrointestinal bleeding can be overt, ocult or obscure. The 
diagnostic approach depends on the clinical presentation. The use of capsule endoscopy is 
usually restricted to patients with obscure occult gastrointestinal ble eding. This should be stated 
with more détails.  
Please spell out all acronyms at first use  
Please use the same goal in the Intro and the Abstract  
 
Methods  
Please give gender distribution, mean age, SD and range  
Please avoid colloquial sentnece such as "F ive patients (5 scintigraphy examinations) were 
diagnosed by planar imaging (planar  group)." Please consider, "In five patients,  
Please state clearly what a "bleeding scintigraphy" is.  Please consider " Twenty patients who 
underwent a total of 21 scinti graphic examinations because of gastrointestinal bleeding     (give 
dates of inclusion)  were retrospectively included in the study. The bleeding site was identified 
by endoscopy (n = patients (give number of patients) or capsule endoscopy (n = give number  of 
patients) or no evidence of gastrointestinal bleeding was identified during the clinical course (n = 
give number of patients).  
Please change "The 21 scintigraphy images" for "The 21 scintigraphy examinations"  
Please change "The parameters were express ed as the mean ± SD." for "The quantitative 
variables were expressed as  mean ± standard deviation [SD] and add ranges .  
 
Results  
Please avoid the use of "exams" which is colloquial and use "examinations"  
Please consider using proportions x/y instead of  x of the y examinations and add corresponding 
percentages  
Please indicate the location of ulcer  
The terminal ileum is part of small bowel.  
 
Discussion  
Please do not use "case". Case is misleading. Use "patient" or "examination".  
Please rewrite "In the three groups (planar group, planar + SPECT group, planar + SPECT/CT 
group) examinations showed high degrees of  accuracy in detecting the presence of 
gastro intestinal bleeding"  
Please add the following limitation" A fourth limitation relates to the absence  of comparison 
with CT angiography that has demonstrated high degrees of accuracy for the diagnosis of active 
gastrointestinal bleeding and with CT -enteroclysis which has emonstrated high degrees of 
accuracy for the diagnosis of obscure gastrointestinal bl eeding." Add the following references  
Jaeckle T, Stuber G, Hoffmann MH, Jeltsch M, Schmitz BL, Aschoff AJ. Detection and 
localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi -
detector row helical CT. Eur Radiol 200 8;18(7):1406 -13. 
Shotar E, Soyer P, Barat M, Dautry R, Pocard M, Placé V, Camus M, Eveno C, Barret M, Dohan 
A.Diagnosis of acute overt gastrointestinal bleeding with CT -angiography: Comparison of the 
diagnostic performance of individual acquisition phases. Diagn Interv Ima ging 2017;98(12):857 -
863 
García -Blázquez V, Vicente -Bártulos A, Olavarria -Delgado A, Plana MN, van der Winden D, 
Zamora J; EBM -Connect Collaboration.Accuracy of CT angiography in the diagnosis of acute 
gastrointestinal bleeding: systematic review and meta -analysis.Eur Radiol 2013;23(5):1181 -90. 
Khalife S, Soyer P, Alatawi A, Vahedi K, Hamzi L, Dray X, Placé V, Marteau P, Boudiaf 
M.Obscure gastrointestinal bleeding: preliminary comparison of 64 -section CT enteroclysis with 
video capsule endoscopy. Eur Radi ol 2011;21(1):79 -86. 
 
Figures  
I suggest adding an illustrative patient.  
 
Table 2  
Please for typos (Rupture instead of rapture)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding: A 
retrospective study  
 
Version: 1 Date: 24 May 2018  
 
Reviewer : Phillippe A. Soyer  
 
Reviewer's report:  
 
This is an interesting study. The design is appropriate wit h an acceptable standard of reference.  
 
I suggest a few amendments  
In general, please add the diagnostic presentation of the bleeding (acute, chronic, occult, overt, 
obscure)  
It would be interesting to state if the patients had CT examination.  
 
Title  
SPEC T/CT fusion imaging in the diagnosis of  gastrointestinal bleeding: A retrospective analysis  
 
Abstract  
Please consider the following purpose  
The purpose of this study was  to retrospectively assess the capabilities of SPECT/CT in the 
diagnosis of gastroi ntestinal bleeding by comparison to planar imaging  alone and SPECT alone.  
 
Introduction  
The authors should indicate that gastrointestinal bleeding can be overt, ocult or obscure. The 
diagnostic approach depends on the clinical presentation. The use of capsule endoscopy is 
usually restricted to patients with obscure occult gastrointestinal ble eding. This should be stated 
with more détails.  
Please spell out all acronyms at first use  
Please use the same goal in the Intro and the Abstract  
 
Methods  
Please give gender distribution, mean age, SD and range  
Please avoid colloquial sentnece such as "F ive patients (5 scintigraphy examinations) were 
diagnosed by planar imaging (planar  group)." Please consider, "In five patients,  
Please state clearly what a "bleeding scintigraphy" is.  Please consider " Twenty patients who 
underwent a total of 21 scinti graphic examinations because of gastrointestinal bleeding     (give 
dates of inclusion)  were retrospectively included in the study. The bleeding site was identified 
by endoscopy (n = patients (give number of patients) or capsule endoscopy (n = give number  of 
patients) or no evidence of gastrointestinal bleeding was identified during the clinical course (n = 
give number of patients).  
Please change "The 21 scintigraphy images" for "The 21 scintigraphy examinations"  
Please change "The parameters were express ed as the mean ± SD." for "The quantitative 
variables were expressed as  mean ± standard deviation [SD] and add ranges .  
 
Results  
Please avoid the use of "exams" which is colloquial and use "examinations"  
Please consider using proportions x/y instead of  x of the y examinations and add corresponding 
percentages  
Please indicate the location of ulcer  
The terminal ileum is part of small bowel.  
 
Discussion  
Please do not use "case". Case is misleading. Use "patient" or "examination".  
Please rewrite "In the three groups (planar group, planar + SPECT group, planar + SPECT/CT 
group) examinations showed high degrees of  accuracy in detecting the presence of 
gastro intestinal bleeding"  
Please add the following limitation" A fourth limitation relates to the absence  of comparison 
with CT angiography that has demonstrated high degrees of accuracy for the diagnosis of active 
gastrointestinal bleeding and with CT -enteroclysis which has emonstrated high degrees of 
accuracy for the diagnosis of obscure gastrointestinal bl eeding." Add the following references  
Jaeckle T, Stuber G, Hoffmann MH, Jeltsch M, Schmitz BL, Aschoff AJ. Detection and 
localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi -
detector row helical CT. Eur Radiol 200 8;18(7):1406 -13. 
Shotar E, Soyer P, Barat M, Dautry R, Pocard M, Placé V, Camus M, Eveno C, Barret M, Dohan 
A.Diagnosis of acute overt gastrointestinal bleeding with CT -angiography: Comparison of the 
diagnostic performance of individual acquisition phases. Diagn Interv Ima ging 2017;98(12):857 -
863 
García -Blázquez V, Vicente -Bártulos A, Olavarria -Delgado A, Plana MN, van der Winden D, 
Zamora J; EBM -Connect Collaboration.Accuracy of CT angiography in the diagnosis of acute 
gastrointestinal bleeding: systematic review and meta -analysis.Eur Radiol 2013;23(5):1181 -90. 
Khalife S, Soyer P, Alatawi A, Vahedi K, Hamzi L, Dray X, Placé V, Marteau P, Boudiaf 
M.Obscure gastrointestinal bleeding: preliminary comparison of 64 -section CT enteroclysis with 
video capsule endoscopy. Eur Radi ol 2011;21(1):79 -86. 
 
Figures  
I suggest adding an illustrative patient.  
 
Table 2  
Please for typos (Rupture instead of rapture)  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received  reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?   
 
2. Do you hold any stocks or shares in an organisation that may in any way gai n or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salar y from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal . I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant