{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:04:51Z","timestamp":1789689891038,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Detailed visualization of the cribriform plate is challenging due to its intricate structure. This study investigates how computed tomography (CT) with a novel photon counting (PC) detector enhance cribriform plate visualization compared to traditionally used energy-integrated detectors in patients. A total of 40 patients were included in a retrospective analysis, with half of them undergoing PC CT (Naeotom Alpha Siemens Healthineers, Forchheim, Germany) and the other half undergoing CT scans using an energy-integrated detector (Somatom Sensation 64, Siemens, Forchheim, Germany) in which the cribriform plate was visualized with a temporal bone protocol. Both groups of scans were evaluated for signal-to-noise ratio, radiation dose, the imaging quality of the whole scan overall, and, separately, the cribriform plate and the clarity of volume rendering reconstructions. Two independent observers conducted a qualitative analysis using a Likert scale. The results consistently demonstrated excellent imaging of the cribriform plate with the PC CT scanner, surpassing traditional technology. The visualization provided by PC CT allowed for precise anatomical assessment of the cribriform plate on multiplanar reconstructions and volume rendering imaging with reduced radiation dose (by approximately 50% per slice) and higher signal-to-noise ratio (by approximately 75%). In conclusion, photon-counting technology provides the possibility of better imaging of the cribriform plate in adult patients. This enhanced imaging could be utilized in skull base-associated pathologies, such as cerebrospinal fluid leaks, to visualize them more reliably for precise treatment.<\/jats:p>","DOI":"10.3390\/tomography10030031","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T05:44:06Z","timestamp":1709876646000},"page":"400-414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Photon Counting Computed Tomography for Accurate Cribriform Plate (Lamina Cribrosa) Imaging in Adult Patients"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5633-741X","authenticated-orcid":false,"given":"Anna","family":"Klempka","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3319-1855","authenticated-orcid":false,"given":"Eduardo","family":"Ackermann","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-348X","authenticated-orcid":false,"given":"Sven","family":"Clausen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9078-5539","authenticated-orcid":false,"given":"Christoph","family":"Groden","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1148\/radiographics.20.6.g00nv071787","article-title":"Multisection CT: Scanning techniques and clinical applications","volume":"20","author":"Rydberg","year":"2000","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/RLI.0000000000000601","article-title":"Recent and Upcoming Technological Developments in Computed Tomography: High Speed, Low Dose, Deep Learning, Multienergy","volume":"55","author":"Lell","year":"2020","journal-title":"Investig. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/RLI.0000000000000172","article-title":"Evolution in Computed Tomography: The Battle for Speed and Dose","volume":"50","author":"Lell","year":"2015","journal-title":"Investig. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/RLI.0000000000000995","article-title":"Computed Tomography 2.0: New Detector Technology, AI, and Other Developments","volume":"58","author":"Lell","year":"2023","journal-title":"Investig. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1109\/TRPMS.2020.3020212","article-title":"Photon Counting CT: Clinical Applications and Future Developments","volume":"5","author":"Hsieh","year":"2021","journal-title":"IEEE Trans. Radiat. Plasma Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1148\/radiol.2018172656","article-title":"Photon-counting CT: Technical Principles and Clinical Prospects","volume":"289","author":"Willemink","year":"2018","journal-title":"Radiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"854","DOI":"10.3348\/kjr.2022.0377","article-title":"Photon-Counting Detector CT: Key Points Radiologists Should Know","volume":"23","author":"Esquivel","year":"2022","journal-title":"Korean J. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/RLI.0000000000000984","article-title":"Advanced Neuroimaging with Photon-Counting Detector CT","volume":"58","author":"Abel","year":"2023","journal-title":"Investig. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3348\/kjr.2020.0144","article-title":"Spectral Computed Tomography: Fundamental Principles and Recent Developments","volume":"22","author":"So","year":"2021","journal-title":"Korean J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tortora, M., Gemini, L., D\u2019Iglio, I., Ugga, L., Spadarella, G., and Cuocolo, R. (2022). Spectral Photon-Counting Computed Tomography: A Review on Technical Principles and Clinical Applications. J. Imaging., 8.","DOI":"10.3390\/jimaging8040112"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s11604-023-01485-0","article-title":"Evaluation of the ear ossicles with photon-counting detector CT","volume":"42","author":"Takahashi","year":"2024","journal-title":"Jpn. J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20220544","DOI":"10.1259\/bjr.20220544","article-title":"Photon-counting detector CT: Early clinical experience review","volume":"96","author":"Sartoretti","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1055\/s-2004-830180","article-title":"Surgical anatomy of the cribriform plate and adjacent areas","volume":"48","author":"Reisch","year":"2005","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.anl.2018.01.013","article-title":"Cribriform plate width is highly variable within and between subjects","volume":"45","author":"Coelho","year":"2018","journal-title":"Auris Nasus Larynx."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/B978-0-444-63855-7.00002-2","article-title":"Anatomy of the olfactory system","volume":"164","author":"Smith","year":"2019","journal-title":"Handb. Clin. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/1945892418768159","article-title":"Novel Radiographic Assessment of the Cribriform Plate","volume":"32","author":"Ganjaei","year":"2018","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_17","first-page":"809","article-title":"On the practical value of differences in the level of the lamina cribrosa of the ethmoid","volume":"41","author":"Keros","year":"1962","journal-title":"Z. Laryngol. Rhinol. Otol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4193\/Rhin.18.013","article-title":"Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak. Clinical retrospective evaluation of 24 cases","volume":"56","author":"Preti","year":"2018","journal-title":"Rhinology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4600","DOI":"10.1038\/s41598-020-61610-1","article-title":"A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery","volume":"10","author":"Abdullah","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1177\/19458924211020549","article-title":"Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations","volume":"35","author":"Fadda","year":"2021","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1136\/neurintsurg-2015-011956","article-title":"Endovascular treatment of cribriform plate dural arteriovenous fistulas: Technical difficulties and complications avoidance","volume":"8","author":"Robert","year":"2016","journal-title":"J. Neurointerv. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.anorl.2020.10.009","article-title":"How to identify the anterior cribriform plate in the medial approach to the frontal sinus","volume":"138","author":"Patron","year":"2021","journal-title":"Eur. Ann. Otorhinolaryngol. Head. Neck Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Spera, I., Cousin, N., Ries, M., Kedracka, A., Castillo, A., Aleandri, S., Vladymyrov, M., Mapunda, J.A., Engelhardt, B., and Luciani, P. (2023). Open pathways for cerebrospinal fluid outflow at the cribriform plate along the olfactory nerves. EBioMedicine, 91.","DOI":"10.1016\/j.ebiom.2023.104558"},{"key":"ref_24","first-page":"e2961","article-title":"Brain Herniation Through the Cribriform Plate: Review and Comparison to Encephaloceles in the Same Region","volume":"10","author":"Rai","year":"2018","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0940-9602(98)80065-4","article-title":"Development of the cribriform plate and of the lamina mediana","volume":"180","author":"Padovan","year":"1998","journal-title":"Ann. Anat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2174\/1573405614666180314150237","article-title":"Cribriform Plate, Crista Galli, Olfactory Fossa and Septal Deviation","volume":"15","author":"Inal","year":"2019","journal-title":"Curr. Med. Imaging Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"677.e13","DOI":"10.1016\/j.crad.2018.02.012","article-title":"Quality assurance in CT: Implementation of the updated national diagnostic reference levels using an automated CT dose monitoring system","volume":"73","author":"Appel","year":"2018","journal-title":"Clin. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1109\/TVCG.2021.3114769","article-title":"Differentiable Direct Volume Rendering","volume":"28","author":"Weiss","year":"2022","journal-title":"IEEE Trans. Vis. Comput. Graph."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4988","DOI":"10.1002\/mp.15832","article-title":"A minimum SNR criterion for computed tomography object detection in the projection domain","volume":"49","author":"Hsieh","year":"2022","journal-title":"Med. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"541","DOI":"10.4300\/JGME-5-4-18","article-title":"Analyzing and interpreting data from likert-type scales","volume":"5","author":"Sullivan","year":"2013","journal-title":"J. Grad. Med. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.3758\/s13423-021-01879-z","article-title":"Informal versus formal judgment of statistical models: The case of normality assumptions","volume":"28","author":"Bishara","year":"2021","journal-title":"Psychon. Bull. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.otc.2016.12.001","article-title":"Overview of Sinonasal and Ventral Skull Base Malignancy Management","volume":"50","author":"Svider","year":"2017","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.wneu.2022.01.034","article-title":"Smell Outcomes in Olfactory Groove Meningioma Resection Through Unilateral versus Bilateral Transcranial Approaches: A Systematic Review and Meta-analysis","volume":"160","author":"Bamimore","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"197","DOI":"10.14639\/0392-100X-N2118","article-title":"Spatial analysis of transnasal olfactory cleft access: A computed tomography study","volume":"43","author":"Chan","year":"2023","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S16.e9","DOI":"10.1016\/j.wneu.2012.02.027","article-title":"Anatomic skull base education using advanced neuroimaging techniques","volume":"79","author":"Topczewski","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e575","DOI":"10.1016\/j.wneu.2023.05.105","article-title":"A Three-Dimensional Anterior and Middle Cranial Fossa Model for Skull Base Surgical Training with Two Layers of the Colored Dura Mater","volume":"176","author":"Yamaoka","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/1971400919849781","article-title":"Construction of three-dimensional printed anatomic models for frontal sinus education","volume":"33","author":"Low","year":"2020","journal-title":"Neuroradiol. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1097\/SCS.0000000000007789","article-title":"Anatomical Variations of Anterior Ethmoidal Foramen and Cribriform Plate: Relations with Sex","volume":"33","author":"Gibelli","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_39","first-page":"117","article-title":"Radiologic changes in the aging nasal cavity","volume":"57","author":"Ganjaei","year":"2019","journal-title":"Rhinology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12987-020-00233-0","article-title":"Cerebrospinal fluid drainage kinetics across the cribriform plate are reduced with aging","volume":"17","author":"Brady","year":"2020","journal-title":"Fluids Barriers CNS"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/02688697.2018.1524077","article-title":"Recurrent epistaxis due to cribriform plate dural arteriovenous fistula: Are they related? Should the treatment be from venous, pial or arterial side?","volume":"36","author":"Tripathi","year":"2022","journal-title":"Br. J. Neurosurg."},{"key":"ref_42","first-page":"225","article-title":"A radiological anatomic study of the cribriform plate compared with constant structures","volume":"42","author":"Erdem","year":"2004","journal-title":"Rhinology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5604\/00306657.1184543","article-title":"Ethmoid roof radiology; analysis of lateral lamella of cribriform plate","volume":"69","author":"Erdogan","year":"2015","journal-title":"Otolaryngol. Pol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1002\/lary.24755","article-title":"Epistaxis caused by a dural AV-fistula at the cribriform plate","volume":"124","author":"Mazuri","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/MOO.0b013e3283631936","article-title":"Management of nasoethmoid fractures","volume":"21","author":"Rosenberger","year":"2013","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.cjtee.2015.07.006","article-title":"The management of naso-orbital-ethmoid (NOE) fractures","volume":"18","author":"Wei","year":"2015","journal-title":"Chin. J. Traumatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.acra.2022.05.021","article-title":"Radiation Dose Reduction in Contrast-Enhanced Abdominal CT: Comparison of Photon-Counting Detector CT with 2nd Generation Dual-Source Dual-Energy CT in an oncologic cohort","volume":"30","author":"Wrazidlo","year":"2023","journal-title":"Acad. Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/RLI.0000000000000948","article-title":"Standardization and Quantitative Imaging with Photon-Counting Detector CT","volume":"58","author":"McCollough","year":"2023","journal-title":"Investig. Radiol."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/3\/31\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:10:54Z","timestamp":1760105454000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/3\/31"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,8]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["tomography10030031"],"URL":"https:\/\/doi.org\/10.3390\/tomography10030031","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,8]]}}}