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Remy-Jardin M, Guiffault L, Oufriche I, Duhamel A, Flohr T, Schmidt B, Remy J. Image quality of lung perfusion with photon-counting-detector CT: comparison with dual-source, dual-energy CT. Eur Radiol 2024:10.1007/s00330-024-10888-0. [PMID: 38967660 DOI: 10.1007/s00330-024-10888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE To evaluate the quality of lung perfusion imaging obtained with photon-counting-detector CT (PCD-CT) in comparison with dual-source, dual-energy CT (DECT). METHODS Seventy-one consecutive patients scanned with PCD-CT were compared to a paired population scanned with dual-energy on a 3rd-generation DS-CT scanner using (a) for DS-CT (Group 1): collimation: 64 × 0.6 × 2 mm; pitch: 0.55; (b) for PCD-CT (Group 2): collimation: 144 × 0.4 mm; pitch: 1.5; single-source acquisition. The injection protocol was similar in both groups with the reconstruction of perfusion images by subtraction of high- and low-energy virtual monoenergetic images. RESULTS Compared to Group 1, Group 2 examinations showed: (a) a shorter duration of data acquisition (0.93 ± 0.1 s vs 3.98 ± 0.35 s; p < 0.0001); (b) a significantly lower dose-length-product (172.6 ± 55.14 vs 339.4 ± 75.64 mGy·cm; p < 0.0001); and (c) a higher level of objective noise (p < 0.0001) on mediastinal images. On perfusion images: (a) the mean level of attenuation did not differ (p = 0.05) with less subjective image noise in Group 2 (p = 0.049); (b) the distribution of scores of fissure visualization differed between the 2 groups (p < 0.0001) with a higher proportion of fissures sharply delineated in Group 2 (n = 60; 84.5% vs n = 26; 26.6%); (c) the rating of cardiac motion artifacts differed between the 2 groups (p < 0.0001) with a predominance of examinations rated with mild artifacts in Group 2 (n = 69; 97.2%) while the most Group 1 examinations showed moderate artifacts (n = 52; 73.2%). CONCLUSION PCD-CT acquisitions provided similar morphologic image quality and superior perfusion imaging at lower radiation doses. CLINICAL RELEVANCE STATEMENT The improvement in the overall quality of perfusion images at lower radiation doses opens the door for wider applications of lung perfusion imaging in clinical practice. KEY POINTS The speed of data acquisition with PCD-CT accounts for mild motion artifacts. Sharply delineated fissures are depicted on PCD-CT perfusion images. High-quality perfusion imaging was obtained with a 52% dose reduction.
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Affiliation(s)
- Martine Remy-Jardin
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France.
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, LILLE, France.
- IMALLIANCE-Haut-de-France, Valenciennes, France.
| | - Lucas Guiffault
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
| | - Idir Oufriche
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
| | - Alain Duhamel
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, LILLE, France
- Department of Biostatistics, University of Lille, CHU Lille, LILLE, France
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Bernhard Schmidt
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Jacques Remy
- Department of Thoracic Imaging, University Hospital Center of Lille, LILLE, France
- Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France
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Pannenbecker P, Heidenreich JF, Huflage H, Gruschwitz P, Patzer TS, Weng AM, Grunz JP, Kunz AS, Bley TA, Petritsch B. The Best of Both Worlds: Ultra-high-pitch Pulmonary Angiography with Free-Breathing Technique by Means of Photon-Counting Detector CT for Diagnosis of Acute Pulmonary Embolism. Acad Radiol 2024:S1076-6332(24)00386-6. [PMID: 38969575 DOI: 10.1016/j.acra.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
RATIONALE AND OBJECTIVES To assess image quality and radiation dose of ultra-high-pitch CT pulmonary angiography (CTPA) with free-breathing technique for diagnosis of pulmonary embolism using a photon-counting detector (PCD) CT compared to matched energy-integrating detector (EID)-based single-energy CTPA. MATERIALS AND METHODS Fifty-one PCD-CTPAs were prospectively compared to 51 CTPAs on a third-generation dual-source EID-CT. CTPAs were acquired with an ultra-high-pitch protocol with free-breathing technique (40 mL contrast medium, pitch 3.2) at 140 kV (PCD) and 70-100 kV (EID). Iodine maps were reconstructed from spectral PCD-CTPAs. Image quality of CTPAs and iodine maps was assessed independently by three radiologists. Additionally, CT attenuation numbers within pulmonary arteries as well as signal-to-noise and contrast-to-noise ratios (SNR, CNR) were compared. Administered radiation dose was compared. RESULTS CT attenuation was higher in the PCD-group (all P < 0.05). CNR and SNR were higher in lobar pulmonary arteries in PCD-CTPAs (P < 0.05), whereas no difference was ascertained within the pulmonary trunk (P > 0.05). Image quality of PCD-CTPA was rated best by all readers (excellent/good image quality in 96.1% of PCD-CTPAs vs. 50.9% of EID-CTPAs). PCD-CT produced no non-diagnostic scans vs. three non-diagnostic (5.9%) EID-CTPAs. Radiation dose was lower with PCD-CT than with EID-CT (effective dose 1.33 ± 0.47 vs. 1.80 ± 0.82 mSv; all P < 0.05). CONCLUSION Ultra-high-pitch CTPA with free-breathing technique with PCD-CT allows for superior image quality with significantly reduced radiation dose and full spectral information. With the ultra-high pitch, only PCD-CTPA enables reconstruction of iodine maps containing additional functional information.
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Affiliation(s)
- Pauline Pannenbecker
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.).
| | - Julius F Heidenreich
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Henner Huflage
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Philipp Gruschwitz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Theresa S Patzer
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas M Weng
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Jan-Peter Grunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Andreas S Kunz
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Thorsten A Bley
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.)
| | - Bernhard Petritsch
- University Hospital Würzburg, Department of Diagnostic and Interventional Radiology, Würzburg, Germany (P.P., J.F.H., H.H., P.G., T.S.P., A.M.W., J.P.G., A.S.K., T.A.B., B.P.); Hospital Klagenfurt am Wörthersee, Department of Diagnostic and Interventional Radiology, Klagenfurt am Wörthersee, Austria (B.P.)
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Grunz JP, Huflage H. Photon-Counting Computed Tomography: Experience in Musculoskeletal Imaging. Korean J Radiol 2024; 25:662-672. [PMID: 38942460 PMCID: PMC11214923 DOI: 10.3348/kjr.2024.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 06/30/2024] Open
Abstract
Since the emergence of the first photon-counting computed tomography (PCCT) system in late 2021, its advantages and a wide range of applications in all fields of radiology have been demonstrated. Compared to standard energy-integrating detector-CT, PCCT allows for superior geometric dose efficiency in every examination. While this aspect by itself is groundbreaking, the advantages do not stop there. PCCT facilitates an unprecedented combination of ultra-high-resolution imaging without dose penalty or field-of-view restrictions, detector-based elimination of electronic noise, and ubiquitous multi-energy spectral information. Considering the high demands of orthopedic imaging for the visualization of minuscule details while simultaneously covering large portions of skeletal and soft tissue anatomy, no subspecialty may benefit more from this novel detector technology than musculoskeletal radiology. Deeply rooted in experimental and clinical research, this review article aims to provide an introduction to the cosmos of PCCT, explain its technical basics, and highlight the most promising applications for patient care, while also mentioning current limitations that need to be overcome.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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de Jong CMM, Kroft LJM, van Mens TE, Huisman MV, Stöger JL, Klok FA. Modern imaging of acute pulmonary embolism. Thromb Res 2024; 238:105-116. [PMID: 38703584 DOI: 10.1016/j.thromres.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
The first-choice imaging test for visualization of thromboemboli in the pulmonary vasculature in patients with suspected acute pulmonary embolism (PE) is multidetector computed tomography pulmonary angiography (CTPA) - a readily available and widely used imaging technique. Through technological advancements over the past years, alternative imaging techniques for the diagnosis of PE have become available, whilst others are still under investigation. In particular, the evolution of artificial intelligence (AI) is expected to enable further innovation in diagnostic management of PE. In this narrative review, current CTPA techniques and the emerging technology photon-counting CT (PCCT), as well as other modern imaging techniques of acute PE are discussed, including CTPA with iodine maps based on subtraction or dual-energy acquisition, single-photon emission CT (SPECT), magnetic resonance angiography (MRA), and magnetic resonance direct thrombus imaging (MRDTI). Furthermore, potential applications of AI are discussed.
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Affiliation(s)
- C M M de Jong
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - L J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - T E van Mens
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J L Stöger
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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Haag F, Emmrich SS, Hertel A, Rink JS, Nörenberg D, Schoenberg SO, Froelich MF. Virtual Non-Contrast versus True Native in Photon-Counting CT: Stability of Density of Upper Abdominal Organs and Vessels. Diagnostics (Basel) 2024; 14:1130. [PMID: 38893656 PMCID: PMC11171968 DOI: 10.3390/diagnostics14111130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The clinical use of photon-counting CT (PCCT) allows for the generation of virtual non-contrast (VNC) series from contrast-enhanced images. In routine clinical practice, specific issues such as ruling out acute bleeding require non-contrast images. The aim of this study is to evaluate the use of PCCT-derived VNC reconstructions in abdominal imaging. PCCT scans of 17 patients including early arterial, portal venous and native sequences were enrolled. VNC reconstructions have been calculated. In every sequence and VNC reconstruction, 10 ROIs were measured (portal vein, descending aorta, inferior vena cava, liver parenchyma, spleen parenchyma, erector spinae muscle, subcutaneous adipose tissue, first lumbar vertebral body, air, and psoas muscle) and density values were compared. The VNC reconstructions show significant changes in density compared to the contrast-enhanced images. However, there were no significant differences present between the true non-contrast (TNC) and any VNC reconstructions in the observed organs and vessels. Significant differences (p < 0.05) between the measured mean density values in the TNC versus VNC reconstructions were found in fat and bone tissue. The PCCT-derived VNC reconstructions seemed to be comparable to the TNC images, despite some deviations shown in the adipose tissue and bone structures. However, the further benefits in terms of specific clinical issues need to be evaluated.
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Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
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Cau R, Saba L, Balestrieri A, Meloni A, Mannelli L, La Grutta L, Bossone E, Mantini C, Politi C, Suri JS, Cavaliere C, Punzo B, Maffei E, Cademartiri F. Photon-Counting Computed Tomography in Atherosclerotic Plaque Characterization. Diagnostics (Basel) 2024; 14:1065. [PMID: 38893593 PMCID: PMC11172199 DOI: 10.3390/diagnostics14111065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Atherosclerotic plaque buildup in the coronary and carotid arteries is pivotal in the onset of acute myocardial infarctions or cerebrovascular events, leading to heightened levels of illness and death. Atherosclerosis is a complex and multistep disease, beginning with the deposition of low-density lipoproteins in the arterial intima and culminating in plaque rupture. Modern technology favors non-invasive imaging techniques to assess atherosclerotic plaque and offer insights beyond mere artery stenosis. Among these, computed tomography stands out for its widespread clinical adoption and is prized for its speed and accessibility. Nonetheless, some limitations persist. The introduction of photon-counting computed tomography (PCCT), with its multi-energy capabilities, enhanced spatial resolution, and superior soft tissue contrast with minimal electronic noise, brings significant advantages to carotid and coronary artery imaging, enabling a more comprehensive examination of atherosclerotic plaque composition. This narrative review aims to provide a comprehensive overview of the main concepts related to PCCT. Additionally, we aim to explore the existing literature on the clinical application of PCCT in assessing atherosclerotic plaque. Finally, we will examine the advantages and limitations of this recently introduced technology.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari-Polo di Monserrato, S.S. 554, 09045 Monserrato, Italy; (R.C.); (A.B.); (C.P.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari-Polo di Monserrato, S.S. 554, 09045 Monserrato, Italy; (R.C.); (A.B.); (C.P.)
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari-Polo di Monserrato, S.S. 554, 09045 Monserrato, Italy; (R.C.); (A.B.); (C.P.)
| | - Antonella Meloni
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy; (A.M.); (F.C.)
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Lorenzo Mannelli
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy; (L.M.); (C.C.); (B.P.); (E.M.)
| | - Ludovico La Grutta
- Department of Radiology, University Hospital “P. Giaccone”, 90127 Palermo, Italy;
| | - Eduardo Bossone
- Cardiology Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University, 66100 Chieti, Italy;
| | - Carola Politi
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari-Polo di Monserrato, S.S. 554, 09045 Monserrato, Italy; (R.C.); (A.B.); (C.P.)
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA;
| | - Carlo Cavaliere
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy; (L.M.); (C.C.); (B.P.); (E.M.)
| | - Bruna Punzo
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy; (L.M.); (C.C.); (B.P.); (E.M.)
| | - Erica Maffei
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy; (L.M.); (C.C.); (B.P.); (E.M.)
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy; (A.M.); (F.C.)
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Makowska A, Treumann T, Venturini S, Christ M. Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners. J Clin Med 2024; 13:2863. [PMID: 38792409 PMCID: PMC11121909 DOI: 10.3390/jcm13102863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.
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Affiliation(s)
- Agata Makowska
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
- Cardiology, Hospital Centre of Biel, 2501 Biel, Switzerland
| | - Thomas Treumann
- Radiology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Stefan Venturini
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
| | - Michael Christ
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
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Remy-Jardin M, Oufriche I, Guiffault L, Duhamel A, Flohr T, Schmidt B, Remy J. Diagnosis of acute pulmonary embolism: when photon-counting-detector CT replaces energy-integrating-detector CT in daily routine. Eur Radiol 2024:10.1007/s00330-024-10724-5. [PMID: 38634875 DOI: 10.1007/s00330-024-10724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To compare the diagnostic approach of acute pulmonary embolism (PE) with photon-counting-detector CT (PCD-CT) and energy-integrating-detector CT (EID-CT). MATERIALS AND METHODS Two cohorts underwent CT angiographic examinations with EID-CT (Group 1; n = 158) and PCD-CT (Group 2; n = 172), (b) with two options in Group 1, dual energy (Group 1a) or single energy (Group 1b) and a single option in Group 2 (spectral imaging with single source). RESULTS In Group 2, all patients benefited from spectral imaging, only accessible to 105 patients (66.5%) in Group 1, with a mean acquisition time significantly shorter (0.9 ± 0.1 s vs 4.0 ± 0 .3 s; p < 0.001) and mean values of CTDIvol and DLP reduced by 46.3% and 47.7%, respectively. Comparing the quality of 70 keV (Group 2) and averaged (Group 1a) images: (a) the mean attenuation within pulmonary arteries did not differ (p = 0.13); (b) the image noise was significantly higher (p < 0.001) in Group 2 with no difference in subjective image noise (p = 0.29); and (c) 89% of examinations were devoid of artifacts in Group 2 vs 28.6% in Group 1a. The percentage of diagnostic examinations was 95.2% (100/105; Group 1a), 100% (53/53; Group 1b), and 95.3% (164/172; Group 2). There were 4.8% (5/105; Group 1a) and 4.7% (8/172; Group 2) of non-diagnostic examinations, mainly due to the suboptimal quality of vascular opacification with the restoration of a diagnostic image quality on low-energy images. CONCLUSION Compared to EID-CT, morphology and perfusion imaging were available in all patients scanned with PCD-CT, with the radiation dose reduced by 48%. CLINICAL RELEVANCE STATEMENT PCD-CT enables scanning patients with the advantages of both spectral imaging, including high-quality morphologic imaging and lung perfusion for all patients, and fast scanning-a combination that is not simultaneously accessible with EID-CT while reducing the radiation dose by almost 50%.
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Affiliation(s)
- Martine Remy-Jardin
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France.
- IMALLIANCE-Haut-de-France, Valenciennes, France.
- Department of Thoracic Imaging, University of Lille, Lille, France.
| | - Idir Oufriche
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Lucas Guiffault
- Department of Thoracic Imaging, University of Lille, Lille, France
| | - Alain Duhamel
- ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Lille, France
- Department of Biostatistics, University of Lille, CHU Lille, Lille, France
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Bernhard Schmidt
- Department of Computed Tomography Research & Development, Siemens Healthineers AG, Forchheim, Germany
| | - Jacques Remy
- Department of Thoracic Imaging, University of Lille, Lille, France
- Department of Radiology, Valenciennes Regional Hospital, Valenciennes, France
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Dane B, Mabud T, Melamud K, Ginocchio L, Smereka P, Okyere M, O'Donnell T, Megibow A. Reduced Intravenous Contrast Dose Portal Venous Phase Photon-Counting Computed Tomography Compared With Conventional Energy-Integrating Detector Portal Venous Phase Computed Tomography. J Comput Assist Tomogr 2024:00004728-990000000-00308. [PMID: 38595174 DOI: 10.1097/rct.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The aim of this study was to compare portal venous phase photon-counting CT (PCCT) using 20 cc less than weight-based contrast dosing with energy-integrating detector CT (EID-CT) using weight-based dosing by quantitative and qualitative analysis. METHODS Fifty adult patients who underwent a reduced intravenous contrast dose portal venous phase PCCT from May 1, 2023, to August 10, 2023, and a prior portal-venous EID-CT with weight-based contrast dosing were retrospectively identified. Hounsfield units (HU) and noise (SD of HU) were obtained from region-of-interest measurements on 70-keV PCCT and EID-CT in 4 hepatic segments, the main and right portal vein, and both paraspinal muscles. Signal-to-noise and contrast-to-noise ratios were computed. Three abdominal radiologists qualitatively assessed overall image quality, hepatic enhancement, and confidence for metastasis identification on 5-point Likert scales. Readers also recorded the presence/absence of hepatic metastases. Quantitative variables were compared with paired t tests, and multiple comparisons were accounted for with a Bonferroni-adjusted α level of .0016. Ordinal logistic regression was used to evaluate qualitative assessments. Interreader agreement for hepatic metastases was calculated using Fleiss' κ. RESULTS Fifty patients (32 women; mean [SD] age, 64 [13] years) were included. There was no significant difference in hepatic HU, portal vein HU, noise, and signal-to-noise or contrast-to-noise ratio between reduced contrast dose portal venous phase PCCT versus EID-CT (all Ps > 0.0016). Image quality, degree of hepatic enhancement, and confidence for metastasis identification were not different for reduced dose PCCT 70-keV images and EID-CT (P = 0.06-0.69). κ Value for metastasis identification was 0.86 (95% confidence interval, 0.70-1.00) with PCCT and 0.78 (95% confidence interval, 0.59-0.98) with EID-CT. CONCLUSION Reduced intravenous contrast portal venous phase PCCT 70-keV images had similar attenuation and image quality as EID-CT with weight-based dosing. Metastases were identified with near-perfect agreement in reduced dose PCCT 70-keV images.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Tarub Mabud
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Kira Melamud
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Luke Ginocchio
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Paul Smereka
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Mabel Okyere
- From the Department of Radiology, NYU Langone Health, New York, NY
| | | | - Alec Megibow
- From the Department of Radiology, NYU Langone Health, New York, NY
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10
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Fletcher JG, Inoue A, Bratt A, Horst KK, Koo CW, Rajiah PS, Baffour FI, Ko JP, Remy-Jardin M, McCollough CH, Yu L. Photon-counting CT in Thoracic Imaging: Early Clinical Evidence and Incorporation Into Clinical Practice. Radiology 2024; 310:e231986. [PMID: 38501953 DOI: 10.1148/radiol.231986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Photon-counting CT (PCCT) is an emerging advanced CT technology that differs from conventional CT in its ability to directly convert incident x-ray photon energies into electrical signals. The detector design also permits substantial improvements in spatial resolution and radiation dose efficiency and allows for concurrent high-pitch and high-temporal-resolution multienergy imaging. This review summarizes (a) key differences in PCCT image acquisition and image reconstruction compared with conventional CT; (b) early evidence for the clinical benefit of PCCT for high-spatial-resolution diagnostic tasks in thoracic imaging, such as assessment of airway and parenchymal diseases, as well as benefits of high-pitch and multienergy scanning; (c) anticipated radiation dose reduction, depending on the diagnostic task, and increased utility for routine low-dose thoracic CT imaging; (d) adaptations for thoracic imaging in children; (e) potential for further quantitation of thoracic diseases; and (f) limitations and trade-offs. Moreover, important points for conducting and interpreting clinical studies examining the benefit of PCCT relative to conventional CT and integration of PCCT systems into multivendor, multispecialty radiology practices are discussed.
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Affiliation(s)
- Joel G Fletcher
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Akitoshi Inoue
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Alex Bratt
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Kelly K Horst
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Chi Wan Koo
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Francis I Baffour
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Jane P Ko
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Martine Remy-Jardin
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Cynthia H McCollough
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
| | - Lifeng Yu
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (J.G.F., A.I., A.B., K.K.H., C.W.K., P.S.R., F.I.B., C.H.M., L.Y.); Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (J.P.K.); and IMALLIANCE-Haut-de-France, Valenciennes, France (M.R.J.)
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11
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Feldle P, Scheuber M, Grunz JP, Heidenreich JF, Pannenbecker P, Nora C, Huflage H, Bley TA, Petritsch B. Virtual non-iodine photon-counting CT-angiography for aortic valve calcification scoring. Sci Rep 2024; 14:4724. [PMID: 38413684 PMCID: PMC10899655 DOI: 10.1038/s41598-024-54918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
Photon-counting detector (PCD)-CT allows for reconstruction of virtual non-iodine (VNI) images from contrast-enhanced datasets. This study assesses the diagnostic performance of aortic valve calcification scoring (AVCS) derived from VNI datasets generated with a 1st generation clinical dual-source PCD-CT. AVCS was evaluated in 123 patients (statistical analysis only comprising patients with aortic valve calcifications [n = 56; 63.2 ± 11.6 years]), who underwent contrast enhanced electrocardiogram-gated (either prospective or retrospective or both) cardiac CT on a clinical PCD system. Patient data was reconstructed at 70 keV employing a VNI reconstruction algorithm. True non-contrast (TNC) scans at 70 keV without quantum iterative reconstruction served as reference in all individuals. Subgroup analysis was performed in 17 patients who received both, prospectively and retrospectively gated contrast enhanced scans (n = 8 with aortic valve calcifications). VNI images with prospective/retrospective gating had an overall sensitivity of 69.2%/56.0%, specificity of 100%/100%, accuracy of 85.4%/81.0%, positive predictive value of 100%/100%, and a negative predictive value of 78.2%/75.0%. VNI images with retrospective gating achieved similar results. For both gating approaches, AVCSVNI showed high correlation (r = 0.983, P < 0.001 for prospective; r = 0.986, P < 0.001 for retrospective) with AVCSTNC. Subgroup analyses demonstrated excellent intra-individual correlation between different acquisition modes (r = 0.986, P < 0.001). Thus, VNI images derived from cardiac PCD-CT allow for excellent diagnostic performance in the assessment of AVCS, suggesting potential for the omission of true non-contrast scans in the clinical workup of patients with aortic calcifications.
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Affiliation(s)
- Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
| | - Marit Scheuber
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Conrads Nora
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
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12
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Pannenbecker P, Heidenreich JF, Grunz JP, Huflage H, Gruschwitz P, Patzer TS, Feldle P, Bley TA, Petritsch B. Image Quality and Radiation Dose of CTPA With Iodine Maps: A Prospective Randomized Study of High-Pitch Mode Photon-Counting Detector CT Versus Energy-Integrating Detector CT. AJR Am J Roentgenol 2024; 222:e2330154. [PMID: 37966036 DOI: 10.2214/ajr.23.30154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND. Dual-energy CT pulmonary angiography (CTPA) with energy-integrating detector (EID) technology is limited by the inability to use high-pitch technique. OBJECTIVE. The purpose of this study was to compare the image quality of anatomic images and iodine maps between high-pitch photon-counting detector (PCD) CTPA and dual-energy EID CTPA. METHODS. This prospective study included 117 patients (70 men and 47 women; median age, 65 years) who underwent CTPA to evaluate for pulmonary embolism between March 2022 and November 2022. Fifty-eight patients were randomized to undergo PCD CTPA (pitch, 2.0), and 59 were randomized to undergo EID CTPA (pitch, 0.55). For each examination, 120-kV polychromatic images, 60-keV virtual monogenetic images (VMIs), and iodine maps were reconstructed. One radiologist measured CNR and SNR. Three radiologists independently assessed subjective image quality (on a scale of 1-4, with a score of 1 denoting highest quality). Radiation dose was recorded. RESULTS. SNR and CNR were higher for PCD CTPA than for EID CTPA for polychromatic images and VMIs, for all assessed vessels other than the left upper lobe artery. For example, for PCD CTPA versus EID CTPA, the right lower lobe artery on polychromatic images had an SNR of 34.5 versus 28.0 (p = .003) and a CNR of 29.2 versus 24.4 (p = .001), and on VMIs it had an SNR of 43.2 versus 32.7 (p = .005) and a CNR of 37.4 versus 29.3 (p = .002). For both scanners for readers 1 and 2, the median image quality score for polychromatic images and VMIs was 1, although distributions indicated significantly better scores for PCD CTPA than for EID CTPA for polychromatic images for reader 1 (p = .02) and reader 2 (p = .005) and for VMIs for reader 1 (p = .001) and reader 2 (p = .006). The image quality of anatomic image sets was not different between PCD CTPA and EID CTPA for reader 3 (p > .05). The image quality of iodine maps was not different between PCD CTPA and EID CTPA for any reader (p > .05). For PCD CTPA versus EID CTPA, the CTDIvol was 3.9 versus 4.5 mGy (p = .03), and the DLP was 123.5 mGy × cm versus 157.0 mGy × cm (p < .001). CONCLUSION. High-pitch PCD CTPA provided anatomic images with better subjective and objective image quality versus dual-energy EID CTPA, with lower radiation dose. Iodine maps showed no significant difference in image quality between scanners. CLINICAL IMPACT. CTPA may benefit from the PCD CT technique.
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Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Philipp Feldle
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic Radiology and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse, 6, D-97080 Würzburg, Germany
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Lu Y, Sun N, Wu P, Zhou G, Peng L, Tang J. The application of infrared thermography technology in flap: A perspective from bibliometric and visual analysis. Int Wound J 2023; 20:4308-4327. [PMID: 37551726 PMCID: PMC10681462 DOI: 10.1111/iwj.14333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023] Open
Abstract
The application of infrared thermography technology (IRT) in flap has become a major focus of research, as it provides a non-invasive, real-time, and quantitative approach for monitoring flap perfusion. In this regard, we conducted a comprehensive visualization and scientometric analysis to systematically summarize and discuss the current state of research in this field. We systematically reviewed publications on the application of IRT in flap procedures from 1999 to 2022, using the Web of Science Core Collection (WoSCC). Through scientometric analysis, we examined annual trends, affiliations, countries, journals, authors, and their relationships, providing insights into current hotspots and future developments in this area. We analysed 522 English studies and found a steady increase in annual publications. The United States and Germany had the highest publication rates, with Beth Israel Deaconess Medical Center and Shanghai Jiaotong University being leading institutions. Notably, Lee BT and Alex Keller emerged as influential authors in this field. Compared to existing techniques, infrared-based technology offers significant advantages for non-invasive monitoring of flap perfusion, including simplicity of operation and objective results. Future trends should focus on interdisciplinary collaborations to develop new infrared devices and achieve intelligent image processing, enabling broader application in various clinical scenarios. This bibliometric study summarizes the progress and landscape of research on 'the Application of infrared thermography technology in flap' over the past two decades, providing valuable insights and serving as a reliable reference to drive further advancements and spark researchers' interest in this field.
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Affiliation(s)
- Yilei Lu
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- National Clinical Research Center of Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
| | - Nianzhe Sun
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- National Clinical Research Center of Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
| | - Panfeng Wu
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- National Clinical Research Center of Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
| | - Guoling Zhou
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- Xiangya Nursing SchoolCentral South UniversityChangshaChina
| | - Lingli Peng
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- National Clinical Research Center of Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
- Xiangya Nursing SchoolCentral South UniversityChangshaChina
- Teaching and Research Section of Clinical Nursing, Xiangya HospitalCentral South UniversityChangshaChina
| | - Juyu Tang
- Department of Orthopedics, Hand & MicrosurgeryXiangya Hospital, Central South UniversityChangshaChina
- National Clinical Research Center of Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
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