CT after Lung Microwave Ablation: Normal Findings and Evolution Patterns of Treated Lesions

Round 1

Reviewer 1 Report

This paper gives considerable details as to the imaging features of chest CT during all phases of follow up after lung microwave ablation. It's a well written and adequately documented manuscript.

1.The aim of this pictorial essay is to describe the CT features of lung lesions treated with MWA
2.Although the topic is not new, this pictorial essay offers a variety of good examples of common CT evolution of lung lesions treated with MWA. Therefore it can help Radiologists who are not fully confident with Ct-guided Interventional procedures to read such exams both in the acute phase and during follow-up.
3.I think the authors have addressed the main point i.e. to describe the CT features of MWA-treated lesion, their evolution and possible complications. 4.The bibliography is short but significant, as the cited authors are the main experts in the field.
5.The figures are various and of good quality. They well represent imaging features during follow up of lung lesions treated with percutaneous MWA, between immediately post procedural and after 6 months .

Author Response

Dear Editors and Reviewers,

 

We thank you for considering our manuscript for publication and for addressing us useful revision comments that would help us improve our work and reach the aim we set for it.

 

For clarity, we will answer to each comment individually.

 

Reviewer 2

While our intent was to give pictorial examples that would aid non specialist radiologist in this area, we agree that a more formal structured review based on a larger case series could be useful for future studies.

 

Reviewer 3

We willingly accepted and tried to fulfill every comment (optional, minor and major).

• P2, Imaging Follow-up L87-88: we added the explanation of the meaning of PET.
• P1, Introduction L60-63: we explained the ‘heat-sink effect’ and its impact on ablation procedures.
• P1-2-3-4-5 We added more references to all sections of the manuscript, with special attention to the lines requested by the reviewer.
• P1, Introduction L54-55: we clarified for how long MWA has been used.
• P1, Introduction L80: we deleted the repetition of the explanation of the term CT.
• P2, Imaging Follow-up L93-95: the protocol we propose is used in most centers with one main difference that we have pointed out.
• P5, Early complications, L184-189: we added statistical values for each one of the mentioned complications.
• P3, Residual or Recurrent Disease, L175-176: we already clarified that between 1 and 6 months a further decrease in size of the consolidation is expected in L168-170.
• P3-4-5: we mentioned figures in the text.
• The aim of our pictorial essay is to give useful imaging examples that would aid radiologist not confident with the argument to interpret such findings and differentiate normal evolution patterns from features of recurrent disease and complications that have a similar CT appearance. As advised, we elaborated a table that summarize the main findings and therefore could be used as a tool for radiologist in every-day clinical practice.
• We added a small conclusion section, to clarify the utility of the pictorial essay.

 

Reviewer 4

• We provided the details of our CT scanner and the protocol of acquisition used.
• Since the manuscript is a pictorial essay, we did not structured our paper as a population study and no statistical analysis was performed, therefore we did not provide number and characteristics of patients. However, we are currently collecting our patient data with detailed clinical and histological characteristics for a future prospective study on effectiveness and safety of this procedure in lung tumours.
• We apologize for the misuse of the term “progression”, that we deleted from the introduction; in fact we only intended to talk about CT findings of recurrent disease, that we explained in the specific paragraph.
• We included figures numbers in the text and added arrows to help the reader interpreting them.

We hope that our answers and corrections are satisfactory. We are extremely grateful for the opportunity to improve our manuscript and reach as many readers as possible.

 

Best regards,

The authors

Reviewer 2 Report

Thank you for your description of a relatively new technique for treating advanced lung malignancy, illustrated by seven cases.

This offers an interesting insight into the technique  for non specialist doctors in this area such as I. I am uncertain as to whether those who use this therapy regularly will find case examples meet their requirements. I wonder if a more formal structured review using a larger case series would be more effective in this regard? 

I have no suggestions for changing the present paper which itself is informative and we'll written and illustrated.

Author Response

While our intent was to give pictorial examples that would aid non specialist radiologist in this area, we agree that a more formal structured review based on a larger case series could be useful for future studies.

Reviewer 3 Report

Comments to the Author

Title: CT after Lung Microwave Ablation: Normal Findings and Evolution Patterns of Treated Lesions.

Authors: Valentina Vespro, Maria Carmela Andrisani, Anna Maria Ierardi, Maria Chiara Bonanno, Alice Phillips, Davide Tosi, Paolo Mendogni, Sara Franzi, and Gianpaolo Carrafiello

 The authors claim that “The aim of this pictorial essay is to describe the typical CT features during follow-up of lung lesions treated with percutaneous MWA and how to interpret and differentiate them from other radiological findings that are commonly encountered in this setting”. However, I don’t feel they have addressed this. Thus, I would not consider the publication of the manuscript in the present form.

Substantial changes need to be done.

 

General: The manuscript presented is well written and clear.

In the following: MA=Major comment, MI = Minor comment, OP = Optional Comment

(OP) P1, Abstract: The authors explain the meaning of FWHM but not the one for PET. The authors should explain all (or none) of the abbreviations used in the abstract.

(MI) P1, Introduction, L44-45: Add reference supporting this statement.

(OP) P2, Introduction, L59: It would be beneficial for the reader’s understanding to include a couple of sentences explaining what the ‘heat-sink effect’ is and how it affects lung cancer patients.

(OP) P2, Introduction, L60-61: What does it mean new technique? It would be relevant to include for how long physicians have been using this technique.

(MI) P2, Introduction, L77-78: Just use CT, the meaning has been already explained in the manuscript.

(MI) P2, Imaging follow-up, L82-85: Is this exclusive for your institution or do others use the same methodology. Please clarify and in case, there are differences, mention them.

(MI) P3, Normal Imaging Features, L100-103: Add references.

(MI) P3, Normal Imaging Features, L104-125: Relevant information is included in this paragraph however, there are no references. The authors should add references as well as statistical data of the occurrence of the mentioned complications.

(MI) P3, Normal Imaging Features, L126-141: Same comment as before.

(MI) P3, Residual or Recurrent Disease, L147-150: Are any changes expected between 1 and 6 months?

(MI) P5, Early complications, L157-160: It would be interesting to see statistical values for each one of the mentioned complications.

(MA) Figures are not mentioned in the text so no explanation is provided, therefore any conclusion can be extracted.

(MA) It is not clear for me which method are the authors proposing. On the abstract the authors claim that “The aim of this pictorial essay is to describe the typical CT features during follow-up of lung lesions treated with percutaneous MWA and how to interpret and differentiate them from other radiological findings that are commonly encountered in this setting”. However, I don’t feel they have addressed this.

One option is to summarize the findings reported in the figures in a table and comment/explain their implications.

(MA) A discussion section is needed summarizing the finding and the contribution of the author in the field as well as the utility of the manuscript for the scientific community.

Author Response

We willingly accepted and tried to fulfill every comment (optional, minor and major).

• P2, Imaging Follow-up L87-88: we added the explanation of the meaning of PET.
• P1, Introduction L60-63: we explained the ‘heat-sink effect’ and its impact on ablation procedures.
• P1-2-3-4-5 We added more references to all sections of the manuscript, with special attention to the lines requested by the reviewer.
• P1, Introduction L54-55: we clarified for how long MWA has been used.
• P1, Introduction L80: we deleted the repetition of the explanation of the term CT.
• P2, Imaging Follow-up L93-95: the protocol we propose is used in most centers with one main difference that we have pointed out.
• P5, Early complications, L184-189: we added statistical values for each one of the mentioned complications.
• P3, Residual or Recurrent Disease, L175-176: we already clarified that between 1 and 6 months a further decrease in size of the consolidation is expected in L168-170.
• P3-4-5: we mentioned figures in the text.
• The aim of our pictorial essay is to give useful imaging examples that would aid radiologist not confident with the argument to interpret such findings and differentiate normal evolution patterns from features of recurrent disease and complications that have a similar CT appearance. As advised, we elaborated a table that summarize the main findings and therefore could be used as a tool for radiologist in every-day clinical practice.

We added a small conclusion section, to clarify the utility of the pictorial essay. 

Reviewer 4 Report

Revision of the essay : “CT after Lung Microwave Ablation: Normal Findings and Evolution Patterns of Treated Lesions”.

The paper describes the application of computer tomography (CT) to monitor a follow-up of MWA-treated lesions, allowing it’s classification in recurrence, progression or complications.

I consider that essay is interesting for the scientific community and I would recommend its publication in the Journal Tomography after the major revisions.

 

Major consideration.

Please provide more details about the technique Computed tomography (CT).

Please clarify the number of patients and characteristics of the patients in this study.

Please indicate the percentages of patients with recurrence, progression or complications based CT analysis .  

In the paper is mentioned “progression”, but no description is done. Can you please indicate how do you classify a patient in progression stage using CT.

Please include in the text, the figures number to help the reader.

Figures, to help the reader please include some arrow and other symbols indicating for instance the local of lesion, the site of ablation etc....

Author Response

• We provided the details of our CT scanner and the protocol of acquisition used.
• Since the manuscript is a pictorial essay, we did not structured our paper as a population study and no statistical analysis was performed, therefore we did not provide number and characteristics of patients. However, we are currently collecting our patient data with detailed clinical and histological characteristics for a future prospective study on effectiveness and safety of this procedure in lung tumours.
• We apologize for the misuse of the term “progression”, that we deleted from the introduction; in fact we only intended to talk about CT findings of recurrent disease, that we explained in the specific paragraph.

We included figures numbers in the text and added arrows to help the reader interpreting them.

Round 2

Reviewer 3 Report

Dear authors,

Thank you for considering my comments and for your detailed response.

I believe you have improved the quality and soundness of the manuscript thus, I would endorse its publication.

Reviewer 4 Report

The authors reply to the comments, improving the article and making it easier to be followed by the readers.

I consider that the article is ready to be published.