Evaluating the Quality of Optimal MRCP Image Using RT-2D-Compressed SENSE(CS)Turbo Spin Echo: Comparing Respiratory Triggering(RT)-2D-SENSE Turbo Spin Echo and Breath Hold-2D-Single-Shot Turbo Spin Echo
Round 1
Reviewer 1 Report
The authors have presented the article and the research topic is of high interest to a broad range of readers and researchers who work in magnetic resonance cholangiopancreatography.
The evaluation and comparison of the two methods are good.
From a reviewer's point of view, the article can be accepted after a few minor revisions.
Comments:
1) Title: The current title used is in a precise manner to explain the concept of the article, but it would be better if the authors consider not using abbreviations and try to highlight the work with easier phrasing so that the researchers new to the field and other general readers can understand the content of the title.
2) At the beginning of the introduction, replace MR cholangiopancreatography (MRCP) with "Magnetic resonance cholangiopancreatography (MRCP)".
3) in line 45, mention, "Mention in brackets that k-space is the 2D or 3D Fourier transform of the image"
4) In section 2.3, the second paragraph explaining the analysis method will be difficult to follow for new readers. The authors should consider simplifying the sentences and to explain what duck sharpness is.
5) Results, Page 7, lines 205 to 213. The sudden mention of "a, b MIP images.." are the authors talking about the MIP images used in Fig.3 (a), (b), and (c)? If so, start the sentence by saying to describe which images the authors are explaining.
6) Results, Page 8, 245 to 247, the images mentioned as (a,b) should be addressed to which figures the authors are explaining. Also,
7) When the authors explain about a certain region or area of the image, that respective place in the images should be highlighted, for instance using rectangular or circle areas. For example, When explaining about Fig.4, at line 245, "ring-shape duck in the liver area", this should be shown as a Highlight in the Images, and also authors should mention about the highlight in the explanation text.
Author Response
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Reviewer 2 Report
This article “Evaluating the Quality of Optimal MRCP Image Using RT-2D-Compressed SENSE(CS)TSE: Comparing RT-2D-SENSE TSE and BH-2D-SSh TSE” can be recommended for publication in tomography after minor corrections. Please address the following comments and follow the modifications.
(1) Please describe the advantages (e.g. cost competent, time competent and rate of accuracy) of MRCP compare to the other imaging techniques.
(2) Is there any effect of patients health history/condition in image quality? If so, please elaborate.
(3) Please make statistical plots for table 2, 3, 4 and 5 for better understanding.
(3) In line 36: spell ‘MRCP’.
(4) In line 40: ‘MRI’ spell it.
(5) Line 108: spell ‘CHDD’, ‘LC’, and ‘IPMN’.
(6) Line 109: change ‘ten’ into ‘10’ and follow the same format.
Author Response
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Reviewer 3 Report
This study would benefit from a sharpening of the discussion and in the conclusion, a direct recommendation for the optimal MRCP should be provided, for patients in a good or bad condition. It would furthermore benefit from images showing examples of the introduced 5-point-scale.
Additional comments:
Line 14: either male and female or men and women
Line 17: delete “were used”
Line 19: Title vs. line 19 – please clarify how many sequences you compare
Line 29-30: Delete or explain “unlike previous studies”
Line 37: MRI in general has complications independent from contrast medium, as do the other techniques – please rewrite
Line 47: please add a citation to the sentence
Line 49: please add more details on the image b or cite it
Line 63: please add more details on the image b or cite it
Line 92: “previous examined” – please clarify
Line 100 – 105: please sharpen the hypothesis
Line 108 – 109: introduce the abbreviations
Line 110: Add details on the MRI used and add the range of the age distribution
Line: 111: post-processing with Philips software? Please clarify
Line 144 etc.: Sharpness of duck?
Line 221 – 222: sentence not correct, has to be rewritten
Line 223: “can be used by most people” – Who is meant here?
Analysis methods: - Is it a Likert-Scale published before or newly introduced in this study?
Author Response
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Reviewer 4 Report
Please declare the abbreviations at first usage since the reader will be from different backgrounds and it will cause a loss of interest. The discussion section should be including a comparison of the recent study with previous ones. Also, the patient cohort is pretty small which is concerning for the declaration of strong outcomes. Additionally, the limitations section should be extended and carefully revised.
Author Response
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Reviewer 5 Report
Without any doubt, the content of this paper is clinically relevant and important. However regarding the staitsitcs some improvements seem to be necessary.
- Equations 1 and 2: I think a literature reference would be appropriate.
- Age: The standard deviation is given with 2 decimal places, the mean value with none. I think 1 decimal place for standard deviation and for the mean value is appropriate.
- Statistical analysis: Kruskal Wallis test is used for the analysis of ordinal scaled data (i.e. grading of sharpness). The terminology "qualitative analysis" is misleading.
- In Chapter 2.4, Cohen's Kappa is mentioned in order to check the degree of agreement between two observers. However, in Chapter 3 (Results) no Kappa value can be found.
- Please comment the sample sizes (10 volunteers, 20 patients).
- Regarding ANOVA and Kruskal-Wallis test: SNR- and CNR-values of 3 sequences have been obtained from each volunteer or from each patient. Therefore, ANOVAs for repeated measurements would be useful. Instead of a Kruskal Wallis test, Friedman test should be used as an alternative in order to compare depenedent samples (i.e. regarding sharpness of duct). It would be senseful to give a p value for each location.
- Chapter 3.1, 3rd line: TSE (inbstead of TSH). Regarding the comparisons (BH-2D-SSh TSE < RT-2D SENSE TSE < RT-2D-CS TSE): Is really each of these comparisons statistcally significant in each location? If not, you should be careful with this presentation.
- Table 2: For SNR and CNR, MRI sequences in 6 different locations have been compared. However, at the end of table 2 only 1 p value is given (for SNR or for CNR).
- Wouldn't it be useful to compare the loacations with each other.
- Table 4: Scoring values range from 1 point to 5 points. For ordinal data, mean and standard deviations are not appropriate. Use medians and ranges instead.
- Page 7, top: "Post hoc results .... showed that the sharpness of duct ... was not significantly different in RT-2D-CS TSE and RT-2D-SENSE TSE. Looking at the mean values (4.13 and 4.76) this seems to be reasonable. Howver, why is each of the comparisons in table 5 statistically significant?
- Page 7, top: "Image quality was significantly different in the other two techniques." What exactly is compared here?
- Table 5: Does this table refer to table 4? What does "Std. Test Statistic" mean?
Author Response
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Round 2
Reviewer 3 Report
The authors improved the quality of the paper in their revision. My concern is foremost the discussions, which needs additional revision: Removal of referring to images in the discussion, as well as presentation of results. This should also shorten and sharpen the discussion.
Small additional corrections:
Line 47: blank space before the bracket, small “t”
Line 111: The sentence needs revision - not the study itself obtained images, also the conditional should not be used here
Added statistical plots: please introduce the abbreviations
Line: 311: "dilatated" needs to be changed to “dilated”
Line 332: mix up of tenses
Author Response
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Reviewer 5 Report
Just one comment: The ranksum test for pepeated measurements is called Friedman test (not Frideman test). Please correct this.
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