Comparison of Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography Values of Liver Metastases from Colorectal Cancer

Round 1

Reviewer 1 Report

The authors report two elastography methods in the detection of liver metastases from colorectal cancer. The study involves 31 adult patients and compares the differences between point shear wave elastography and two-dimensional shear wave elastography. Through the correlation analysis between metastasis density and demographic/clinical data, including age, BMI, tumor histology, and serum biomarkers, the study found that two-dimensional shear wave elastography correlated significantly with the patient’s age and serum biomarkers and showed positive associations of moderate magnitude. The noninvasive elastography imaging modality may be complementary to classic ultrasound scans and can potentially differentiate benign from malignant local liver cancers and determine types of liver metastases. There are several concerns in the manuscript. The authors need to address the following issues before the manuscript is accepted for publication in Gastroenterology Insights: 

1. The authors stated that colorectal cancer patients with lesion sizes under 2 cm were not included. How were the criteria defined, and whether all less than 2 cm sized lesions cannot be detected by elastography?
2. The authors may need to discuss when to use PET/CT (MRI), ultrasound, biopsy, or elastography to better diagnose and stratify patients.
3. The context format and abbreviations are messed up throughout the manuscript. There are too many unnecessary blanks between texts. The manuscript repeatedly defines abbreviations, such as pSWE and 2D-SWE, adenocarcinoma (MD-AC), and reference intervals. CRC was not defined at its first appearance but later.
4. The age range was 37 – 80 years old, but the 4.1 results section showed 30 – 80 years old. Please confirm.
5. BMI (0.278) is confusing. It should be BMI (p = 0.278).
6. AFRI was not defined. The reference format was not consistent and accurate.

The manuscript needs moderate editing of English language. 

Author Response

1. Lesions larger than 2 cm are included for more accurate measurement values
2. PET/CT, MRI, and liver biopsy are better for staging of malignant lesions.
3. Unnecessary blanks between texts-removed. The manuscript repeatedly defines abbreviations, such as pSWE and 2D-SWE, adenocarcinoma (MD-AC), and reference intervals-reduced their number. CRC was defined at its first appearance.
4. Confirm.
5. BMI p = 0.278
6. AFRI was defined.

Author Response File: Author Response.pdf

Reviewer 2 Report

This study compared point shear wave elastography and 2-dimensional shear wave elastography and found that they were equally effective in measuring the stiffness of liver metastases in patients diagnosed with colorectal cancer. The study is scientifically sound but the presentation needs improvement. See detailed comments in the attached pdf.

Comments for author File: Comments.pdf

Author Response

I applied the suggested changes by your side.

Author Response File: Author Response.pdf