Intravesical Contrast-Enhanced MRI: A Potential Tool for Bladder Cancer Surveillance and Staging

Round 1

Reviewer 1 Report

There is only one comment.

The figures in a manuscript  have the role to support  the text, helping the reader to understand better what the author(s) intended to communicate.

In this respect, the Figure Legends should not be so long and and exhaustive.

Figure legend should be short and concise.

All explanations you placed in the Figure Legends should be transferred in the text where they belong, having at the end, in round brackets, the number of the figure they are referring to - ie, xxldfewis  afjdsșfg (Fig.1).

Author Response

We thank the reviewer for comment and legends have been shortened in revised manuscript.

Reviewer 2 Report

The authors promoted and proposed a new and low-cost radiological approach for BC staging and surveillance. The manuscript needs a revision before consideration for publication:

 

• In the introduction, references are needed when presenting all economic and epidemiological data.
• At the end of the introduction, you should present the aim of the manuscript.
• You already traded the cost of care in the management of BC at the beginning of the introduction and in a dedicated paragraph. Please do not be redundant. 
• Please include also novel and futuristic new tools for managing BC such as Micro-ultrasound (MUS) which is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. A recent article has been published on the topic and I believe it is worthy of consideration to include in your manuscript in order to provide guidance on future imaging prospects. Please include it (DOI: 10.3390/medicina58111624).
• What about the timing to perform ICE-MRI?
• What do you think about VIRADS? Please include it in your discussion focusing on differences and similarities.
• Check typos 

 

Author Response

Reviewer 2 : The authors promoted and proposed a new and low-cost radiological approach for BC staging and surveillance. The manuscript needs a revision before consideration for publication:

• In the introduction, references are needed when presenting all economic and epidemiological data.

Response: We thank the reviewer for the comment and we have now cited references for economic and epidemiological data

 

• At the end of the introduction, you should present the aim of the manuscript.

 Response: We thank the reviewer for comment and we have now added aim of the manuscript in reorganized introduction.

• You already traded the cost of care in the management of BC at the beginning of the introduction and in a dedicated paragraph. Please do not be redundant. 

Response: We thank the reviewer for comment and we have now removed the redundancy in the manuscript about cost of care.

•  
• Please include also novel and futuristic new tools for managing BC such as Micro-ultrasound (MUS) which is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. A recent article has been published on the topic and I believe it is worthy of consideration to include in your manuscript in order to provide guidance on future imaging prospects. Please include it (DOI: 10.3390/medicina58111624).

 

Response: We thank the reviewer for comment and we have now reviewed a bladder cancer study using  Micro-ultrasound in the revised manuscript.

• What about the timing to perform ICE-MRI?

Response: We thank the reviewer for the comment and the total scan time of 30min is now added.

• What do you think about VIRADS? Please include it in your discussion focusing on differences and similarities.

Response: Thank you for bringing up the point of VIRADS and figure 3 of the review conforms to the consensus view of VIRADS on unenhanced T2 weighted MRI underestimating the bladder wall thickness than unenhanced T1 weighted MRI. As described in section 2.3, VIRADS recommends dynamic contrast enhanced MRI (DCE-MRI) is dramatically superior to CT (Fig.2B) by 30-40% in preoperative tumor staging of BCa but the window of opportunity for uniform contrast in lumen with DCE-MRI is shorter than with ICE-MRI. Both DCE-MRI and ICE-MRI similar in the sense that contrast enhancement is a function of GBCA concentration delivered to the tumor via arterial perfusion and urothelial diffusion, respectively. However, the rapid washout of injected GBCA leads to transient enhancement of tumor (<3min) and continuous accumulation of injected GBCA in urine rapidly reduces the image contrast between the lumen and bladder wall owing to pseduolayering which leaves a rapidly closing window for bladder tumor imaging by DCE-MRI. In contrast, ICE-MRI extends the time available for imaging blader for much longer than 3min.

 

 Check typos 

Response: Thank you, we have double checked the typos.

Round 2

Reviewer 2 Report

The revised version is worthy of publication. The manuscript has been improved in the highlighted weak points.