Review for 10.1186/s12876-022-02129-9 (2022)

Title: Prognostic Role of Multiparameter MRI and radiomics in Progression of
Advanced Unresectable Hepatocellular Carcinoma Following Combined Transcatheter Arterial
Chemoembolization and Lenvatinib Therapy
Version: 2 Date: 30 Nov 2021
Reviewer's report:
SPECIFIC COMMENTS
This manuscript is pleasurable and flowing, in general; no major issues are appreciable.
Although language used is appropriate (I have noted that a certified native speaker with
proficiencies in the scientific-medical field was attached. However, I recommend to Editorial
staff to check the final version because I am not a native English speaker.
TITLE
The title is not so clear and direct. Personally, I believe it could be improved, for
example: “Prognostic Role of Multiparameter MRI and radiomics in Progression of
Advanced Unresectable Hepatocellular Carcinoma Following Combined Transcatheter Arterial
Chemoembolization and Lenvatinib Therapy”. I suggest removing the last sentence. If the editor
agrees, the authors could consider the change of the title.
ABSTRACT
The abstract is well structured in all its section, but it does not properly reflect the main text, not
highlighting the most important aspects of this paper. Therefore, some adjustments are needed.
For example: Which MRI parameters the authors analyzed? Which kind of radiomic features
did they analyse?
KEYWORDS
Authors did not reported keywords. Please, add KWs, possibly from MeSH Browser.
INTRODUCTION
Although the introduction fits the context of the study, it could be improved. In fact, many
concepts clearly explicated in an exhaustive introduction could help readers to become
passionate about reading the paper and using it as a reference.
In my opinion, the introduction should be expanded with comments on the different
types of transarterial chemoembolization. In particular, it is demonstrated that there is
a non-superiority of transarterial chemoembolization with respect to bland embolization
in hepatocarcinoma patients [United European Gastroenterol J. 2017;5(4):511-518.
doi:10.1177/2050640616673516]. Please, could the Authors cite this article and discuss here (or
in Materials and Methods or in Discussion) answering the reason why they used conventional
TACE.
Furthermore, the Authors referred to MRI without specifying the type of contrast media. In
fact, there are many diagnostic improvements using Gd-EOB-DTPA MRI, as reported in other
published paper such as J Gastroenterol Hepatol. 2016 Jan;31(1):69-80. doi: 10.1111/jgh.13150.
PMID: 26312574. Please, could the Author fix this point and cite this article?
MATERIALS & METHODS
It is mandatory to report informations regard the MRI evaluation.
It is well known that the decision on whether a HCC patient is a responder or progressor
after treatment may vary among different radiologists, especially in case of a non-specifically
trained radiologist and, therefore, regardless of the adopted criteria, patients should be
evaluated by experienced radiologists to minimize variability in this critical instance [Eur
Radiol. 2018;28(9):3611-3620. doi:10.1007/s00330-018-5393-3]. Please, could the Authors
report the methodology used (one or more experienced radiologist evaluated MRI?) citing the
aforementioned paper [Eur Radiol. 2018;28(9):3611-3620. doi:10.1007/s00330-018-5393-3].
Moreover, the author stated that: “Final decisions were made based on consensus in cases of
discord”. What does it mean? How the authors reach the final decision?
However, the usefulness of the results of this paper is the possibility to be introduced in the
clinical practice and therefore it is essential to report the type of chemo-embolization that has
been performed by the Authors. In particular, according to [Ann Hepatol. 2021;22:100278.
doi:10.1016/j.aohep.2020.10.006], what kind of chemo-embolization was performed? Water-in-
oil (Wio) or chemotherapeutic-in-oil (Cio)? Furthermore, during the execution of the procedures
did the authors consider accurately the amount of absorbed radiant dose? In my opinion a
correct standardization of the procedures it is also possible to reduce the number of rays
absorbed for both patients and radiologists and reduce possible stochastic effects [Med Phys.
2012 May;39(5):2491-8. doi: 10.1118/1.3702457. PMID: 22559619.]. in my opinion, this theme
could be briefly analyzed in this section but, most of all, in the discussion section.
RESULTS
Results remain not so clear and could be better structured. therefore, and further adjustments are
needed to understand the main text without tables.
DISCUSSION
Could the authors discuss if the low hyperenhancement of HCC is a marker of poor prognosis
also because the TACE efficacy was low in hypovascular lesions?
TABLES & FIGURES
Tables & Figures are satisfactory, and they correctly match the quality standard of this Journal