{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:57:46Z","timestamp":1790495866963,"version":"4.1.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the quantitative reliability of virtual non-contrast images derived from spectral computed tomography pulmonary angiography across eight thoracic tissues, assessing their feasibility as a true non-contrast substitute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective cross-sectional study, we analyzed 169 patients undergoing spectral computed tomography pulmonary angiography. Attenuation differences between true non-contrast and virtual non-contrast images were evaluated across eight anatomical regions. Statistical assessments included Bonferroni-corrected Wilcoxon signed-rank tests, Pearson correlation (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      ), Lin's concordance correlation coefficient, and Bland\u2013Altman analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Virtual non-contrast performance showed four distinct patterns. (1)\n                      <jats:italic toggle=\"yes\">Excellent agreement.<\/jats:italic>\n                      Lung parenchyma and erector spinae muscle demonstrated high absolute concordance (concordance correlation coefficient\u2009=\u20090.981 and 0.876, respectively) with clinically negligible biases (3.8\u2005Hounsfield units and \u22121.0\u2005Hounsfield units). (2)\n                      <jats:italic toggle=\"yes\">Moderate agreement.<\/jats:italic>\n                      The aorta and pulmonary artery shared identical concordance correlation coefficient values (0.430) but exhibited divergent clinical threshold exceedances, primarily driven by a larger mean bias in the pulmonary artery (8.8\u2005Hounsfield units). (3)\n                      <jats:italic toggle=\"yes\">Stable systematic offsets.<\/jats:italic>\n                      The T6 vertebral body and mediastinal fat exhibited massive systematic biases (66.2\u2005Hounsfield units and \u221211.1\u2005Hounsfield units, respectively), leading to poor absolute agreement (concordance correlation coefficient\u2009=\u20090.390 and 0.531). However, both maintained strong linear correlations (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.902 and 0.816) and extremely low outlier rates beyond the 95% limits of agreement. (4)\n                      <jats:italic toggle=\"yes\">Unacceptable agreement.<\/jats:italic>\n                      The thyroid gland and superior vena cava yielded clinically unacceptable reliability due to proportional bias and beam-hardening artifacts. The physical true non-contrast acquisition accounted for 53.0% of the total effective radiation dose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Spectral virtual non-contrast imaging accurately substitutes true non-contrast imaging in the lung parenchyma and erector spinae muscle. Although major vessels show moderate reliability, the massive systematic underestimation in vertebral bone precludes its direct clinical use for quantitative assessment without validated mathematical correction factors. Intrinsically iodine-rich organs and structures prone to streak artifacts remain unsuitable for virtual non-contrast substitution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03000605261487280","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:23:01Z","timestamp":1790137381000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative comparison of virtual non-contrast and true non-contrast computed tomography pulmonary angiography images across eight thoracic tissue types: A retrospective cross-sectional study"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5971-477X","authenticated-orcid":false,"given":"Jiulong","family":"Yan","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Soochow 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University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0419-274X","authenticated-orcid":false,"given":"Ying","family":"Shen","sequence":"additional","affiliation":[{"name":"Suzhou Medical College of Soochow University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3519-5832","authenticated-orcid":false,"given":"Jin","family":"Gao","sequence":"additional","affiliation":[{"name":"Suzhou City University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7263-9106","authenticated-orcid":false,"given":"Xinxing","family":"Ma","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Soochow University"},{"name":"Institute of Medical Imaging, Soochow University, 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