Diagnostic Value of Radioisotope Cisternography Using ¹¹¹In-DTPA in a Patient with Rhinorrhea and Purulent Meningitis

Round 1

Reviewer 1 Report

Dear Authors,

please pay attention to the following questions and queries:

1. Line 40: please provide the whole term RIC before using that for the first time in the text.
2. Lines 52-57: please provide the normal range of the CSF measures or link them to the results presented in Table 1.
3. Line 68: please mention that you conducted a lumbar puncture to gain CSF for examination. Then provide the time point of the first lumbar puncture during the clinical course.
4. Line 69: please mention that the laboratory results were measured in whole blood/plasma or serum.
5. Table 1: how many days after admission and initiation of antibiotic therapy were measured the follow-up values mentioned in table 1?
6. Line 72: how many days after admission and initiation of antibiotic therapy did the mental state of the patient improve?
7. Line 100: please provide the whole term SPECT before using that for the first time in the text.

Best Regards

Author Response

Dear reviewer

Thank you for your comments.

We have updated the manuscript according to all your suggestions.

Please see the attachment.

Kind regards,

Authors

Author Response File: Author Response.docx

Reviewer 2 Report

The presented work is weak discussing the use of 111In-2 DTPA in a Patient with Rhinorrhea and Purulent Meningitis for  cisternography,

The main weak issues are:

1- More patients have to be assessed

2- Comparison with other imaging modalities is required for this clinical case. 

Author Response

Dear reviewer

1. It is a unique case report, not a paper dealing with a group of patients. We cannot provide a group of patients with all mentioned attributes (rhinorrhea, purulent meningitis, and RIC use).

2. Within the discussion paragraph, we have provided a comparison of several imaging modalities used to detect the origin of rhinorrhea. We have explained their advantages, as well as limitations.

If you have specific comparison suggestions please let us know, so we can incorporate them.

Kind regards

Authors

Reviewer 3 Report

This manuscript is an excellent written case report. I have some minor comments to consider:

Abstract: Line 40, write the full name for RIC.

Describe briefly why 99mTc-DTPA is chosen as a tracer for CSF leakage instead of 99mTc-pertechnetate.

Discussion section: lines 179-182: Is the backwash issue to be circumvented by aspiration of a volume of CSF equal to the injection volume? See https://pubmed.ncbi.nlm.nih.gov/32355870/ for an example of this methodology.

 

Author Response

Dear reviewer

Thank you for your comments.

1. As you have suggested, we have explained the abbreviation "RIC" in the main text.

2. We have updated the manuscript with a comparison of Tc DTPA and Tc pertechnetate

3. As to your question about the backwash phenomenon. We think it is not possible to completely circumvent the backwash phenomenon by prior aspiration of the same volume as the volume subsequently administered to the subarachnoid space. It seems to be linked mainly to the use of atraumatic needles, the needle's cone orientation, and the number of LP attempts.  

Hope it answered your question

Please see the attachment for all changes made.

Kind regards

Authors

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Dear Authors,

thank you for providing comprehensive and convincing answers to my questions and queries and made changes, which have contributed to the optimization of your manuscript and increased the publishing potential of your work.

Best Regards