Reviewer’s report
Title: 
Clinical and MRI features of sacral insufficiency fractures after
radiotherapy in patients with cervical cancer
Version: 
2 
Date: 
15 Nov 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
I had the pleasure to review the manuscript entitled "Clinical and MRI features
of sacral insufficiency fractures after radiotherapy in patients
with cervical cancer". Although I cannot recommend this manuscript for
publication, I would like to invite the authors to revise their manuscript
considering the following points:
Major points:
- "Coronal FS-T2WI may be more useful to detect and characterize these
fractures than other imaging sequences". This is not a novel finding. All
radiologists adhere to this practice in their routine daily practice. I am not sure if
your study provides any new information or novelty.
- Why no "fat saturation" was employed on T1 weighted images?
- You mentioned "The conclusive diagnostic criterion was based on radiologic
findings". However, the sensitivity of MRI is reportedly higher than CT and MR
should be considered as a reference standard for CT and radiographs. 
Minor points:
- There is no background information or description of the problem in the
abstract to support the study rationale. You have only mentioned the study
objectives in your abstract. I would add one or two sentences as the lead of the
abstract to provide an introduction to the main study topic, to highlight the gap in
knowledge and the motivation or rationale for the study for the abstract readers. 
- You found: 53.6% of patients (15/28) had concomitant pelvic fractures". This is
a really high number. Why the prevalence of concomitant fractures is so high in
your population with no history of trauma?
-Please define "BS Imaging" as "Bone Scintigraphy". All abbreviations should
be spelled out on the first mention with the acronym provided in parenthesis
afterward.
REQUESTED REVISIONS: 
As above
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes