Reviewer ’s report  
 
Title: Increased LDH5/LDH1 ratio in preoperative di agnosis of uterine sarcoma with 
inconclusive MRI and LDH total activity but suggestive CT s can: a case report  
 
Version: 0 Date: 17 May 2018  
 
Reviewer: Tomonori Nagai  
 
Reviewer's report:  
 
This paper is case report about preoperative diagnostic tool for suspicion of uterine sarcoma. 
Currently, preoperative  diagnosis for uterine sarcoma using imaging and hematological findings 
has not exhibited a high accuracy. Meanwhile, especially, it is very interesting that LDH5/LDH1 
ratio was useful for preoperative diagnosis of uterine sarcoma. But, I have some major c oncerns 
about this paper.  
 
 
 
1. How many times were measurements of LDH isoenzymes performed? If performed 
several times, did the respective results change?  
 
 
2. In case of uterine sarcoma, intratumoral hyperintense signal on T2 -weighted MRI images 
suggests hi gh cellular or high vascularity. In addition, hyperintense signal on T1 -
weighted is thought to indicate intratumoral hemorrhage and coagulative necrosis. In this 
report, there is no detailed description about MRI findings.  
 
 
3. On Figure 2, there is no macro scopic image of the tumor cut surface. Please add it.  
 
 
4. Though it is certain that CT findings were useful on this case, you should not disprove 
the availability of MRI findings as diagnostic tool for suspicion of uterine sarcoma.  
 
 
 
 
 
 
 
 
 
 
 
 
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, plea se specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 the manuscrip t or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written Eng lish 
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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1. Have you in the past five years received reimburseme nts, f ees, funding, or salary from an 
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3. Do you hold or are you currently applying for any patents  relating to the content of the 
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4. Have you received reimbursements, fees, funding, or salary 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?  
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below. If your reply is yes to any, please give details below.  
 
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