INVITED REVIEW
Advancements in Computed Tomography Angiography for Pulmonary Embolism Assessment
Ludovica R. M. Lanzafame,
Claudia Gulli,
Christian Booz,
Thomas J. Vogl,
Luca Saba,
Riccardo Cau,
Patrizia Toia,
Giorgio Ascenti,
Michele Gaeta,
Silvio Mazziotti,
Tommaso D'Angelo,
Corresponding Author
Ludovica R. M. Lanzafame
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Correspondence: Ludovica R. M. Lanzafame ([email protected])
Search for more papers by this authorClaudia Gulli
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorChristian Booz
Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Search for more papers by this authorThomas J. Vogl
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Search for more papers by this authorLuca Saba
Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
Search for more papers by this authorRiccardo Cau
Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
Search for more papers by this authorPatrizia Toia
Department of Radiology, AOUP Paolo Giaccone, Palermo, Italy
Search for more papers by this authorGiorgio Ascenti
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorMichele Gaeta
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorSilvio Mazziotti
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorTommaso D'Angelo
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorLudovica R. M. Lanzafame,
Claudia Gulli,
Christian Booz,
Thomas J. Vogl,
Luca Saba,
Riccardo Cau,
Patrizia Toia,
Giorgio Ascenti,
Michele Gaeta,
Silvio Mazziotti,
Tommaso D'Angelo,
Corresponding Author
Ludovica R. M. Lanzafame
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Correspondence: Ludovica R. M. Lanzafame ([email protected])
Search for more papers by this authorClaudia Gulli
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorChristian Booz
Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Search for more papers by this authorThomas J. Vogl
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
Search for more papers by this authorLuca Saba
Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
Search for more papers by this authorRiccardo Cau
Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
Search for more papers by this authorPatrizia Toia
Department of Radiology, AOUP Paolo Giaccone, Palermo, Italy
Search for more papers by this authorGiorgio Ascenti
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorMichele Gaeta
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorSilvio Mazziotti
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorTommaso D'Angelo
Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, Messina, Italy
Search for more papers by this authorABSTRACT
Pulmonary embolism (PE) is a critical condition stemming from venous thromboembolism, with potentially fatal outcomes. Computed tomography pulmonary angiography (CTPA) serves as the gold standard for diagnosing PE, offering unparalleled diagnostic accuracy, accessibility, and speed. Recent innovations, such as spectral CT systems and artificial intelligence (AI)-driven algorithms, have enhanced the diagnostic and prognostic capabilities of CTPA, enabling precise anatomical and functional assessments. This review highlights these technological advancements and their clinical implications.
Conflicts of Interest
T.D. and G.A. received speaking fees from Bracco and Philips. The other authors declare no conflicts of interest.
References
- 1S. V. Konstantinides, G. Meyer, C. Becattini, et al., “2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration With the European Respiratory Society (ERS): The Task Force for the Diagnosis and management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC),” European Heart Journal 41, no. 4 (2020): 543–603.
- 2F. Lavorini, V. Di Bello, M. L. De Rimini, et al., “Diagnosis and Treatment of Pulmonary Embolism: A Multidisciplinary Approach,” Multidisciplinary Respiratory Medicine 8, no. 1 (2013): 75.
- 3J. Bĕlohlávek, V. Dytrych, and A. Linhart, “Pulmonary Embolism, Part I: Epidemiology, Risk Factors and Risk Stratification, Pathophysiology, Clinical Presentation, Diagnosis and Nonthrombotic Pulmonary Embolism,” Experimental & Clinical Cardiology 18, no. 2 (2013): 129–138.
- 4M. Turetz, A. T. Sideris, O. A. Friedman, N. Triphathi, and J. M. Horowitz, “Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism,” Seminars in Interventional Radiology 35, no. 2 (2018): 92–98.
- 5G. Piazza and S. Z. Goldhaber, “Acute Pulmonary Embolism,” Circulation 114, no. 2 (2006): e28–e32.
- 6S. E. Thomas, I. Weinberg, R. M. Schainfeld, K. Rosenfield, and G. M. Parmar, “Diagnosis of Pulmonary Embolism: A Review of Evidence-Based Approaches,” Journal of Clinical Medicine 13, no. 13 (2024): 3722.
- 7C. L. Low, R. Y. Kow, A. Abd Aziz, et al., “Diagnostic Yield of CT Pulmonary Angiogram in the Diagnosis of Pulmonary Embolism and Its Predictive Factors,” Cureus 15, no. 6 (2023): e40484.
- 8P. D. Stein, S. E. Fowler, L. R. Goodman, et al., “Multidetector Computed Tomography for Acute Pulmonary Embolism,” New England Journal of Medicine 354, no. 22 (2006): 2317–2327.
- 9A. Laqmani, M. Kurfürst, S. Butscheidt, et al., “CT Pulmonary Angiography at Reduced Radiation Exposure and Contrast Material Volume Using Iterative Model Reconstruction and iDose4 Technique in Comparison to FBP,” PLoS ONE 11, no. 9 (2016): e0162429.
- 10T. Burdenski, K. K. Bressem, L. C. Adams, N. F. Grauhan, and S. M. Niehues, “CT Diagnostics of Pulmonary Embolism: Does Iodine Delivery Rate Still Affect Image Quality in Iterative Reconstruction?” Clinical Hemorheology and Microcirculation 79, no. 1 (2021): 81–89.
- 11B. Taslakian, L. A. Latson, M. T. Truong, et al., “CT Pulmonary Angiography of Adult Pulmonary Vascular Diseases: Technical Considerations and Interpretive Pitfalls,” European Journal of Radiology 85, no. 11 (2016): 2049–2063.
- 12A. M. Mortimer, R. K. Singh, J. Hughes, R. Greenwood, and M. C. Hamilton, “Use of Expiratory CT Pulmonary Angiography to Reduce Inspiration and Breath-Hold Associated Artefact: Contrast Dynamics and Implications for Scan Protocol,” Clinical Radiology 66, no. 12 (2011): 1159–1166.
- 13R. W. Bauer, B. Schell, M. Beeres, et al., “High-Pitch Dual-Source Computed Tomography Pulmonary Angiography in Freely Breathing Patients,” Journal of Thoracic Imaging 27, no. 6 (2012): 376–381.
- 14A. J. E. Moore, J. Wachsmann, M. R. Chamarthy, L. Panjikaran, Y. Tanabe, and P. Rajiah, “Imaging of Acute Pulmonary Embolism: An Update,” Cardiovascular Diagnosis and Therapy 8, no. 3 (2017): 225–243.
10.21037/cdt.2017.12.01 Google Scholar
- 15A. Machin, G. Gill, and J. M. Pappachan, “Hampton's Hump,” BMJ Case Reports (2013): bcr2013201789.
- 16I. Andrade, G. Mehdipoor, R. Le Mao, et al., “Prognostic Significance of Computed Tomography-Assessed Right Ventricular Enlargement in Low-Risk Patients With Pulmonary Embolism: Systematic Review and Meta-Analysis,” Thrombosis Research 197 (2021): 48–55.
- 17S. D. Qanadli, M. El Hajjam, A. Vieillard-Baron, et al., “New CT Index to Quantify Arterial Obstruction in Pulmonary Embolism: Comparison With Angiographic Index and Echocardiography,” AJR American Journal of Roentgenology 176, no. 6 (2001): 1415–1420.
- 18I. Mastora, M. Remy-Jardin, P. Masson, et al., “Severity of Acute Pulmonary Embolism: Evaluation of a New Spiral CT Angiographic Score in Correlation With Echocardiographic Data,” European Radiology 13, no. 1 (2003): 29–35.
- 19W. Ghanima, M. Abdelnoor, L. O. Holmen, B. E. Nielssen, and P. M. Sandset, “The Association Between the Proximal Extension of the Clot and the Severity of Pulmonary Embolism (PE): A Proposal for a New Radiological Score for PE,” Journal of Internal Medicine 261, no. 1 (2007): 74–81.
- 20C. T. Jørgensen, M. Tavoly, H. H. Pettersen, et al., “The Venous Thrombosis Registry in Østfold Hospital (TROLL Registry)—Design and Cohort Description,” Research and Practice in Thrombosis and Haemostasis 6, no. 5 (2022): e12770.
10.1002/rth2.12770 Google Scholar
- 21D. K. Kang, C. Thilo, U. J. Schoepf, et al., “CT Signs of Right Ventricular Dysfunction: Prognostic Role in Acute Pulmonary Embolism,” JACC Cardiovasc Imaging 4, no. 8 (2011): 841–849.
- 22F. G. Meinel, J. W. Nance, U. J. Schoepf, et al., “Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-Analysis,” American Journal of Medicine 128, no. 7 (2015): 747–759.e742.
- 23A. J. Weekes, J. D. Raper, K. Lupez, et al., “Development and Validation of a Prognostic Tool: Pulmonary Embolism Short-Term Clinical Outcomes Risk Estimation (PE-SCORE),” PLoS ONE 16, no. 11 (2021): e0260036.
- 24A. J. Weekes, J. D. Raper, D. Esener, et al., “Comparing Predictive Performance of Pulmonary Embolism Risk Stratification Tools for Acute Clinical Deterioration,” Journal of the American College of Emergency Physicians Open 4, no. 3 (2023): e12983.
- 25Y. M. Ende-Verhaar, L. J. Meijboom, L. J. M. Kroft, et al., “Usefulness of Standard Computed Tomography Pulmonary Angiography Performed for Acute Pulmonary Embolism for Identification of Chronic Thromboembolic Pulmonary Hypertension: Results of the InShape III Study,” Journal of Heart and Lung Transplantation 38, no. 7 (2019): 731–738.
- 26G. Boon, Y. M. Ende-Verhaar, L. F. M. Beenen, et al., “Prediction of Chronic Thromboembolic Pulmonary Hypertension With Standardised Evaluation of Initial Computed Tomography Pulmonary Angiography Performed for Suspected Acute Pulmonary Embolism,” European Radiology 32, no. 4 (2022): 2178–2187.
- 27N. J. Braams, G. Boon, F. S. de Man, et al., “Evolution of CT Findings After Anticoagulant Treatment for Acute Pulmonary Embolism in Patients With and Without an Ultimate Diagnosis of Chronic Thromboembolic Pulmonary Hypertension,” European Respiratory Journal 58, no. 6 (2021): 2100699.
- 28C. H. McCollough, S. Leng, L. Yu, and J. G. Fletcher, “Dual- and Multi-Energy CT: Principles, Technical Approaches, and Clinical Applications,” Radiology 276, no. 3 (2015): 637–653.
- 29L. S. Alizadeh, T. J. Vogl, S. S. Waldeck, et al., “Dual-Energy CT in Cardiothoracic Imaging: Current Developments,” Diagnostics 13, no. 12 (2023): 2116.
- 30Y. Chen, T. Wu, Y. Zhu, J. Chen, C. Gao, and L. Wu, “Trends and Hotspots of Energy-Based Imaging in Thoracic Disease: A Bibliometric Analysis,” Insights Into Imaging 15, no. 1 (2024): 209.
- 31P. Rajiah, “Dual-Energy Computed Tomography in Thoracic Imaging—Current Practices and Utility: Survey of the Society of Thoracic Radiology,” Journal of Thoracic Imaging 35, no. 2 (2020): W43–W50.
- 32M. H. Albrecht, T. J. Vogl, S. S. Martin, et al., “Review of Clinical Applications for Virtual Monoenergetic Dual-Energy CT,” Radiology 293, no. 2 (2019): 260–271.
- 33T. D'Angelo, G. Cicero, S. Mazziotti, et al., “Dual Energy Computed Tomography Virtual Monoenergetic Imaging: Technique and Clinical Applications,” BJR 92, no. 1098 (2019): 20180546.
10.1259/bjr.20180546 Google Scholar
- 34Y. Ozawa, Y. Ohno, H. Nagata, et al., “Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging,” Diagnostics 13, no. 13 (2023): 2295.
- 35R. Yuan, W. P. Shuman, J. P. Earls, et al., “Reduced Iodine Load at CT Pulmonary Angiography With Dual-Energy Monochromatic Imaging: Comparison With Standard CT Pulmonary Angiography–A Prospective Randomized Trial,” Radiology 262, no. 1 (2012): 290–297.
- 36J. Cheng, Y. Yin, H. Wu, et al., “Optimal Monochromatic Energy Levels in Spectral CT Pulmonary Angiography for the Evaluation of Pulmonary Embolism,” PLoS ONE 8, no. 5 (2013): e63140.
- 37T. D'Angelo, A. M. Bucher, L. Lenga, et al., “Optimisation of Window Settings for Traditional and Noise-Optimised Virtual Monoenergetic Imaging in Dual-Energy Computed Tomography Pulmonary Angiography,” European Radiology 28, no. 4 (2018): 1393–1401.
- 38M. Meyer, H. Haubenreisser, C. Schabel, et al., “CT Pulmonary Angiography in Patients With Acute or Chronic Renal Insufficiency: Evaluation of a Low Dose Contrast Material Protocol,” Scientific Reports 8, no. 1 (2018): 1995.
- 39A. Meier, K. Higashigaito, K. Martini, et al., “Dual Energy CT Pulmonary Angiography With 6G Iodine-A Propensity Score-Matched Study,” PLoS ONE 11, no. 12 (2016): e0167214.
- 40J. Weiss, M. Notohamiprodjo, M. Bongers, et al., “Noise-Optimized Monoenergetic Post-Processing Improves Visualization of Incidental Pulmonary Embolism in Cancer Patients Undergoing Single-Pass Dual-Energy Computed Tomography,” La Radiologia Medica 122, no. 4 (2017): 280–287.
- 41K. Bae, K. N. Jeon, S. B. Cho, et al., “Improved Opacification of a Suboptimally Enhanced Pulmonary Artery in Chest CT: Experience Using a Dual-Layer Detector Spectral CT,” AJR American Journal of Roentgenology 210, no. 4 (2018): 734–741.
- 42P. Pannenbecker, H. Huflage, J.-P. Grunz, et al., “Photon-Counting CT for Diagnosis of Acute Pulmonary Embolism: Potential for Contrast Medium and Radiation Dose Reduction,” European Radiology 33, no. 11 (2023): 7830–7839.
- 43P. Pannenbecker, J. F. Heidenreich, H. Huflage, et al., “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,” Academic Radiology 31, no. 12 (2024): 5280–5288.
- 44J. M. Mihailovic, M. R. Bruesewitz, J. R. Swicklik, et al., “Simultaneous High-Pitch Multi-Energy CT Pulmonary Angiography Using a Dual-Source Photon-Counting-Detector CT: A Phantom Experiment,” Journal of Applied Clinical Medical Physics [Electronic Resource] 25, no. 11 (2024): e14496.
- 45F. Tatsugami, T. Higaki, Y. Nakamura, Y. Honda, and K. Awai, “Dual-Energy CT: Minimal Essentials for Radiologists,” Japanese Journal of Radiology 40, no. 6 (2022): 547–559.
- 46I. Vlahos, M. C. Jacobsen, M. C. Godoy, K. Stefanidis, and R. R. Layman, “Dual-Energy CT in Pulmonary Vascular Disease,” British Journal of Radiology 95, no. 1129 (2022): 20210699.
- 47S. F. Thieme, C. R. Becker, M. Hacker, K. Nikolaou, M. F. Reiser, and T. R. Johnson, “Dual Energy CT for the Assessment of Lung Perfusion–Correlation to Scintigraphy,” European Journal of Radiology 68, no. 3 (2008): 369–374.
- 48S. F. Thieme, V. Graute, K. Nikolaou, et al., “Dual Energy CT Lung Perfusion Imaging—Correlation With SPECT/CT,” European Journal of Radiology 81, no. 2 (2012): 360–365.
- 49S. Si-Mohamed, C. Moreau-Triby, P. Tylski, et al., “Head-to-Head Comparison of Lung Perfusion With Dual-Energy CT and SPECT-CT,” Diagnostic and Interventional Imaging 101, no. 5 (2020): 299–310.
- 50E. K. Weidman, A. J. Plodkowski, D. F. Halpenny, et al., “Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps,” Radiology 289, no. 2 (2018): 546–553.
- 51R. J. Gertz, F. Gerhardt, M. Pienn, et al., “Dual-Layer Dual-Energy CT-Derived Pulmonary Perfusion for the Differentiation of Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension,” European Radiology 34, no. 5 (2024): 2944–2956.
- 52J. V. Hansen, M. W. Poulsen, J. E. Nielsen-Kudsk, M. K. Kalra, M. D. Lyhne, and A. Andersen, “Quantitative Pulmonary Perfusion in Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension,” Pulmonary Circulation 14, no. 4 (2024): e12445.
- 53A. Kosmala, P. Gruschwitz, S. Veldhoen, et al., “Dual-Energy CT Angiography in Suspected Pulmonary Embolism: Influence of Injection Protocols on Image Quality and Perfused Blood Volume,” International Journal of Cardiovascular Imaging 36, no. 10 (2020): 2051–2059.
- 54C. B. Monti, M. Zanardo, A. Cozzi, et al., “Dual-Energy CT Performance in Acute Pulmonary Embolism: A Meta-Analysis,” European Radiology 31, no. 8 (2021): 6248–6258.
- 55P. Apfaltrer, V. Bachmann, M. Meyer, et al., “Prognostic Value of Perfusion Defect Volume at Dual Energy CTA in Patients With Pulmonary Embolism: Correlation With CTA Obstruction Scores, CT Parameters of Right Ventricular Dysfunction and Adverse Clinical Outcome,” European Journal of Radiology 81, no. 11 (2012): 3592–3597.
- 56S. Jawad, P. S. Ulriksen, A. Kalhauge, and K. L. Hansen, “Acute Pulmonary Embolism Severity Assessment Evaluated With Dual Energy CT Perfusion Compared to Conventional CT Angiographic Measurements,” Diagnostics 11, no. 3 (2021): 495.
- 57D. J. Im, J. Hur, K. H. Han, et al., “Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured with Dual-Energy CT,” American Journal of Roentgenology 209, no. 5 (2017): 1015–1022.
- 58K. Li, Y. Li, Z. Qi, J. W. Garrett, T. M. Grist, and G. H. Chen, “Quantitative Lung Perfusion Blood Volume Using Dual Energy CT-Based Effective Atomic Number (Z(eff)) Imaging,” Medical Physics 48, no. 11 (2021): 6658–6672.
- 59T. D'Angelo, S. Barbera, V. Ascenti, et al., “Pulmonary Embolism Detection Without Intravenous Contrast Using Electron Density and Z-Effective Maps From Dual-Energy CT,” Radiology Advances 1, no. 3 (2024): umae025.
10.1093/radadv/umae025 Google Scholar
- 60X. Kong, H. X. Sheng, G. M. Lu, et al., “Xenon-Enhanced Dual-Energy CT Lung Ventilation Imaging: Techniques and Clinical Applications,” AJR American Journal of Roentgenology 202, no. 2 (2014): 309–317.
- 61Y. Masutani, H. MacMahon, and K. Doi, “Computerized Detection of Pulmonary Embolism in Spiral CT Angiography Based on Volumetric Image Analysis,” Ieee Transactions on Medical Imaging 21, no. 12 (2002): 1517–1523.
- 62Y. Masutani, H. MacMahon, and K. Doi, “Computer-Assisted Detection of Pulmonary Embolism,” SPIE, Medical Imaging 3979 (2000).
- 63H. Huhtanen, M. Nyman, T. Mohsen, A. Virkki, A. Karlsson, and J. Hirvonen, “Automated Detection of Pulmonary Embolism From CT-Angiograms Using Deep Learning,” BMC Medical Imaging 22, no. 1 (2022): 43.
- 64T. Weikert, D. J. Winkel, J. Bremerich, et al., “Automated Detection of Pulmonary Embolism in CT Pulmonary Angiograms Using an AI-Powered Algorithm,” European Radiology 30, no. 12 (2020): 6545–6553.
- 65E. Colak, F. C. Kitamura, S. B. Hobbs, et al., “The RSNA Pulmonary Embolism CT Dataset,” Radiology: Artificial Intelligence 3, no. 2 (2021): e200254.
- 66E. Lanza, A. Ammirabile, and M. Francone, “nnU-Net-Based Deep-Learning for Pulmonary Embolism: Detection, Clot Volume Quantification, and Severity Correlation in the RSPECT Dataset,” European Journal of Radiology 177 (2024): 111592.
- 67R. W. Foley, S. Glenn-Cox, J. Rossdale, et al., “Automated Calculation of the Right Ventricle to Left Ventricle Ratio on CT for the Risk Stratification of Patients With Acute Pulmonary Embolism,” European Radiology 31, no. 8 (2021): 6013–6020.
- 68A.-C. Klemenz, L. Albrecht, M. Manzke, et al., “Improved Image Quality in CT Pulmonary Angiography Using Deep Learning-Based Image Reconstruction,” Scientific Reports 14, no. 1 (2024): 2494.
- 69F. Hagen, L. Vorberg, F. Thamm, et al., “Improved Detection of Small Pulmonary Embolism on Unenhanced Computed Tomography Using an Artificial Intelligence-Based Algorithm – A Single Centre Retrospective Study,” International Journal of Cardiovascular Imaging 40, no. 11 (2024): 2293–2304.
- 70K. Batra, Y. Xi, S. Bhagwat, A. Espino, and R. M. Peshock, “Radiologist Worklist Reprioritization Using Artificial Intelligence: Impact on Report Turnaround Times for CTPA Examinations Positive for Acute Pulmonary Embolism,” AJR American Journal of Roentgenology 221, no. 3 (2023): 324–333.
- 71W. Zhang, Y. Guo, and Q. Jin, “Radiomics and Its Feature Selection: A Review,” Symmetry 15, no. 10 (2023): 1834.
- 72J. Gotta, L. D. Gruenewald, T. Geyer, et al., “Indicators for Hospitalization in Acute Pulmonary Embolism: Uncover the Association between D-Dimer Levels, Thrombus Volume and Radiomics,” Academic Radiology 31, no. 6 (2024): 2610–2619.
- 73J. Gotta, V. Koch, T. Geyer, et al., “Imaging-Based Risk Stratification of Patients With Pulmonary Embolism Based on Dual-Energy CT-Derived Radiomics,” European Journal of Clinical Investigation 54, no. 4 (2024): e14139.
