introduction of the literature review

How to write a literature review introduction (+ examples)

The introduction to a literature review serves as your reader’s guide through your academic work and thought process. Explore the significance of literature review introductions in review papers, academic papers, essays, theses, and dissertations. We delve into the purpose and necessity of these introductions, explore the essential components of literature review introductions, and provide step-by-step guidance on how to craft your own, along with examples.

Why you need an introduction for a literature review

When you need an introduction for a literature review, what to include in a literature review introduction, examples of literature review introductions, steps to write your own literature review introduction.

A literature review is a comprehensive examination of the international academic literature concerning a particular topic. It involves summarizing published works, theories, and concepts while also highlighting gaps and offering critical reflections.

In academic writing , the introduction for a literature review is an indispensable component. Effective academic writing requires proper paragraph structuring to guide your reader through your argumentation. This includes providing an introduction to your literature review.

It is imperative to remember that you should never start sharing your findings abruptly. Even if there isn’t a dedicated introduction section .

Instead, you should always offer some form of introduction to orient the reader and clarify what they can expect.

There are three main scenarios in which you need an introduction for a literature review:

• Academic literature review papers: When your literature review constitutes the entirety of an academic review paper, a more substantial introduction is necessary. This introduction should resemble the standard introduction found in regular academic papers.
• Literature review section in an academic paper or essay: While this section tends to be brief, it’s important to precede the detailed literature review with a few introductory sentences. This helps orient the reader before delving into the literature itself.
• Literature review chapter or section in your thesis/dissertation: Every thesis and dissertation includes a literature review component, which also requires a concise introduction to set the stage for the subsequent review.

You may also like: How to write a fantastic thesis introduction (+15 examples)

It is crucial to customize the content and depth of your literature review introduction according to the specific format of your academic work.

In practical terms, this implies, for instance, that the introduction in an academic literature review paper, especially one derived from a systematic literature review , is quite comprehensive. Particularly compared to the rather brief one or two introductory sentences that are often found at the beginning of a literature review section in a standard academic paper. The introduction to the literature review chapter in a thesis or dissertation again adheres to different standards.

Here’s a structured breakdown based on length and the necessary information:

Academic literature review paper

The introduction of an academic literature review paper, which does not rely on empirical data, often necessitates a more extensive introduction than the brief literature review introductions typically found in empirical papers. It should encompass:

• The research problem: Clearly articulate the problem or question that your literature review aims to address.
• The research gap: Highlight the existing gaps, limitations, or unresolved aspects within the current body of literature related to the research problem.
• The research relevance: Explain why the chosen research problem and its subsequent investigation through a literature review are significant and relevant in your academic field.
• The literature review method: If applicable, describe the methodology employed in your literature review, especially if it is a systematic review or follows a specific research framework.
• The main findings or insights of the literature review: Summarize the key discoveries, insights, or trends that have emerged from your comprehensive review of the literature.
• The main argument of the literature review: Conclude the introduction by outlining the primary argument or statement that your literature review will substantiate, linking it to the research problem and relevance you’ve established.
• Preview of the literature review’s structure: Offer a glimpse into the organization of the literature review paper, acting as a guide for the reader. This overview outlines the subsequent sections of the paper and provides an understanding of what to anticipate.

By addressing these elements, your introduction will provide a clear and structured overview of what readers can expect in your literature review paper.

Regular literature review section in an academic article or essay

Most academic articles or essays incorporate regular literature review sections, often placed after the introduction. These sections serve to establish a scholarly basis for the research or discussion within the paper.

In a standard 8000-word journal article, the literature review section typically spans between 750 and 1250 words. The first few sentences or the first paragraph within this section often serve as an introduction. It should encompass:

• An introduction to the topic: When delving into the academic literature on a specific topic, it’s important to provide a smooth transition that aids the reader in comprehending why certain aspects will be discussed within your literature review.
• The core argument: While literature review sections primarily synthesize the work of other scholars, they should consistently connect to your central argument. This central argument serves as the crux of your message or the key takeaway you want your readers to retain. By positioning it at the outset of the literature review section and systematically substantiating it with evidence, you not only enhance reader comprehension but also elevate overall readability. This primary argument can typically be distilled into 1-2 succinct sentences.

In some cases, you might include:

• Methodology: Details about the methodology used, but only if your literature review employed a specialized method. If your approach involved a broader overview without a systematic methodology, you can omit this section, thereby conserving word count.

By addressing these elements, your introduction will effectively integrate your literature review into the broader context of your academic paper or essay. This will, in turn, assist your reader in seamlessly following your overarching line of argumentation.

Introduction to a literature review chapter in thesis or dissertation

The literature review typically constitutes a distinct chapter within a thesis or dissertation. Often, it is Chapter 2 of a thesis or dissertation.

Some students choose to incorporate a brief introductory section at the beginning of each chapter, including the literature review chapter. Alternatively, others opt to seamlessly integrate the introduction into the initial sentences of the literature review itself. Both approaches are acceptable, provided that you incorporate the following elements:

• Purpose of the literature review and its relevance to the thesis/dissertation research: Explain the broader objectives of the literature review within the context of your research and how it contributes to your thesis or dissertation. Essentially, you’re telling the reader why this literature review is important and how it fits into the larger scope of your academic work.
• Primary argument: Succinctly communicate what you aim to prove, explain, or explore through the review of existing literature. This statement helps guide the reader’s understanding of the review’s purpose and what to expect from it.
• Preview of the literature review’s content: Provide a brief overview of the topics or themes that your literature review will cover. It’s like a roadmap for the reader, outlining the main areas of focus within the review. This preview can help the reader anticipate the structure and organization of your literature review.
• Methodology: If your literature review involved a specific research method, such as a systematic review or meta-analysis, you should briefly describe that methodology. However, this is not always necessary, especially if your literature review is more of a narrative synthesis without a distinct research method.

By addressing these elements, your introduction will empower your literature review to play a pivotal role in your thesis or dissertation research. It will accomplish this by integrating your research into the broader academic literature and providing a solid theoretical foundation for your work.

Comprehending the art of crafting your own literature review introduction becomes significantly more accessible when you have concrete examples to examine. Here, you will find several examples that meet, or in most cases, adhere to the criteria described earlier.

Example 1: An effective introduction for an academic literature review paper

To begin, let’s delve into the introduction of an academic literature review paper. We will examine the paper “How does culture influence innovation? A systematic literature review”, which was published in 2018 in the journal Management Decision.

The entire introduction spans 611 words and is divided into five paragraphs. In this introduction, the authors accomplish the following:

• In the first paragraph, the authors introduce the broader topic of the literature review, which focuses on innovation and its significance in the context of economic competition. They underscore the importance of this topic, highlighting its relevance for both researchers and policymakers.
• In the second paragraph, the authors narrow down their focus to emphasize the specific role of culture in relation to innovation.
• In the third paragraph, the authors identify research gaps, noting that existing studies are often fragmented and disconnected. They then emphasize the value of conducting a systematic literature review to enhance our understanding of the topic.
• In the fourth paragraph, the authors introduce their specific objectives and explain how their insights can benefit other researchers and business practitioners.
• In the fifth and final paragraph, the authors provide an overview of the paper’s organization and structure.

In summary, this introduction stands as a solid example. While the authors deviate from previewing their key findings (which is a common practice at least in the social sciences), they do effectively cover all the other previously mentioned points.

Example 2: An effective introduction to a literature review section in an academic paper

The second example represents a typical academic paper, encompassing not only a literature review section but also empirical data, a case study, and other elements. We will closely examine the introduction to the literature review section in the paper “The environmentalism of the subalterns: a case study of environmental activism in Eastern Kurdistan/Rojhelat”, which was published in 2021 in the journal Local Environment.

The paper begins with a general introduction and then proceeds to the literature review, designated by the authors as their conceptual framework. Of particular interest is the first paragraph of this conceptual framework, comprising 142 words across five sentences:

“ A peripheral and marginalised nationality within a multinational though-Persian dominated Iranian society, the Kurdish people of Iranian Kurdistan (a region referred by the Kurds as Rojhelat/Eastern Kurdi-stan) have since the early twentieth century been subject to multifaceted and systematic discriminatory and exclusionary state policy in Iran. This condition has left a population of 12–15 million Kurds in Iran suffering from structural inequalities, disenfranchisement and deprivation. Mismanagement of Kurdistan’s natural resources and the degradation of its natural environmental are among examples of this disenfranchisement. As asserted by Julian Agyeman (2005), structural inequalities that sustain the domination of political and economic elites often simultaneously result in environmental degradation, injustice and discrimination against subaltern communities. This study argues that the environmental struggle in Eastern Kurdistan can be asserted as a (sub)element of the Kurdish liberation movement in Iran. Conceptually this research is inspired by and has been conducted through the lens of ‘subalternity’ ” ( Hassaniyan, 2021, p. 931 ).

In this first paragraph, the author is doing the following:

• The author contextualises the research
• The author links the research focus to the international literature on structural inequalities
• The author clearly presents the argument of the research
• The author clarifies how the research is inspired by and uses the concept of ‘subalternity’.

Thus, the author successfully introduces the literature review, from which point onward it dives into the main concept (‘subalternity’) of the research, and reviews the literature on socio-economic justice and environmental degradation.

While introductions to a literature review section aren’t always required to offer the same level of study context detail as demonstrated here, this introduction serves as a commendable model for orienting the reader within the literature review. It effectively underscores the literature review’s significance within the context of the study being conducted.

Examples 3-5: Effective introductions to literature review chapters

The introduction to a literature review chapter can vary in length, depending largely on the overall length of the literature review chapter itself. For example, a master’s thesis typically features a more concise literature review, thus necessitating a shorter introduction. In contrast, a Ph.D. thesis, with its more extensive literature review, often includes a more detailed introduction.

Numerous universities offer online repositories where you can access theses and dissertations from previous years, serving as valuable sources of reference. Many of these repositories, however, may require you to log in through your university account. Nevertheless, a few open-access repositories are accessible to anyone, such as the one by the University of Manchester . It’s important to note though that copyright restrictions apply to these resources, just as they would with published papers.

Master’s thesis literature review introduction

The first example is “Benchmarking Asymmetrical Heating Models of Spider Pulsar Companions” by P. Sun, a master’s thesis completed at the University of Manchester on January 9, 2024. The author, P. Sun, introduces the literature review chapter very briefly but effectively:

PhD thesis literature review chapter introduction

The second example is Deep Learning on Semi-Structured Data and its Applications to Video-Game AI, Woof, W. (Author). 31 Dec 2020, a PhD thesis completed at the University of Manchester . In Chapter 2, the author offers a comprehensive introduction to the topic in four paragraphs, with the final paragraph serving as an overview of the chapter’s structure:

PhD thesis literature review introduction

The last example is the doctoral thesis Metacognitive strategies and beliefs: Child correlates and early experiences Chan, K. Y. M. (Author). 31 Dec 2020 . The author clearly conducted a systematic literature review, commencing the review section with a discussion of the methodology and approach employed in locating and analyzing the selected records.

Having absorbed all of this information, let’s recap the essential steps and offer a succinct guide on how to proceed with creating your literature review introduction:

• Contextualize your review : Begin by clearly identifying the academic context in which your literature review resides and determining the necessary information to include.
• Outline your structure : Develop a structured outline for your literature review, highlighting the essential information you plan to incorporate in your introduction.
• Literature review process : Conduct a rigorous literature review, reviewing and analyzing relevant sources.
• Summarize and abstract : After completing the review, synthesize the findings and abstract key insights, trends, and knowledge gaps from the literature.
• Craft the introduction : Write your literature review introduction with meticulous attention to the seamless integration of your review into the larger context of your work. Ensure that your introduction effectively elucidates your rationale for the chosen review topics and the underlying reasons guiding your selection.

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• UConn Library
• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

How to write a good literature review

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list if you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can use boolean operators to help narrow down your search:

Read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models and methods? Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible, and make sure you read any landmark studies and major theories in your field of research.

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

You can use our free APA Reference Generator for quick, correct, consistent citations.

To begin organising your literature review’s argument and structure, you need to understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly-visual platforms like Instagram and Snapchat – this is a gap that you could address in your own research.

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarising sources in order.

Try to analyse patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organise your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text, your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, discussing the significance of findings in relation to the literature as a whole.
• Critically evaluate: mention the strengths and weaknesses of your sources.
• Write in well-structured paragraphs: use transitions and topic sentences to draw connections, comparisons and contrasts.

In the conclusion, you should summarise the key findings you have taken from the literature and emphasise their significance.

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarise yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

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Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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Introduction

Literature reviews take time. here is some general information to know before you start.  .

•  VIDEO -- This video is a great overview of the entire process.  (2020; North Carolina State University Libraries) --The transcript is included --This is for everyone; ignore the mention of "graduate students" --9.5 minutes, and every second is important  
• OVERVIEW -- Read this page from Purdue's OWL. It's not long, and gives some tips to fill in what you just learned from the video.  
• NOT A RESEARCH ARTICLE -- A literature review follows a different style, format, and structure from a research article.  

Steps to Completing a Literature Review

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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

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Literature reviews

What this guide covers, what is a literature review, literature review resources, types of literature reviews, what is the difference between a literature review and a systematic review, related information and guides, further help.

• Conducting your search
• Store and organise the literature
• Evaluate and critique the literature
• Different subject areas
• Find literature reviews

Reusing content from this guide

Attribute our work under a Creative Commons Attribution-NonCommercial 4.0 International License.

The literature review process involves a number of steps.

This guide focuses on:

• evaluating.

A literature review is a survey and critical analysis of what has been written on a particular topic, theory, question or method.

"In writing the literature review, the purpose is to explore what knowledge and ideas have been established on a topic, what approaches and viewpoints have been adopted, and what are their strengths and weaknesses."

Source: "Focus and frame". (2008). In Eriksson, P. & Kovalainen, A. Introducing Qualitative Methods: Qualitative methods in business research (pp. 44) . London: SAGE Publications Ltd. doi: 10.4135/9780857028044.

Get an overview on doing a literature review:

• Sage research methods online - Literature review methods map Information on the literature review methodology with links to further resources - the Project Planner, books, articles, videos and more.
• Ten simple rules for writing a literature review Gives 10 tips on how to approach and carry out a literature review. By Pautasso M (2013) Ten Simple Rules for Writing a Literature Review. PLoS Comput Biol9(7): e1003149.
• The literature review. In: Doing your undergraduate program This chapter looks at the purpose of literature reviews, how it is done, setting the boundaries of your search and more.

• More books on literature reviews A selection of literature review books available via UQ Library Search.

The type of literature review you do will depend on a variety of factors:

• Your discipline
• The purpose - undergraduate assessment, PHD thesis, journal article?
• Your lecturer or supervisor's requirements

Always follow the guidelines outlined by your lecturer or supervisor or consult the instructions for authors (for journal articles), when conducting your literature review.

• is an overview of the significant literature on a topic
• typically includes a critical analysis of each work included
• demonstrates the reviewers knowledge of the topic
• is a list of citations of research sources (books, journal articles, websites etc) on a topic
• includes a brief summary and analysis or evaluation of each citation = the annotation
• a critical assessment of all research studies on a particular research question
• has specific criteria for collecting and evaluating the literature
• includes a synthesis of the findings of the included studies
• This method developed by Griffith University's School of Environment bridges the gap between traditional narrative review methods and meta-analyses to enable students to produce results that are reliable, quantifiable and reproducible.

The requirements of narrative literature reviews are usually quite different than systematic reviews . However, you may be required to adopt some of the characteristics of a systematic approach when doing your literature review. Check the guidelines or criteria that have been set by your supervisor so you know what is expected of you.

Characteristics of reviews

• Meeting the review family: Exploring review types and associated information retrieval requirements This article defines different review types and discusses appropriate search methods for each type.
• Writing literature reviews - Student Support Student Support provides information on how to write effective literature reviews.
• Writing skills Learn strategies for good writing from the Graduate School.
• Systematic reviews An overview of systematic reviews and resources to support producing one.
• Subject guides See recommended resources in different subject areas.
• Grey literature Find literature that is not available in traditional channels of publishing and distribution.
• How to find guides Techniques and resources to find specific information formats.

Contact the Librarian team .

Phone: + 617 334 64312 during opening hours

Email: [email protected]

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support

What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

How To Write An A-Grade Literature Review

3 straightforward steps (with examples) + free template.

By: Derek Jansen (MBA) | Expert Reviewed By: Dr. Eunice Rautenbach | October 2019

Quality research is about building onto the existing work of others , “standing on the shoulders of giants”, as Newton put it. The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.

Long story short, this chapter is a pretty big deal, which is why you want to make sure you get it right . In this post, I’ll show you exactly how to write a literature review in three straightforward steps, so you can conquer this vital chapter (the smart way).

Overview: The Literature Review Process

• Understanding the “ why “
• Finding the relevant literature
• Cataloguing and synthesising the information
• Outlining & writing up your literature review
• Example of a literature review

But first, the “why”…

Before we unpack how to write the literature review chapter, we’ve got to look at the why . To put it bluntly, if you don’t understand the function and purpose of the literature review process, there’s no way you can pull it off well. So, what exactly is the purpose of the literature review?

Well, there are (at least) four core functions:

• For you to gain an understanding (and demonstrate this understanding) of where the research is at currently, what the key arguments and disagreements are.
• For you to identify the gap(s) in the literature and then use this as justification for your own research topic.
• To help you build a conceptual framework for empirical testing (if applicable to your research topic).
• To inform your methodological choices and help you source tried and tested questionnaires (for interviews ) and measurement instruments (for surveys ).

Most students understand the first point but don’t give any thought to the rest. To get the most from the literature review process, you must keep all four points front of mind as you review the literature (more on this shortly), or you’ll land up with a wonky foundation.

Okay – with the why out the way, let’s move on to the how . As mentioned above, writing your literature review is a process, which I’ll break down into three steps:

• Finding the most suitable literature
• Understanding , distilling and organising the literature
• Planning and writing up your literature review chapter

Importantly, you must complete steps one and two before you start writing up your chapter. I know it’s very tempting, but don’t try to kill two birds with one stone and write as you read. You’ll invariably end up wasting huge amounts of time re-writing and re-shaping, or you’ll just land up with a disjointed, hard-to-digest mess . Instead, you need to read first and distil the information, then plan and execute the writing.

Step 1: Find the relevant literature

Naturally, the first step in the literature review journey is to hunt down the existing research that’s relevant to your topic. While you probably already have a decent base of this from your research proposal , you need to expand on this substantially in the dissertation or thesis itself.

Essentially, you need to be looking for any existing literature that potentially helps you answer your research question (or develop it, if that’s not yet pinned down). There are numerous ways to find relevant literature, but I’ll cover my top four tactics here. I’d suggest combining all four methods to ensure that nothing slips past you:

Method 1 – Google Scholar Scrubbing

Google’s academic search engine, Google Scholar , is a great starting point as it provides a good high-level view of the relevant journal articles for whatever keyword you throw at it. Most valuably, it tells you how many times each article has been cited, which gives you an idea of how credible (or at least, popular) it is. Some articles will be free to access, while others will require an account, which brings us to the next method.

Method 2 – University Database Scrounging

Generally, universities provide students with access to an online library, which provides access to many (but not all) of the major journals.

So, if you find an article using Google Scholar that requires paid access (which is quite likely), search for that article in your university’s database – if it’s listed there, you’ll have access. Note that, generally, the search engine capabilities of these databases are poor, so make sure you search for the exact article name, or you might not find it.

Method 3 – Journal Article Snowballing

At the end of every academic journal article, you’ll find a list of references. As with any academic writing, these references are the building blocks of the article, so if the article is relevant to your topic, there’s a good chance a portion of the referenced works will be too. Do a quick scan of the titles and see what seems relevant, then search for the relevant ones in your university’s database.

Method 4 – Dissertation Scavenging

Similar to Method 3 above, you can leverage other students’ dissertations. All you have to do is skim through literature review chapters of existing dissertations related to your topic and you’ll find a gold mine of potential literature. Usually, your university will provide you with access to previous students’ dissertations, but you can also find a much larger selection in the following databases:

• Open Access Theses & Dissertations
• Stanford SearchWorks

Keep in mind that dissertations and theses are not as academically sound as published, peer-reviewed journal articles (because they’re written by students, not professionals), so be sure to check the credibility of any sources you find using this method. You can do this by assessing the citation count of any given article in Google Scholar. If you need help with assessing the credibility of any article, or with finding relevant research in general, you can chat with one of our Research Specialists .

Alright – with a good base of literature firmly under your belt, it’s time to move onto the next step.

Need a helping hand?

Step 2: Log, catalogue and synthesise

Once you’ve built a little treasure trove of articles, it’s time to get reading and start digesting the information – what does it all mean?

While I present steps one and two (hunting and digesting) as sequential, in reality, it’s more of a back-and-forth tango – you’ll read a little , then have an idea, spot a new citation, or a new potential variable, and then go back to searching for articles. This is perfectly natural – through the reading process, your thoughts will develop , new avenues might crop up, and directional adjustments might arise. This is, after all, one of the main purposes of the literature review process (i.e. to familiarise yourself with the current state of research in your field).

As you’re working through your treasure chest, it’s essential that you simultaneously start organising the information. There are three aspects to this:

• Logging reference information
• Building an organised catalogue
• Distilling and synthesising the information

I’ll discuss each of these below:

2.1 – Log the reference information

As you read each article, you should add it to your reference management software. I usually recommend Mendeley for this purpose (see the Mendeley 101 video below), but you can use whichever software you’re comfortable with. Most importantly, make sure you load EVERY article you read into your reference manager, even if it doesn’t seem very relevant at the time.

2.2 – Build an organised catalogue

In the beginning, you might feel confident that you can remember who said what, where, and what their main arguments were. Trust me, you won’t. If you do a thorough review of the relevant literature (as you must!), you’re going to read many, many articles, and it’s simply impossible to remember who said what, when, and in what context . Also, without the bird’s eye view that a catalogue provides, you’ll miss connections between various articles, and have no view of how the research developed over time. Simply put, it’s essential to build your own catalogue of the literature.

I would suggest using Excel to build your catalogue, as it allows you to run filters, colour code and sort – all very useful when your list grows large (which it will). How you lay your spreadsheet out is up to you, but I’d suggest you have the following columns (at minimum):

• Author, date, title – Start with three columns containing this core information. This will make it easy for you to search for titles with certain words, order research by date, or group by author.
• Categories or keywords – You can either create multiple columns, one for each category/theme and then tick the relevant categories, or you can have one column with keywords.
• Key arguments/points – Use this column to succinctly convey the essence of the article, the key arguments and implications thereof for your research.
• Context – Note the socioeconomic context in which the research was undertaken. For example, US-based, respondents aged 25-35, lower- income, etc. This will be useful for making an argument about gaps in the research.
• Methodology – Note which methodology was used and why. Also, note any issues you feel arise due to the methodology. Again, you can use this to make an argument about gaps in the research.
• Quotations – Note down any quoteworthy lines you feel might be useful later.
• Notes – Make notes about anything not already covered. For example, linkages to or disagreements with other theories, questions raised but unanswered, shortcomings or limitations, and so forth.

If you’d like, you can try out our free catalog template here (see screenshot below).

2.3 – Digest and synthesise

Most importantly, as you work through the literature and build your catalogue, you need to synthesise all the information in your own mind – how does it all fit together? Look for links between the various articles and try to develop a bigger picture view of the state of the research. Some important questions to ask yourself are:

• What answers does the existing research provide to my own research questions ?
• Which points do the researchers agree (and disagree) on?
• How has the research developed over time?
• Where do the gaps in the current research lie?

To help you develop a big-picture view and synthesise all the information, you might find mind mapping software such as Freemind useful. Alternatively, if you’re a fan of physical note-taking, investing in a large whiteboard might work for you.

Step 3: Outline and write it up!

Once you’re satisfied that you have digested and distilled all the relevant literature in your mind, it’s time to put pen to paper (or rather, fingers to keyboard). There are two steps here – outlining and writing:

3.1 – Draw up your outline

Having spent so much time reading, it might be tempting to just start writing up without a clear structure in mind. However, it’s critically important to decide on your structure and develop a detailed outline before you write anything. Your literature review chapter needs to present a clear, logical and an easy to follow narrative – and that requires some planning. Don’t try to wing it!

Naturally, you won’t always follow the plan to the letter, but without a detailed outline, you’re more than likely going to end up with a disjointed pile of waffle , and then you’re going to spend a far greater amount of time re-writing, hacking and patching. The adage, “measure twice, cut once” is very suitable here.

In terms of structure, the first decision you’ll have to make is whether you’ll lay out your review thematically (into themes) or chronologically (by date/period). The right choice depends on your topic, research objectives and research questions, which we discuss in this article .

Once that’s decided, you need to draw up an outline of your entire chapter in bullet point format. Try to get as detailed as possible, so that you know exactly what you’ll cover where, how each section will connect to the next, and how your entire argument will develop throughout the chapter. Also, at this stage, it’s a good idea to allocate rough word count limits for each section, so that you can identify word count problems before you’ve spent weeks or months writing!

PS – check out our free literature review chapter template…

3.2 – Get writing

With a detailed outline at your side, it’s time to start writing up (finally!). At this stage, it’s common to feel a bit of writer’s block and find yourself procrastinating under the pressure of finally having to put something on paper. To help with this, remember that the objective of the first draft is not perfection – it’s simply to get your thoughts out of your head and onto paper, after which you can refine them. The structure might change a little, the word count allocations might shift and shuffle, and you might add or remove a section – that’s all okay. Don’t worry about all this on your first draft – just get your thoughts down on paper.

Once you’ve got a full first draft (however rough it may be), step away from it for a day or two (longer if you can) and then come back at it with fresh eyes. Pay particular attention to the flow and narrative – does it fall fit together and flow from one section to another smoothly? Now’s the time to try to improve the linkage from each section to the next, tighten up the writing to be more concise, trim down word count and sand it down into a more digestible read.

Once you’ve done that, give your writing to a friend or colleague who is not a subject matter expert and ask them if they understand the overall discussion. The best way to assess this is to ask them to explain the chapter back to you. This technique will give you a strong indication of which points were clearly communicated and which weren’t. If you’re working with Grad Coach, this is a good time to have your Research Specialist review your chapter.

Finally, tighten it up and send it off to your supervisor for comment. Some might argue that you should be sending your work to your supervisor sooner than this (indeed your university might formally require this), but in my experience, supervisors are extremely short on time (and often patience), so, the more refined your chapter is, the less time they’ll waste on addressing basic issues (which you know about already) and the more time they’ll spend on valuable feedback that will increase your mark-earning potential.

Literature Review Example

In the video below, we unpack an actual literature review so that you can see how all the core components come together in reality.

Let’s Recap

In this post, we’ve covered how to research and write up a high-quality literature review chapter. Let’s do a quick recap of the key takeaways:

• It is essential to understand the WHY of the literature review before you read or write anything. Make sure you understand the 4 core functions of the process.
• The first step is to hunt down the relevant literature . You can do this using Google Scholar, your university database, the snowballing technique and by reviewing other dissertations and theses.
• Next, you need to log all the articles in your reference manager , build your own catalogue of literature and synthesise all the research.
• Following that, you need to develop a detailed outline of your entire chapter – the more detail the better. Don’t start writing without a clear outline (on paper, not in your head!)
• Write up your first draft in rough form – don’t aim for perfection. Remember, done beats perfect.
• Refine your second draft and get a layman’s perspective on it . Then tighten it up and submit it to your supervisor.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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38 Comments

Thank you very much. This page is an eye opener and easy to comprehend.

This is awesome!

I wish I come across GradCoach earlier enough.

But all the same I’ll make use of this opportunity to the fullest.

Thank you for this good job.

Keep it up!

You’re welcome, Yinka. Thank you for the kind words. All the best writing your literature review.

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Thank you for this whole literature writing review.You have simplified the process.

I’m so glad I found GradCoach. Excellent information, Clear explanation, and Easy to follow, Many thanks Derek!

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Thank you Coach, you have greatly enriched and improved my knowledge

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if anyone is to get a paper done on time and in the best way possible, GRADCOACH is certainly the go to area!

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Good morning scholar. I’m delighted coming to know you even before the commencement of my dissertation which hopefully is expected in not more than six months from now. I would love to engage my study under your guidance from the beginning to the end. I love to know how to do good job

Thank you so much Derek for such useful information on writing up a good literature review. I am at a stage where I need to start writing my one. My proposal was accepted late last year but I honestly did not know where to start

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Writing: Literature Review Basics

• What is Synthesis?
• Organizing Your Research
• Paraphrasing, Summary, or Direct Quotation?
• Introductions
• Conclusions
• All Writing Guides: Home
• CORE Library Home

The Most Important Thing

The best time to write an introduction is AFTER you write the body of your paper.

Well, how do you know what to introduce until after you've figured out what you want to say?

The best time to write an introduction is as one of the last things you do.

Basic Introduction Template

For any other sort of scholarly writing, the following basic structure works well for an introduction:

• What has been said or done on this topic?  
• What is the problem with what has been said or done?
• What will you offer to solve the problem?  (The answer to this is your thesis statement.)
• How does your solution address necessary change?

Writing an Introduction

The job of an introduction is to preview what you are going to say so the audience knows what is coming.  A good introduction starts out generally and works towards a specific statement of what you intend to discuss in your writing. 

The introduction explains the focus and establishes the importance of the subject. It discusses what kind of work has been done on the topic and identifies any controversies within the field or any recent research which has raised questions about earlier assumptions. It may provide background or history, and it indicates why the topic is important, interesting, problematic, or relevant in some way.  It concludes with a purpose or thesis statement. In a stand-alone literature review, this statement will sum up and evaluate the state of the art in this field of research; in a review that is an introduction or preparatory to a larger work, such as the Culminating Project, it will suggest how the review findings will lead to the research the writer proposes to undertake.

In a literature review, an introduction may contain the following:

• A concise definition of a topic under consideration (this may be a descriptive or argumentative thesis, or proposal), as well as the scope of the related literature being investigated. (Example: If the topic under consideration is ‘women’s wartime diaries’, the scope of the review may be limited to published or unpublished works, works in English, works from a particular location, time period, or conflict, etc.)  
• The introduction should also note what topics are being included and what are intentional exclusions. (Example: “This review will not explore the diaries of adolescent girls.”)
• A final sentence should signal the list of key topics that will be used to discuss the selected sources.

Many theories have been proposed to explain what motivates human behavior. Although the literature covers a wide variety of such theories, this review will focus on five major themes which emerge repeatedly throughout the literature reviewed. These themes are incorporation of the self-concept into traditional theories of motivation, the influence of rewards on motivation, the increasing importance of internal forces of motivation, autonomy and self-control as sources of motivation, and narcissism as an essential component of motivation. Although the literature presents these themes in a variety of contexts, this paper will primarily focus on their application to self-motivation.

Let's break that apart.

• << Previous: Paraphrasing, Summary, or Direct Quotation?
• Next: Conclusions >>
• Last Updated: Feb 12, 2024 9:02 AM
• URL: https://azhin.org/cummings/basiclitreview

© 2015 - 2024

How do I Write a Literature Review?: #5 Writing the Review

• Step #1: Choosing a Topic
• Step #2: Finding Information
• Step #3: Evaluating Content
• Step #4: Synthesizing Content
• #5 Writing the Review
• Citing Your Sources

WRITING THE REVIEW 

You've done the research and now you're ready to put your findings down on paper. When preparing to write your review, first consider how will you organize your review.

The actual review generally has 5 components:

Abstract  -  An abstract is a summary of your literature review. It is made up of the following parts:

• A contextual sentence about your motivation behind your research topic
• Your thesis statement
• A descriptive statement about the types of literature used in the review
• Summarize your findings
• Conclusion(s) based upon your findings

Introduction :   Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review:

• Define or identify the general topic, issue, or area of concern. This provides the reader with context for reviewing the literature.
• Identify related trends in what has already been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish your reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope)  - 

Body :  The body of a literature review contains your discussion of sources and can be organized in 3 ways-

• Chronological -  by publication or by trend
• Thematic -  organized around a topic or issue, rather than the progression of time
• Methodical -  the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the literature's researcher or writer that you are reviewing

You may also want to include a section on "questions for further research" and discuss what questions the review has sparked about the topic/field or offer suggestions for future studies/examinations that build on your current findings.

Conclusion :  In the conclusion, you should:

Conclude your paper by providing your reader with some perspective on the relationship between your literature review's specific topic and how it's related to it's parent discipline, scientific endeavor, or profession.

Bibliography :   Since a literature review is composed of pieces of research, it is very important that your correctly cite the literature you are reviewing, both in the reviews body as well as in a bibliography/works cited. To learn more about different citation styles, visit the " Citing Your Sources " tab.

• Writing a Literature Review: Wesleyan University
• Literature Review: Edith Cowan University
• << Previous: Step #4: Synthesizing Content
• Next: Citing Your Sources >>
• Last Updated: Aug 22, 2023 1:35 PM
• URL: https://libguides.eastern.edu/literature_reviews

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• Review Article
• Open access
• Published: 27 April 2024

Advancing the local climate zones framework: a critical review of methodological progress, persisting challenges, and future research prospects

• Jie Han   ORCID: orcid.org/0009-0003-3165-631X 1 ,
• Jingyi Cai 1 ,
• Leixin Ouyang 2 &
• Zhengxuan Liu   ORCID: orcid.org/0000-0002-2761-5078 3  

Humanities and Social Sciences Communications volume  11 , Article number:  538 ( 2024 ) Cite this article

363 Accesses

Metrics details

• Environmental studies
• Science, technology and society

The local climate zones (LCZs) classification system has emerged as a more refined method for assessing the urban heat island (UHI) effect. However, few researchers have conducted systematic critical reviews and summaries of the research on LCZs, particularly regarding significant advancements of this field in recent years. This paper aims to bridge this gap in scientific research by systematically reviewing the evolution, current status, and future trends of LCZs framework research. Additionally, it critically assesses the impact of the LCZs classification system on climate-responsive urban planning and design. The findings of this study highlight several key points. First, the challenge of large-scale, efficient, and accurate LCZs mapping persists as a significant issue in LCZs research. Despite this challenge, the universality, simplicity, and objectivity of the LCZs framework make it a promising tool for a wide range of applications in the future, especially in the realm of climate-responsive urban planning and design. In conclusion, this study makes a substantial contribution to the advancement of LCZs research and advocates for the broader adoption of this framework to foster sustainable urban development. Furthermore, it offers valuable insights for researchers and practitioners engaged in this field.

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Introduction.

Urbanization is an irreversible process that will continue to accelerate over the next three decades, resulting in a projected global urban population increase of up to 668 million (UN-Habitat 2022 ). While urbanization brings economic development, cultural exchange, and technological progress, it also concentrates people in cities, leading to higher greenhouse gas emissions and pollutants. These emissions contribute to air quality degradation, global warming, and climate change. Urban heat island (UHI), characterized by higher temperatures in urban areas compared to their surrounding rural areas, is a consequence of urbanization, driven by unique urban surfaces and anthropogenic heat release. UHI carries numerous adverse effects, including increased energy consumption, air pollution, degradation of living conditions, and elevated heat-related mortality rates. All of these challenges significantly impede sustainable development, underscoring the critical importance of identifying, mitigating, and adapting to UHI (Huang and Lu 2018 ).

The term “urban heat island” was first introduced by Balchin and Pye ( 1947 ), and it has since become a prominent research field within urban climate studies (Peng et al. 2022 , Zhang et al. 2022 , Mo et al. 2024 ). The central issue in UHI research revolves around quantifying urban heat island intensity (UHII) (Huang and Lu 2018 ). The conventional approach to UHI evaluation involves computing UHII by comparing the average temperature difference between urban and rural areas. However, this method encounters limitations due to the diverse nature of urban morphology, land cover, and human activities, leading to varying UHII results within urban areas. Consequently, UHI analysis and mitigation strategies based on these results lack precision. Another challenge with the urban-rural dichotomy lies in selecting suburban measurement points that are minimally affected by urbanization. With urbanization, the once-clear social, political, and economic boundaries between urban and rural areas have blurred. It is more accurate to describe the relationship between urban and rural areas as a continuous and dynamic system rather than a rigid dichotomy.

To address the shortcomings of the traditional “urban-rural dichotomy” in UHI research, the local climate zones (LCZs) classification system, introduced by Stewart and Oke ( 2012 ), offers a fresh research framework. This system has expanded its applications beyond UHI research and is now being employed in other domains related to sustainable urban development, including urban planning (Pradhesta et al. 2019 , Kopp et al. 2021 ), building energy consumption (Yang et al. 2020a , 2022 , Benjamin et al. 2021 ), and urban thermal comfort (Lau et al. 2019 , Wu et al. 2022 ).

Table 1 lists the existing review articles on LCZs research. Many researchers in the domain of LCZs mapping have directed their attention to the current advancements in this area. For instance, Huang et al. ( 2023 ) offered a comprehensive review of LCZs mapping, providing detailed analyses of remote sensing (RS)-based and geographic information system (GIS)-based methods. They discussed RS-based methods in terms of feature sets, classification units, training areas, classification algorithms, and accuracy assessment, while GIS-based methods were elaborated based on LCZ parameters, basic spatial units (BSUs), classification algorithms, and accuracy assessment. Quan and Bansal ( 2021 ) summarized the general LCZs mapping processes in the reviewed studies, encompassing data collection, defining BSUs, calculating urban canopy parameters (UCPs), LCZs classification, post-processing, and performance evaluation. Ma et al. ( 2021 ) conducted a timely investigation into RS-based LCZs mapping applications. They analyzed and evaluated several aspects influencing LCZs mapping performance, including mapping units/scales, transferability, sample datasets, low accuracy, and classification schemes. Meanwhile, researchers have dedicated their focus to the field pertaining to the LCZs framework. For example, Lehnert et al. ( 2021 ) provided a comprehensive analysis of the application of the LCZs framework in European urban areas, demonstrating an increasing and widely recognized use of LCZs in climate research across European cities. Xue et al. ( 2020 ) explored the applications of LCZs schemes in various research fields such as meteorology, atmospheric science, environmental science, remote sensing, architectural technology, civil engineering, and ecology by conducting a bibliometric analysis of articles citing LCZs using CiteSpace. Additionally, most review studies utilize bibliometric analysis to review LCZs research. However, bibliometric analysis has the limitation of time lag due to the literature on which it is based, which can not sufficiently reflect the latest research progress.

The mentioned studies indicate the significant attention LCZs-related research has garnered within the academic community. Nonetheless, several noticeable gaps exist: 1) Few researchers have systematically conducted critical reviews and comprehensive summaries of LCZs research, especially concerning its recent notable advancements. 2) A thorough investigation into its development, research methodologies, and broader applications, particularly in sustainable urban development contexts, is warranted. This paper’s innovations and contributions primarily involve:

1) Given recent advancements, this study comprehensively examines and categorizes research methods and application areas within the LCZs framework. This analysis provides a thorough understanding of theoretical foundations and practical applications, contributing to a more holistic comprehension of LCZs studies.

2) The paper critically evaluates the effectiveness of the LCZs classification system in supporting climate-responsive urban planning and design. This assessment is crucial in understanding the practical utility of the LCZs framework for sustainable urban development and its potential to mitigate UHI challenges.

The primary sections of this paper are structured as follows: The literature survey and corresponding quantitative analysis are presented in Literature Survey. Advancements in local climate zones framework introduces the LCZs framework and delves into the measurement of UCPs. Recent advancements in manual sampling and mapping methods of LCZs reviews the progress of LCZs research methods applied in UHI research. Application of LCZs framework in various scenarios explores the various application areas of LCZs, with a particular focus on its utility in UHI research and climate-sensitive urban design. Limitations, challenges, and future prospects engages in a discussion regarding research limitations and potential future applications of the LCZs framework. Conclusions presents the key findings and conclusions drawn from the study. This structured approach allows for a systematic and in-depth exploration of the LCZs classification system’s development and its multifaceted applications in the context of research related to sustainable urban development.

Literature survey

This study conducted a comprehensive screening of all peer-reviewed journal and conference papers that cited the original LCZs framework articles based on the Web of Science dataset. As of February 2023, a total of 1534 papers were identified. Based on this, we performed literature statistics and bibliometric analysis to quantitatively assess the current state of development of LCZs research.

Literature statistics

The literature statistics were conducted from three aspects: annual output, country distribution, and research fields. Figures 1 and 2 provide visual representations of the annual output and the country distribution of LCZs research for the period spanning from 2013 to 2022. Since the introduction of the LCZs framework in 2012, there has been a notable surge in publications related to LCZs research. Specifically, the number of publications has seen a substantial increase, starting at 17 in 2013 and reaching 300 in 2022. This upward trend underscores the escalating interest and engagement in LCZs research within the academic community and beyond. Furthermore, the distribution of countries reveals five nations that have made substantial contributions to LCZs research. China stands out with the highest number of papers, accounting for 668 publications, which amounts to approximately 43.55% of the total papers. Following China, the United States, Germany, the United Kingdom, and Australia have also made significant contributions to LCZs research, with 333, 225, 176, and 104 publications, respectively. These statistics highlight the global reach and significance of LCZs research, with diverse countries actively participating in advancing this research field.

Annual output of LCZs research.

Country distribution of LCZs research.

Table 2 provides an overview of the distribution of research fields related to LCZs. LCZs research is characterized by its interdisciplinary nature, encompassing a wide spectrum of academic disciplines. The research content of LCZs studies spans several fields: (1) Meteorology and atmospheric sciences: The LCZs framework is employed to investigate urban meteorology, evaluate the impact of urbanization on weather patterns, and develop models for urban climate simulations; (2) Environmental sciences and ecology: The LCZs classification system helps identify and quantify the effect of urbanization on ecosystems, biodiversity, and the overall environment; (3) Physical sciences: The LCZs classification takes into account physical parameters such as surface materials, building density, and thermal admittance. This classification helps physical scientists study the thermal characteristics of urban surfaces, develop models for energy balance calculations, and explore the impact of different materials on the UHI effect; (4) Geography: Geographers use LCZs framework to investigate urban morphology, land use dynamics, urban-rural interactions, and the relationship between urban form and climate; (5) Energy and fuels: The LCZs classification system helps identify areas with high energy demand or heat stress, guiding the development of energy-efficient buildings, urban cooling techniques, and renewable energy integration; (6) RS: RS is a prominent and integral research direction within LCZs. It involves the use of satellite and aerial imagery to map and monitor large-scale urban climates, often supported by GIS technologies. The multidisciplinary nature of LCZs research enables cross-disciplinary collaboration and knowledge integration, making it a versatile framework for understanding and addressing urban climate challenges.

Bibliometric analysis

The study employs the concept of “co-occurrence clustering” and utilizes the CiteSpace visualization software to conduct a bibliometric analysis of the screening results. In this analysis, the fundamental unit of information extraction and structural construction is the “keywords”. The research utilizes a “keyword co-occurrence” network to depict the knowledge structure, research evolution, and current research focal points within the LCZs application field. In this network, each node corresponds to a keyword found in the literature, and the links represent the connections between these keywords. The objective is to visually and analytically explore the nodes, links, and overall network structure, shedding light on the present state of development in the LCZs application field. This approach allows for a systematic and data-driven examination of the relationships between keywords and their significance within the context of LCZs research. It facilitates the identification of trends, patterns, and emerging areas of interest within this field, providing valuable insights for researchers and practitioners alike.

In the analyzed literature employing the LCZs framework, several recurring nodes stand out, shedding light on the primary objectives and emphases of LCZs research. The top five frequently occurring nodes include “urban heat island,” “temperature,” “climate,” “impact,” and “city,” as illustrated in Fig. 3 . These nodes collectively indicate that LCZs research primarily seeks to understand the factors influencing urban climates (“climate” and “city”), particularly the impact on temperature parameters (“temperature”). There is a notable focus on examining how the factors affect UHI (“urban heat island”), which aligns with the LCZs framework’s original purpose. The high frequency of “urban heat island” (697 times, with 144 mentions in 2021) underscores its central role in LCZs research. This centrality stems from the LCZs framework’s inception, which aimed to address the limitations of the “urban-rural dichotomy” in UHI studies, enabling a more nuanced understanding of UHI impacts and the development of effective mitigation strategies.

Keyword co-present of the analyzed LCZs literature.

Advancements in local climate zones framework

Local climate zone classification system.

LCZs are defined as areas with uniform surface cover, structure, material, and human activity, with a minimum radius of 200–500 m, which exhibit local-scale, climatic nature, and zonal representation as depicted in Fig. 4 . The LCZs classification system is based on 10 UCPs with recommended ranges, allowing for classification into 17 standard LCZ patterns, comprising 10 built types and 7 land cover types. The various LCZ types represent the diverse compositions of buildings, roads, plants, soils, rocks, and water. The names of standard built types primarily reflect three building structure characteristics (Density: compact/open; Height: high/mid/low; Material: heavy/lightweight) and building type (general/industrial). Conversely, the counterparts of standard land cover types mainly reflected the vegetation and land cover characteristics.

Schematic diagram of standard LCZs.

The process of LCZs classification usually involves four steps: data acquisition, UCPs calculation, LCZs classification, and accuracy evaluation. The first step is to collect the required information for the study area (e.g., field measurements and satellite images). The second step involves calculating UCPs using the data gathered in the previous step. A detailed description of the calculation methods for UCPs is provided in Measurement of urban canopy parameters. For LCZs classification, the results from UCPs calculation can assist in identifying the best match between field sites and LCZ classes. Additionally, LCZs subclasses can be customized when UCPs deviate from the recommended ranges of the standard set of classes. For instance, a combination of LCZ 4 (Open high-rise) and 3 (Compact low-rise) can provide LCZ 3 4 (Compact low-rise with open high-rise).

Measurement of urban canopy parameters

For achieving precise LCZs classification, obtaining accurate values for UCPs is of paramount importance. These UCPs are primarily related to surface structure parameters, including sky view factor (SVF) (Steyn 1980 , Matzarakis et al. 2007 , Liang et al. 2017 ), aspect ratio (AR) (Masson 2000 ), and height of roughness elements (HRE) (Yan and Huang 2022 , Wu et al. 2023 ). They also encompass surface cover parameters such as building surface fraction (BSF) (Yu et al. 2010 , Guo et al. 2022 , Jifroudi et al. 2022 , Wei et al. 2023 ), impervious surface fractions (ISF), and pervious surface fractions (PSF) (Deng and Wu 2013 , Sytsma et al. 2020 ). Surface fabric parameters (surface admittance and surface albedo (Bartmiński and Siłuch 2022 , Tahooni et al. 2023 )) and human activity parameters (anthropogenic heat flux (Yu et al. 2021 , Wang et al. 2022b , Liu and Li 2023 )) are equally included.

In the absence of specific heat-related indicators, most current studies rely on the geometric and ground cover values to define LCZs. Table 3 highlights the various methods employed in previous studies to measure parameters related to ground cover and geometry. Measurement methods for SVF are typically categorized as fisheye photographs, satellite images, street view images, and numerical simulations. Parameters such as AR, BSF, ISF, PSF, HRE, and TRC are primarily grouped into three categories: field measurement, satellite image calculation, and building data acquisition.

In summary, methods for measuring UCPs mainly consist of manual measurement and satellite image calculation. Manual measurement involves collecting data from a few sampling points in a region and then averaging them to determine UCP values. However, this approach is time-consuming, labor-intensive, and prone to inaccuracies, rendering it unsuitable for large-scale urban climate studies based on the LCZs framework. In contrast, alternative methods such as RS and simulation modeling can be more effectively employed for UCPs measurements. These methods offer a more efficient and accurate means of collecting UCPs, enabling a comprehensive and reliable analysis of urban climate patterns and their impact on human well-being and the environment. Furthermore, there is a pressing need to establish standardized procedures for measuring UCPs. Future research within the LCZs framework could emphasize the standardization of UCP calculation using RS and GIS data to ensure precise results.

Calculating urban heat island intensity using the LCZs framework

The LCZs framework method focuses on defining the UHI magnitude using the temperature difference between LCZs, represented by ΔT LCZ X-LCZ D , rather than the traditional “urban-rural” temperature difference (ΔT u-r ) (Stewart and Oke 2012 ). Here, LCZ X denotes any class within the LCZs classification system, while the temperature of LCZ D (low plants) serves as the baseline. This calculation method not only offers a more physically grounded understanding of UHII but also enhances its analysis and comparability. Numerous studies have affirmed the efficacy of the LCZs-based UHII calculation method. For example, Shi et al. ( 2021 ) computed surface urban heat island (SUHI) intensity by analyzing the difference in land surface temperature (LST) between LCZs and compared it with the conventional “urban-rural dichotomy” method. The results revealed that the LCZs-based UHII calculation method yielded a more precise measure of SUHI intensity. Similarly, Budhiraja et al. ( 2019 ) examined the seasonal SUHI intensity of Delhi using both LCZs-based and “urban-rural dichotomy” methods, concluding that the former provided a more detailed understanding of the relationship between urban structure and SUHI.

Two primary UHI types were assessed using the LCZs-based UHII calculation method: atmospheric urban heat island (AUHI) and SUHI. Concerning AUHI, Chen et al. ( 2021 ) explored the connection between the diurnal temperature range and AUHI intensity using the LCZs-based UHII calculation method under varying meteorological conditions categorized by precipitation. Yang et al. ( 2017 ) investigated the characteristics of local AUHI at selected LCZ sites, employing the LCZs-based UHII calculation method. Regarding SUHI, Wang et al. ( 2021 ) calculated surface urban heat island intensity (SUHII) using this method and proposed a sustainable urban green infrastructure planning strategy based on the analysis results. O’Malley and Kikumoto ( 2022 ) delved into heat storage in Tokyo Prefecture, utilizing the LCZs-based UHII calculation method to compute nocturnal-diurnal SUHI differences. Finally, Zheng et al. ( 2022 ) scrutinized the changes of LCZs and surface SUHII within Chang-Zhu-Tan’s primary urban area, employing the LCZs-based UHII calculation method.

In conclusion, the LCZs-based UHII calculation method represents a significant advancement in UHI research. Its ability to capture localized UHI variations, enhance comparability across regions, and guide targeted mitigation strategies makes it a valuable tool for urban planning and climate adaptation. However, addressing data challenges and standardization issues will be crucial to fully realize its potential for widespread application. Further research should focus on refining data acquisition and measurement techniques within the LCZs framework to ensure the accuracy and reliability of UHII assessments.

Recent advancements in manual sampling and mapping methods of LCZs research

This section explores the research methods employed within the LCZs framework for UHI research, specifically focusing on the manual sampling method for limited LCZs and LCZs mapping methods for large-scale applications.

Manual sampling method for limited LCZs

In the early stages of UHI research based on the LCZs framework, the primary emphasis was on LCZs classification through a manual sampling approach. This method involved the identification of LCZ types for a limited number of land parcels using manual techniques, such as scrutinizing satellite images, live photos, and conducting field surveys, for urban climate investigations. For instance, Yang et al. ( 2017 ) conducted a study examining the local UHI characteristics across 12 LCZs. These LCZs were selected based on a thorough review of satellite images, street-level views, and on-site fieldwork. In another research endeavor, Yang et al. ( 2018 ) investigated 14 distinct LCZs using field data and high-resolution satellite images to analyze the thermal characteristics of each location.

However, it is important to note that the manual sampling method has limitations, particularly when applied to large-scale urban climate investigations. It necessitates a substantial number of researchers to manually identify the LCZ type of each plot, which is resource-intensive and time-consuming. Moreover, there is a risk of human error during the identification process, potentially compromising the accuracy and reliability of the results. Consequently, while the manual sampling method has proven valuable for in-depth studies focusing on limited LCZs, it may not be suitable for broader urban climate investigations within expansive urban areas. In such cases, alternative LCZs mapping methods are typically preferred to ensure efficiency and accuracy.

LCZs mapping methods

The evolution of the LCZs framework has given rise to LCZs mapping methods tailored for large-scale urban climate studies. These methods simplify the representation of urban climate within the LCZs framework, enabling comparative analyses across different cities and enhancing the universality and applicability of findings. Moreover, LCZs framework facilitates the transformation of “climate language,” supporting the development of climate-sensitive urban design. LCZs mapping methods can be categorized into two types based on their data sources and classification algorithms: GIS-based and RS-based mapping methods (Tamás et al. 2015 ).

GIS-based LCZs mapping method

The GIS-based LCZs mapping method comprises six main steps, as depicted in Fig. 5 (Quan and Bansal 2021 ). Initially, it involves collecting GIS data and defining BSUs to segment the urban environment into smaller blocks for LCZs classification. Subsequently, the UCPs values for each BSU are calculated using GIS data, and the LCZ type for each BSU is determined based on the LCZs framework. Finally, post-processing is carried out to merge adjacent units for simplification and size adjustment, ultimately leading to the generation and evaluation of the LCZs map. BSUs refer to the spatial scale of LCZ classification, and the size of a BSU must meet the size requirement of the LCZs framework. The definition of BSUs is typically divided into lot area polygons (Lelovics et al. 2014 , Unger et al. 2014 ), urban blocks (Wu et al. 2018 , Quan 2019 ), and regular grids (Chen et al. 2020a ). Additionally, pre-processing of the GIS data is often necessary before calculating the UCPs. Common pre-processing includes: (1) Data cleaning: GIS datasets may contain errors or inconsistencies, such as missing values, outliers, or topological errors. It’s important to clean the data to avoid inaccuracies. (2) Spatial resolution matching: GIS datasets may have different spatial resolutions, which can affect the accuracy of UCPs calculations. Pre-processing is necessary to resample or aggregate datasets to a common spatial resolution to ensure compatibility for analysis. (3) Others: Steps such as data normalization and data integration are performed as needed. Overall, pre-processing of GIS data is essential before calculating UCPs to ensure data cleanliness, compatibility, and suitability for analysis, leading to more accurate and reliable results.

General steps of GIS-based LCZs mapping method (Quan and Bansal 2021 ).

The use of GIS-based LCZs mapping has gained traction in urban climate studies since the pioneering study by Lelovics et al. ( 2014 ) in Hungary. For example, Quan et al. ( 2017 ) developed and tested a bottom-up, fine-grained 3D LCZs mapping method utilizing GIS and land cover data, with urban block units serving as BSUs. Geletič et al. ( 2019 ) employed the GIS-based LCZs mapping method to explore the inter-zone and intra-zone seasonal variations of SUHI in three central European cities.

Despite its precision, the GIS-based LCZs mapping method has limitations. Firstly, obtaining accurate and consistent ground truth data for calculating UCPs poses a significant challenge, leading to limited availability of urban data. The inability to acquire comprehensive and detailed datasets for estimating UCPs, particularly those related to thermal aspects, can significantly impact the accuracy of LCZs mapping. Secondly, the merging of BSUs exists in post-processing, making it challenging to find optimal solutions, particularly in intricate urban environments. This process may not fully capture the complexity of LCZs mapping.

RS-based LCZs mapping method

RS is a technology that leverages remote sensors to collect data from target objects and analyze it to extract valuable information. Advances in RS information acquisition, transmission, and storage technologies have diminished the limitations of RS applications due to improved data quality and the increased availability of multiple RS data sources (Liu et al. 2006 ). RS satellites streamline fieldwork complexity and time intervals while delivering quantifiable and qualitative data (Dhingra and Kumar 2019 ). Optical RS imagery is gradually favored for identifying and categorizing land types and has become a pivotal research area.

RS-based LCZs mapping methods also have several limitations. One key limitation is the spatial and temporal resolution of the RS data. RS data may not always provide complete coverage or may be affected by cloud cover, which means that RS images need to be processed for stitching. However, since the spatial and temporal resolution of different remotely sensed images may vary, the stitching process may impact the accuracy and completeness of the LCZs mapping. Additionally, RS-based LCZs mapping requires specialized knowledge in remote sensing and image processing, which can be a barrier for non-remote sensing professionals. This limitation restricts the widespread application of RS-based LCZs mapping in urban planning and climate studies.

However, compared to GIS-based approaches, RS-based LCZs mapping methods offer several advantages, including higher resolution, finer spatial and temporal data, and the ability to quickly cover large areas. As a result, RS-based LCZs mapping has become the preferred approach for LCZs classification.

To enhance the accuracy of LCZs map classification, RS researchers have employed various benchmark datasets and classifiers. Regarding the benchmark dataset, Hu et al. ( 2018 ) utilized Sentinel-1 Dual-Pol data in LCZs mapping. Yang et al. ( 2020b ) employed multi-source datasets, including Luojia1-01 nighttime light imagery, Landsat-8, Sentinel-2, and building vector data, to generate LCZs maps. They found that a combination of object-based and pixel-based data with multi-source data improved LCZs mapping workflow. Machine learning classifiers, such as random forests and support vector machines (Xu et al. 2017 , Hu et al. 2018 , Hay Chung et al. 2021 ), are widely used for LCZs classification based on free multi-temporal RS data. In recent years, deep learning techniques have also been employed in RS-based LCZs mapping, as artificial intelligence has advanced. For example, Liu et al. ( 2019 ) combined object-based image analysis with convolutional neural networks (CNN) for LCZs mapping. Huang et al. ( 2021 ) introduced a CNN-based LCZ classification model for LCZs mapping in 32 Chinese cities. Their model achieved high overall accuracy in more than 50% of the cities.

Urban climate studies based on the LCZs framework face notable challenges due to the demand for expertise in meteorological science, RS, and machine learning, as well as data availability issues and non-standardized urban description methods. To address these challenges, Bechtel et al. ( 2015 ) proposed the world urban database and access portal tool (WUDAPT) protocol for LCZs mapping, which was developed ultimately into the LCZs generator (Demuzere et al. 2021 ), an online platform that generates LCZs mapping solely needing a training area file as input and also provides automated accuracy assessment. This approach aims to collect, store, and disseminate climate-related data on urban physical geography globally. The WUDAPT approach merges local expert knowledge with the LCZs framework to categorize the urban landscape into LCZs, generating LCZs maps for urban regions. The WUDAPT, outlined in Fig. 6 , has been widely adopted for urban climate studies in numerous regions. For example, Demuzere et al. ( 2022 ) generated a 100 m-resolution global LCZs map, accessible for download at https://doi.org/10.5281/zenodo.6364594 . Cai et al. ( 2018 ) created an LCZs map for the Yangtze River Delta megaregion in China. Ren et al. ( 2019 ) generated LCZs maps for over 20 cities and three major economic regions in China, offering recommendations for enhancement. Demuzere et al. ( 2019 ) constructed LCZs maps for Europe. Beyond urban climate studies, WUDAPT finds applications in various domains, including urban pollution (Shi et al. 2019 ) and multi-scale urban atmospheric modeling (Ching et al. 2019 ).

WUDAPT workflow (Bechtel et al. 2015 ).

LCZs mapping methods represent a pivotal advancement within the LCZs framework, enabling more extensive and systematic urban climate studies. These methods are indispensable for gaining insights into urban climatology, which is crucial for informed urban planning and climate-responsive urban design. While both GIS-based and RS-based LCZs mapping methods offer advantages, it’s essential to consider their respective strengths and limitations. GIS-based approaches provide high precision but may suffer from data availability issues and the complexity of post-processing. In contrast, RS-based methods offer freely available multi-temporal data and can quickly capture large-scale urban environments but may require extensive computational resources and expertise. The integration of machine learning and deep learning techniques into RS-based LCZs mapping has significantly improved classification accuracy and efficiency. However, these methods often demand large training datasets and computational resources. Further research should focus on optimizing these techniques for resource-constrained environments. The WUDAPT protocol stands out as a promising approach for LCZs mapping, offering generality, simplicity, and objectivity. Its reliance on local expert knowledge enhances accuracy, especially in areas with limited data availability. However, challenges persist in implementing this protocol universally, particularly in regions lacking local expertise.

In summary, LCZs mapping methods represent a pivotal milestone in urban climate research. They offer versatile tools for understanding and addressing the UHI effect and other climate-related urban challenges. As technology and data availability continue to advance, these methods are poised to play an increasingly prominent role in shaping sustainable and climate-resilient cities.

Application of LCZs framework in various scenarios

The application domains of the LCZs framework can be categorized and analyzed based on the keywords found in the screened literature. This analysis spans three principal areas: (1) LCZs framework in UHI studies: The primary application of the LCZs framework remains in the domain of UHI research. It provides a valuable tool for investigating the causes and consequences of UHIs, helping researchers better comprehend their impacts on urban climates and devising strategies to mitigate them. Given the growing significance of UHI effects in urban areas, continued research in this area is essential. (2) LCZs research contributions to urban design and climate change mitigation: LCZs research also makes substantial contributions to urban design and climate change mitigation efforts. The framework enables a more refined understanding of how urban structures and land use impact local climates. Consequently, it aids urban planners and policymakers in developing climate-sensitive urban designs and strategies to reduce the UHI effect and its associated challenges. (3) LCZs framework in diverse fields: LCZs research has found applications in various other domains, such as urban ventilation, precipitation, thermal comfort, carbon emissions, and building energy consumption. This indicates the versatility of the LCZs framework and its potential to inform a broad spectrum of urban-related research.

In summary, the LCZs framework has evolved to become a valuable tool in various research scenarios. While its origins lie in addressing UHI research limitations, it now extends its influence to inform urban design, climate change mitigation, and a range of interdisciplinary studies. Its adaptability and versatility underscore the continued relevance of LCZs research in addressing contemporary urban challenges.

LCZs framework in urban heat island studies

UHI research is crucial for understanding the impact of urban environments and devising strategies to mitigate UHI effects. Traditional studies have focused on 2D built environment parameters, such as building density, road density, and green space area, extracted from available data sources like weather data or satellite imagery for 2D planar UHI studies. Recent investigations have revealed that 3D built environment factors, including building height and SVF, have a more substantial influence on UHI than the 2D parameters (Luo et al. 2023 ). Consequently, there is a growing need for research that assesses and characterizes UHI through 3D spatial analysis, rather than the planar UHI estimation (Kim and Brown 2021 ). The LCZs system, which integrates both 2D and 3D UCPs, is well-suited for 3D UHI studies and can contribute to advancing the understanding of UHI and its influencing factors.

Table 4 provides examples of UHI research conducted using the LCZs framework, covering various climate types and research contents. These studies span different climate types, including tropical, subtropical, temperate, and more. UHI research typically falls into two categories: SUHI, which concerns the temperature difference between urban and rural areas at the surface level, and AUHI, which examines corresponding air temperature differences. Temperature variables in UHI studies can further be categorized into LST and air temperature, depending on the type of UHI under investigation. Research objectives encompass the identification, influencing factors, and mitigation strategies associated with UHI. UHI studies employ four primary measurement methods, including fixed measurement (utilizing fixed meteorological stations or establishing stationary observation points for thermal environment measurements), mobile measurement (employing mobile vehicles equipped with climate observation instruments to collect and record climate data along predefined routes), ground measurement (retrieving LST using thermal infrared data), and numerical simulation.

Given the dispersed nature of measurement points and the limited equipment available for LCZs investigations, many UHI studies opt for mobile measurement or LST retrieval methods to gather temperature data across extensive areas. Furthermore, contemporary LCZs framework research has shifted its focus from single-city examinations to comparative analyses between cities. This shift highlights the generalizability of the LCZs framework and its contributions to the growing trend of multi-regional urban climate research.

LCZs research contributions to urban design and climate change mitigation

Well-planned cities are essential for achieving sustainable urban development (Bai 2018 ). Climate-sensitive urban design plays a pivotal role in addressing the challenges posed by rising temperatures, which threaten residents’ thermal comfort (Kim and Brown 2021 ). However, existing urban planning systems struggle to cope with the complexities of local, regional, and global warming. Integrating climate considerations into data requirements and analysis methods is crucial for practical urban design applications (Perera and Emmanuel 2018 ).

The development of urban climate mapping systems has emerged as a responsive tool for climate-conscious urban planning. LCZs offer a structured classification system for land surface characteristics, forming the basis for surface parameterization methods (Ren et al. 2011 , Jin et al. 2020 ). LCZs facilitate the examination of the relationship between urban morphology and climate, providing meteorological data that informs building and urban design decisions. This framework has yielded significant insights into climate-responsive urban design, as exemplified by recent research endeavors.

For instance, Perera and Emmanuel ( 2018 ) utilized the LCZs framework to guide urban planning in Colombo, establishing it as a valuable theoretical foundation for crafting climate-sensitive cities. Likewise, Maharoof et al. ( 2020 ) applied the LCZs framework to investigate the implementation of climate-sensitive urban planning in densely populated urban areas, as illustrated by their case study of Glasgow city center. Another study by Pradhesta et al. ( 2019 ) dissected the critical components of thermal comfort within the LCZs framework, emphasizing factors such as roughness feature height, packing density, surface cover, and thermal admittance of materials. These components prove pivotal in the design of urban spaces that prioritize residents’ thermal comfort.

In essence, the LCZs framework offers a powerful tool for formulating climate-sensitive urban design strategies that enhance the quality of life and the sustainability of our cities. Climate-conscious urban design based on LCZs revolves around several key facets:

i) Green infrastructure: Integrating green infrastructure into urban planning stands as a critical measure for mitigating the effects of climate change on cities and their inhabitants. A comprehensive evaluation by Emmanuel and Loconsole ( 2015 ) underscores the effectiveness of green infrastructure options in combatting urban overheating, particularly within the context of a warming climate. Notably, increasing green coverage by approximately 20% over current levels could potentially eliminate up to half of the projected extra UHI effect by 2050 (Emmanuel and Loconsole 2015 ). Further insights from Kotharkar et al. ( 2020 ) reveal that greening initiatives not only serve as cooling strategies but also enhance pedestrian-level comfort. Intriguingly, their research highlights the superior results achieved by planting vegetation along streets, as opposed to concentrating greenery in designated areas. Li et al. ( 2022b ) further advocate for the moderation of SUHI through the strategic implementation of urban blue-green infrastructure. Stepani and Emmanuel ( 2022 ) advocate optimizing green spaces within public realms rather than merely increasing their quantity, emphasizing that climate-responsive design necessitates a diverse array of solutions, extending beyond green infrastructure.

ii) Blue infrastructure: The concept of blue infrastructure encompasses a network of natural and artificial water systems, including rivers, lakes, canals, and drainage systems, which serve as vital resources for human communities. Li et al. ( 2022b ) recommended harnessing the seasonal variations and spatial distribution of water bodies to enhance the cooling performance of LCZ G (Water). Factors such as distance and flow rates within rivers significantly influence the cooling effects, making them key considerations for urban planners and policymakers. Furthermore, they stress the importance of accounting for the growing risks of floods and droughts in East African cities, necessitating the design of blue infrastructure capable of adapting to seasonal variations and changing climates.

iii) Building design: Building resilience to climate change-induced extreme weather events is a crucial consideration in urban design. Passive cooling strategies, including cool roofs, emerge as effective means to reduce energy consumption and mitigate the UHI effect. Kotharkar et al. ( 2020 ) highlight the efficacy of cool roofs, specially designed to reflect more sunlight and absorb less heat than traditional roofing materials, particularly in densely populated urban areas.

iv) Street design: Urban streets represent a significant component of contemporary urban planning, encompassing approximately one-quarter of urban areas. They wield considerable influence in shaping comfortable urban environments. However, the climate-sensitive street design goes beyond rigid one-size-fits-all approaches. Maharoof et al. ( 2020 ) advocate for the integration of LCZ parameters with form-based considerations such as orientation and façade geometry. This nuanced approach recognizes that different street typologies may demand distinct design strategies, underscoring the importance of tailoring designs to specific urban contexts.

v) Other considerations: Research by O’Malley and Kikumoto ( 2022 ) suggests that mitigating UHI effects can be achieved through constructing lower-rise and open LCZs. They note that high-rise buildings possess larger heat storage capacities relative to lower-rise structures. Additionally, Zheng et al. ( 2022 ) proposed the full utilization of the cooling potential inherent in LCZ A-D and LCZ G and emphasized the need for judicious regulation of construction land areas (built LCZs) in future urban development plans.

Leveraging insights from LCZs-based research, climate-sensitive urban design should center around the integration of green and blue infrastructure, innovative building design, and flexible street design elements to counter the adverse impacts of climate change and foster the creation of sustainable, climate-responsive urban environments.

i) Green-blue infrastructure: Urban areas can benefit significantly from nature-based solutions, such as green roofs, gardens, and urban forests. These solutions serve dual purposes, including mitigating the negative impacts of climate change and promoting biodiversity. Furthermore, green corridors, such as tree-lined streets and bike paths, serve as multifunctional assets. They not only improve air quality but also offer enhanced mobility options for residents and reduce noise pollution. Water features, such as fountains and ponds, not only enhance the aesthetic appeal of public spaces but also provide cooling through evaporation.

ii) Building design: To mitigate UHI effects, building design should incorporate various strategies, including green roofs, cool roofs, shade provision, and sustainable materials. Green roofs are particularly advantageous because they contribute to cooling both buildings and their surroundings by absorbing and subsequently releasing moisture through transpiration. Additionally, cool roofs reflect sunlight and possess lower heat absorption than traditional roofing materials. The reduction in heat transfer into buildings beneath the roof not only lowers cooling costs but also enhances indoor comfort during hot weather. Moreover, building design can introduce shading solutions in outdoor areas, thereby reducing the amount of sunlight absorbed by buildings and their surroundings, thus contributing to cooler environments. Sustainable building materials, such as recycled steel, bamboo, and reclaimed wood, can play a pivotal role in reducing the environmental footprint of construction, ensuring that buildings are more sustainable, efficient, and comfortable.

iii) Street design: The design of urban streets plays a crucial role in mitigating UHI effects. Incorporating vegetation, green roofs, and other green elements into street design can effectively provide shade and evaporative cooling. Furthermore, using permeable pavement materials allows rainwater to penetrate the surface, promoting evaporation and reducing the amount of heat absorbed and re-emitted by the pavement. This is particularly important as impervious surfaces, like concrete and asphalt, tend to absorb and re-emit substantial amounts of heat, exacerbating UHI effects. By reducing the prevalence of impervious surfaces in street design, the adverse impacts of UHI can be mitigated. Additionally, thoughtful street furniture design, including streetlights and bus shelters, can be employed to provide shade and further reduce UHI effects.

In summary, urban design strategies that incorporate green-blue infrastructure, utilize innovative building design techniques, and employ street design elements prioritizing vegetation and sustainability offer comprehensive solutions to mitigate the adverse effects of UHI. These strategies enhance the overall resilience and comfort of urban areas, preparing them for the challenges posed by climate change.

Applications of the LCZs framework in other domains

Urban climate studies.

Beyond its primary application in UHI studies, the LCZs framework offers substantial utility across various domains of urban climate research. This adaptable framework enables researchers to explore both spatial and temporal dynamics of ventilation and precipitation patterns at a local scale, providing crucial insights for developing effective strategies to mitigate the environmental and health impacts of urbanization. For instance, Zhao et al. ( 2020 ) effectively employed the LCZs framework to analyze local-scale urban ventilation performance in Shenyang. In another study, Yang et al. ( 2019a ) evaluated the ventilation efficiency of different LCZs in Shanghai by assessing the frontal area index across various LCZ types. Chen et al. ( 2021 ) conducted a quantitative assessment of the relationship between daily temperature variations and UHII under varying meteorological conditions, classifying data using precipitation as a criterion. Additionally, Shi et al. ( 2022 ) assessed the influence of urban ventilation corridors on UHII using the LCZs framework. Yang et al. ( 2020c ) explored the spatial and temporal variations in humidity within the urban canopy across eight LCZ plots in Nanjing, analyzing the interplay between humidity differences, condensation precipitation events, meteorological parameters, and UHI. In a related study, Savić et al. ( 2020 ) scrutinized precipitation patterns in different urbanization settings by segregating areas into “urbanized” and “non-urbanized” based on LCZs classifications.

In summation, the utilization of the LCZs framework within urban climate research enhances our comprehension of the intricate connections between urban design and the multifaceted facets of urban climate. This broader perspective empowers researchers to devise effective strategies aimed at mitigating the repercussions of urbanization on the environment and human well-being, ultimately contributing to the enhancement of urban living conditions.

Enhancing outdoor thermal comfort

The quality of outdoor thermal comfort significantly influences the livability of urban areas. Changes in urban surfaces can substantially affect LST, consequently leading to elevated air temperatures and increased heat stress on urban residents (Lau et al. 2019 ). The LCZs framework proves to be a valuable tool in advancing research on outdoor thermal comfort by capturing the nuances of urban surface characteristics. For instance, Lau et al. ( 2019 ) employed a combination of questionnaires and field measurements to gauge subjective thermal sensations within eight distinct LCZs in Hong Kong. Unger et al. ( 2018 ) examined daily and seasonal fluctuations of outdoor human thermal perceptions, scrutinizing diverse LCZ types based on meteorological data. On a quantitative note, Liu et al. ( 2018 ) analytically assessed the levels of outdoor thermal comfort within nine LCZs in Shenzhen, dissecting the impact of various urban spatial characteristics. Schibuola and Tambani ( 2022 ) engaged in an evaluation of outdoor thermal comfort using the LCZs framework, offering a basis for comparative analysis of mitigation strategies. Meanwhile, Unal Cilek and Uslu ( 2022 ) analyzed the thermal conditions in urban green spaces across three distinct canopy cover scenarios using LCZs framework. Lastly, Wu et al. ( 2022 ) assessed the thermal comfort levels in Shenzhen throughout the year 2020 based on the LCZs framework.

These studies demonstrate that the LCZs framework enables a more profound comprehension of how urban surface characteristics affect outdoor thermal comfort. This understanding is crucial for developing and optimizing mitigation strategies in urban planning and design to enhance the quality of life and comfort for urban residents.

Tackling carbon emissions and building energy consumption

Cities play a significant role in global energy consumption and carbon dioxide emissions (Zhou 2022b ), making the development of sustainable urban areas pivotal for achieving climate stability objectives (Zhou 2023 , Zhou et al. 2023 ). The form and function of the built environment closely intertwine with its carbon emission patterns. Hence, the LCZs framework emerges as a valuable tool for research focused on mitigating carbon emissions and optimizing building energy efficiency. Through the creation of a regional carbon map grounded in the LCZs framework, researchers can furnish urban planners and decision-makers with crucial insights into urban carbon emissions, thereby bolstering strategic initiatives for carbon reduction and management.

Recent studies have harnessed the potential of the LCZs framework to scrutinize and chart building carbon emissions and energy utilization within urban landscapes. Notably, Wu et al. ( 2018 ) established correlations between building carbon emissions and LCZs classifications, culminating in a detailed mapping of LCZs-based building carbon emissions in Shanghai. This research enables a granular understanding of urban-scale carbon dynamics, essential for localized mitigation efforts. Additionally, Sharifi et al. ( 2018 ) introduced a novel LCZs-based urban carbon mapping method, offering a standardized approach to urban carbon assessment. This method found application in major global cities like Bangkok, Shanghai, and Tokyo, facilitating comprehensive carbon analysis. Moreover, the adaptability of the LCZs framework extends to energy consumption assessments for city-level energy management and planning. For instance, Yang et al. ( 2019b ) devised a diagnostic equation for daily maximum UHI indices grounded in the LCZs framework, effectively applying it to simulate building energy consumption. In a similar vein, Kotharkar et al. ( 2022 ) explored cooling loads and energy requisites for two distinct building typologies, leveraging the LCZs framework for insights into energy planning.

Collectively, these studies underscore the versatility and promise of the LCZs framework in guiding urban sustainability endeavors and informed energy planning, ultimately steering cities toward a greener, more energy-efficient future.

Limitations, challenges, and future prospects

Limitations and challenges.

While the LCZs framework presents a promising avenue for standardizing the exchange of global urban temperature data, its widespread adoption faces challenges due to the lack of a unified approach to data sourcing and LCZs classification, leading to inconsistencies in LCZs framework research. To ensure methodological consistency, it is essential to establish a standardized LCZs framework research protocol. The WUDAPT method, designed for data sharing and user-friendliness, shows promise for future urban climate studies based on LCZs mapping. However, a critical challenge remains in improving this method’s accuracy. Consequently, a key concern in LCZs research is developing a large-scale, effective, and precise LCZs mapping approach by leveraging various benchmark datasets and classifiers. This paper highlights current issues in the LCZs mapping process and suggests potential enhancements.

i) Data availability: Data availability poses significant challenges for LCZs mapping, stemming from several factors. These include limitations in the spatial and temporal resolution of RS data, difficulties in obtaining accurate and consistent ground truth data for calculating UCPs, the high cost associated with accessing high-quality RS data, etc. These challenges emphasize the need for a generalizable framework that addresses data availability issues. The WUDAPT team is actively working towards this goal and has curated a list of datasets for UCPs calculation, including building data, tree data, and urban population data, which can be accessed on the official website ( https://www.wudapt.org/third-party-data/ ).

ii) RS-based mapping: RS-based mapping predominantly relies on freely available Landsat satellite image data. However, the limited image resolution of Landsat data can compromise LCZs mapping accuracy. To mitigate this limitation, the use of low-cost and user-friendly unmanned aerial vehicles (UAVs) devices for high-resolution RS image capture is worth considering. This approach can mitigate the impact of weather conditions and cloud cover on images, ultimately enhancing the precision of training sample identification and LCZs classification.

iii) Training samples: The overall accuracy of the WUDAPT method depends on the precise identification of LCZ types within the training samples. However, challenges may arise during data collection and UCPs calculation due to limited professional knowledge among researchers, potentially leading to inaccurate LCZs identification. To mitigate these challenges, the accuracy of training sample recognition can be improved through the standardization of data collection and UCPs calculation processes. This will help reduce subjective errors and address expertise-related constraints that can hinder manual recognition.

iv) Classifier: Apart from training samples, the classifier’s ability to achieve high-precision LCZ type recognition is pivotal in LCZs mapping research. Recent advancements in artificial intelligence, particularly deep learning, have revolutionized image recognition and found widespread application in image classification tasks. Consequently, the emerging trend is to leverage neural network algorithms to achieve large-scale, efficient, and precise LCZs mapping.

By addressing these challenges and limitations, the LCZs framework can evolve into a more robust tool for urban climate research and planning, ensuring improved accuracy and consistency across studies.

Future prospects

The LCZs framework’s generality, simplicity, and objectivity make it remarkably versatile, positioning it for extensive application across various future research domains. Beyond its current role in UHI effect research, the framework exhibits potential for a plethora of other areas, such as urban design, outdoor thermal comfort, carbon emissions, building energy consumption. The trajectory of LCZs framework research can be delineated into the following directions:

i) Enhancing understanding of UHI: Previous studies evaluating UHI effects have predominantly relied on 2D planar analysis, which does not account for the 3D physical form of cities. The LCZs framework provides an avenue for 3D spatial analysis, facilitating a more comprehensive evaluation of UHII. This advancement can significantly enhance our understanding of UHI effects and foster the development of innovative UHI mitigation strategies.

ii) Urban design: The LCZs framework serves as a valuable tool for identifying climate risks within urban areas. Urban planners, government decision-makers, and stakeholders can leverage this framework to formulate plans for climate-sensitive urban development, thereby promoting the creation of sustainable and resilient cities. Through the utilization of the LCZs framework, these stakeholders can gain valuable insights into potential climate risks, enabling them to proactively implement measures that enhance the effectiveness and efficiency of urban planning and development.

iii) Exploring complex urban climates: While recent urban climate studies have started to consider the influence of complex geographical factors such as topography and water bodies, there remains a research gap concerning mountainous cities. These cities, characterized by unique topographical elements and complex urban climates, have received comparatively less research attention. Therefore, future urban climate research can delve into the analysis of urban climates in mountainous cities using the LCZs framework. By leveraging this framework, researchers can gain a deeper understanding of the intricate interactions between topographical features and urban climates in these unique settings.

iv) LCZs-based economic-environmental analysis: Economic-environmental analysis aids policymakers and businesses in harmonizing economic growth with environmental sustainability by quantifying the environmental impacts of economic activities (Zhou 2022a ). Future LCZs research can evolve towards economic-environmental analysis. The LCZs framework provides a foundational understanding of urban physical characteristics and functions, which can be correlated with economic activities and environmental impacts. Integrating economic analysis into LCZ studies, such as integrating lifecycle assessment methods to quantify the environmental impacts of various urban development scenarios, enables researchers to investigate the cost-effectiveness of diverse urban development strategies, evaluate the economic implications of carbon emission reduction, and assess the financial advantages of sustainable building practices.

These future research directions promise to further amplify the applicability and impact of the LCZs framework in urban climate studies, urban planning, economic activities, and climate-conscious urban development.

Conclusions

This study provides a systematic and critical overview of LCZs framework research, exploring its evolution, current status, and future prospects based on recent advancements. It underscores the LCZs classification system’s effectiveness in guiding climate-responsive planning and design. The study’s key contributions are summarized as follows:

1) The proliferation of publications on the LCZs framework has been remarkable, escalating from 17 in 2013 to 300 in 2022. This surge in research reflects a prominent trend towards interdisciplinary collaboration, with LCZs research encompassing ten primary categories, including meteorology atmospheric sciences, environmental sciences ecology, and physical sciences among others.

2) The ongoing challenge of achieving large-scale, efficient, and accurate LCZs mapping remains a central concern in LCZs research. Efforts to address this challenge have been underway, with researchers integrating diverse benchmark datasets, employing UAVs, and utilizing deep learning classifiers.

3) In the realm of UHI studies, the LCZs framework has demonstrated its suitability for 3D UHI analysis, enriching the comprehension of UHI dynamics and their repercussions on urban environments. Recent LCZs framework investigations have evolved from single-city analyses to comparative studies encompassing multiple cities. Moving forward, the LCZs framework holds promise for deciphering the complexities of urban climates influenced by intricate geographical factors.

4) For climate-responsive urban design, the LCZs framework serves as an invaluable instrument for devising strategies that prioritize climate sensitivity in urban planning and development. The integration of green and blue infrastructure, building design principles, and innovative street design emerges as fundamental elements in fostering climate-conscious cities through the LCZs framework.

5) The LCZs framework exhibits versatility across various research domains, including outdoor thermal comfort, carbon emissions analysis, and building energy consumption assessments. Its application contributes significantly to advancing ecological urban construction and promoting sustainable urban development.

In summation, the LCZs framework stands out as a powerful instrument with broad implications for urban climate research, urban planning, and the advancement of climate-resilient and sustainable cities. Its ongoing evolution and refinement are poised to catalyze innovation and advancements in these crucial domains.

Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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Acknowledgements

This work was supported by Innovation Project of Guangxi Graduate Education (YCSW2023306), Natural Science Foundation of Guangxi Province of China (No.2018GXNSFAA281212).

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Jie Han, Nan Mo & Jingyi Cai

Department of Mechanical Engineering, University of Akron, Akron, OH, USA

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Jie Han: Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Writing—original draft. Nan Mo: Conceptualization, Formal analysis, Investigation, Methodology, Writing—original draft. Jingyi Cai: Conceptualization, Formal analysis, Investigation, Methodology, Writing—review & editing. Leixin Ouyang: Conceptualization, Formal analysis, Investigation. Zhengxuan Liu: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Writing—original draft, Writing—review & editing.

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Han, J., Mo, N., Cai, J. et al. Advancing the local climate zones framework: a critical review of methodological progress, persisting challenges, and future research prospects. Humanit Soc Sci Commun 11 , 538 (2024). https://doi.org/10.1057/s41599-024-03072-8

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Intelligent environments and assistive technologies for assisting visually impaired people: a systematic literature review

• Published: 03 May 2024

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• Leandro Rossetti de Souza 1 ,
• Rosemary Francisco 2   na1 ,
• João Elison da Rosa Tavares 1   na1 &
• Jorge Luis Victória Barbosa 1   na1  

Intelligent environments (IE) refer to physical spaces imbued with pervasive and seamless intelligence, created to proactively support individuals in their daily routines. Developments in technologies such as the internet of things (IoT) and artificial intelligence (AI) have taken these environments from theoretical notions to practical realities. Simultaneously, the field of ambient assisted living (AAL) has made significant strides. Evolving from AT, AAL represents an application of IE that specifically seeks to enable individuals-especially those with disabilities or the elderly-to lead healthier, more independent, and dignified lives through the assistance of technology integrated within their living environments. The confluence of IE and AAL has led to the rise of innovative solutions aimed at enhancing the lives of individuals with special needs, such as the visually impaired people (VIP). This research presents a systematic literature review investigating the utilization of IE, underpinned by AAL principles, in supporting VIPs. Initially, a pool of 14,760 studies was obtained from 9 databases, all published up to December 2022. After applying specific inclusion and exclusion criteria, this pool was reduced to 101 articles. Each of these articles was reviewed, analyzed, and categorized into four functional and operating principle categories to address five research questions. The study proposes multiple taxonomies as an approach to holistically synthesize the various technologies and devices categorized in the reviewed articles. Emerging research challenges and trends in this domain are highlighted, with a substantial trend being the escalating use of deep learning (DL) techniques. These techniques have been pivotal in the development of systems focused on object detection, path recognition, and navigation for devices, particularly smartphones, geared towards enhancing the lives of VIPs.

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Souza, L.R.d., Francisco, R., Rosa Tavares, J.E.d. et al. Intelligent environments and assistive technologies for assisting visually impaired people: a systematic literature review. Univ Access Inf Soc (2024). https://doi.org/10.1007/s10209-024-01117-y

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• Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice
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• http://orcid.org/0000-0001-6477-0117 Irina Gessl 1 ,
• http://orcid.org/0000-0002-1849-5123 Garifallia Sakellariou 2 , 3 ,
• Brigitte Wildner 4 ,
• http://orcid.org/0000-0002-1647-2083 Georgios Filippou 5 , 6 ,
• http://orcid.org/0000-0003-1526-4052 Peter Mandl 1 ,
• Maria Antonietta D’Agostino 7 ,
• http://orcid.org/0000-0002-4527-852X Victoria Navarro-Compán 8
• 1 Division of Rheumatology, Internal Medicine 3 , Medical University of Vienna , Vienna , Austria
• 2 Department of Internal Medicine and Therapeutics , Università di Pavia , Pavia , Italy
• 3 Istituti Clinici Scientifici Maugeri SpA SB IRCCS , Pavia , Italy
• 4 University Library , Medical University of Vienna , Wien , Austria
• 5 Rheumatology , IRCCS Ospedale Galeazzi - Sant'Ambrogio , Milan , Italy
• 6 Department of Biomedical and Clinical Sciences , University of Milan , Milan , Italy
• 7 Rheumatology Department , Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS , Rome , Italy
• 8 Department of Rheumatology , University Hospital La Paz, IdiPaz , Madrid , Spain
• Correspondence to Dr Victoria Navarro-Compán, Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain; mvictoria.navarroc{at}gmail.com

Objective To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force.

Methods We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments.

Results For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT.

Conclusion This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.

• Chondrocalcinosis
• Ultrasonography

Data availability statement

Data are available on reasonable request. Original data are available from authors on reasonable request.

https://doi.org/10.1136/ard-2023-225247

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WHAT IS ALREADY KNOWN ON THIS TOPIC

There is an increasing interest in the application of imaging in crystal-induced arthropathies, with many studies on diagnosis, monitoring and predicting treatment response or severity. However, there are no recommendations on the use of imaging in crystal-induced arthropathies clinical practice.

WHAT THIS STUDY ADDS

We performed a systematic literature review, encompassing the applications of imaging for making a diagnosis, monitoring, predict treatment response or disease severity, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition and basic calcium phosphate deposition.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

The results of the systematic literature review provided the basis for the development of evidence-based European Alliance of Associations for Rheumatology recommendations for the use of imaging in crystal-induced arthropathies in clinical practice.

Introduction

Crystal-induced arthropathies (CiAs) are the most common inflammatory arthropathies in adults and include various crystal deposition diseases such as gout, calcium-pyrophosphate (CPP) deposition (CPPD) and basic calcium phosphate deposition (BCPD), which also includes hydroxyapatite deposition. 1–3 While these conditions present with heterogenous symptoms and disease courses, they share some common attributes. The demonstration of the respective crystals in synovial fluid analysis (SFA) is traditionally regarded as the gold standard in the diagnosis of CiA. 1 2 However, fluid aspiration might not always be possible or feasible, especially in the intercritical periods common to these diseases. 3 4

Imaging plays an increasing role in the diagnosis of and as an aid for treatment decisions in rheumatic and musculoskeletal diseases (RMD). 5 An increasing evidence of the diagnostic capacity of various imaging methods exists in CiA, especially in gout. 6 7 This is reflected in the gout and (preliminary) CPPD classification criteria, respectively. 1 2 8 9 In contrast, evidence of the diagnostic capacity of various imaging methods for BCPD is scarce and classification criteria are lacking.

Imaging has shown to be very useful for detection, monitoring or predicting the disease course in several RMDs. Guidance for physicians on the use of such techniques has been published either as part of diagnostic and treatment guidelines or as imaging recommendations for individual RMDs. 10–12 However, such recommendations are missing for CiA and evidence regarding the application of imaging for monitoring or prediction in this group is scarce.

The aim of this study was to systematically assess published evidence regarding the use of imaging in CiA. Specifically, we wanted to evaluate the utility and the added value of imaging to help clinicians in the diagnostic, monitoring and prediction workup of patients with CIA in daily practice as well as its role in guiding interventions and patient education.

Search strategy

Systematic literature reviews (SLRs) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist. 13 The areas of interest in the application of imaging in CiA were identified by the task force, covering the aspects of diagnosis, follow-up, prediction of treatment response/disease severity, guided interventions and patient education in three different CIA: gout, CPPD and BCPD. 14 research questions (RQ) (RQ1–RQ4 for gout, RQ5–RQ8 for CPPD, RQ9–RQ12 for BCP, RQ13: guiding procedures, RQ14: patient education) were formulated and rephrased according to the PICOS (Patient, Intervention, Comparator, Outcome, Study design) framework, featuring predefined inclusion and exclusion criteria. Four search strategies for gout, CPPD, BCPD and patient education were developed together with an expert librarian (BW) ( online supplemental table 16–26 ). Searches in Medline, Embase and Central were run from inception to 31 March 2022. The retrieved records were imported into a citation manager software (Zotero) and duplicates were removed. The two reviewers performing the SLR (IG and GS) screened the titles and abstracts independently, disagreement was resolved by consensus. The presence of studies fulfilling the inclusion criteria for the RQ on imaging-guided procedures and patient education was also checked in the disease-specific searches.

Supplemental material

A protocol was shared among the reviewers, but the study was not registered.

Inclusion criteria

Original research studies as well as SLRs in the English language on adult (≥18 years old) patients with confirmed or suspect CiA were eligible for inclusion. Studies assessing conventional radiography (CR), ultrasound (US), dual-energy CT (DECT), MRI, CT or other imaging modalities were included. Narrative reviews, case reports and case series were excluded while the study designs eligible for inclusion varied depending on the RQ ( online supplemental table 1 ).

Data extraction

The full texts of the eligible articles were retrieved and data were extracted into a standardised form, including, if possible, 2×2 tables for diagnostic studies to allow the calculation of sensitivity, specificity, positive and negative predictive value, as well as OR, risk ratio (RR) or HR for prognostic studies, along with 95% CI. The same article could be included in more than one RQ. In addition, the references of the included SLRs were handsearched, looking for additional studies. The results were summarised in tables. Due to an expected strong degree of clinical heterogeneity across studies, meta-analyses were not prespecified before study selection and extraction.

Risk of bias assessment

Risk of bias (RoB) of the included studies was assessed with different tools, depending on the RQ and study design. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used for diagnostic studies, 14 the Newcastle-Ottawa scale (NOS) for cohort and case–control studies, 15 the Cochrane RoB (RoB2) for randomised controlled trials (RCTs) and the ROBIS tool for SLRs. 16

Four searches were performed, retrieving 3.043 records (gout search), 687 records (CPPD search), 1389 records (BCPD search) and 254 records (education search). We included 45 studies from the gout search for RQ1–4 ( online supplemental figure 1 ) 50 studies from the CPPD search for RQ 5–8 ( online supplemental figure 2 ), 52 studies for RQ 9–12 for BCPD ( online supplemental figure 3 ), no study for RQ13 for imaging-guided procedures and 2 studies for RQ14 on patient education ( online supplemental figure 4 ).

Out of 3.043 records retrieved by the search, 256 manuscripts were selected for full-text review and 88 studies were finally included for RQ1–4. Of those, seven studies were retrieved from the hand search ( online supplemental figure 1 ).

RQ1: diagnostic value of individual imaging methods in gout

For RQ1, 45 papers were included. The majority of the studies assessed the diagnostic capacity of DECT (28 studies) and US (23 studies) while CR, CT and MRI were evaluated in 7, 3 and 0 studies, respectively ( table 1 ).

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Overview of included studies for each RQ and imaging method

For gout, 31 cross-sectional studies, 6 case–control studies and 8 SLRs were included. The comparator was SFA or fulfilled classification criteria in all but four studies, 17–20 in which imaging was compared with clinical diagnosis or tophi tissue samples ( online supplemental table 2 ).

Among studies assessing the diagnostic capacity of DECT for the diagnosis of gout, 21/28 (75%) 6 18 19 21–38 and 21/28 (75%) 6 18 19 21–24 26 29–31 33–36 38–43 reported sensitivity and specificity, respectively of ≥80%. The sensitivity ranged from 52.8% to 100.0%, the specificity from 50.0% to 100.0%. Five studies out of 28 (17.9%) reported on the performance of DECT to diagnose gout in groups of patients with different disease duration. 6 31 38 41 44 Three out of these five studies (60%) 6 38 41 found numerically lower sensitivity (35.7% vs 92.9%, 38.0% vs 77.6% and 55% vs 81%) with similar specificity in the group with shorter disease duration of 1 year or less while two studies (40%) 31 44 found no difference between the subgroup with a shorter disease duration and the overall cohort. In 16/28 (57.1%) studies performing DECT, only the (previously) symptomatic side was assessed, 18 19 22 26–28 33 37–41 43–46 in 5/28 (17.9%) studies, a predefined set of joints was assessed 21 24 25 29 34 and in the remaining 1/28 study (3.6%), the (most) symptomatic joint or recently symptomatic joint as well as the contralateral metatarsophalangeal one joint was assessed. 42 The remaining studies 23 30–32 35 47 were meta-analyses without data on the assessed joints. Sensitivity and specificity in studies assessing only a prespecified set of joints ranged from 82% to 92% and 75% to 93% compared with 55% to 100% and 50% to 100% in studies assessing (previously) symptomatic joints only. The set of joints included the feet in all studies ( figure 1 , online supplemental table 2 ).

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Overview of included studies for research question 1: Diagnostic utility of imaging methods for the diagnosis of gout. CR, conventional radiograph; DC, double contour sign; DECT, dual-energy CT; FN, false negative; FP, false positive; Inf, inflammation; TN, true negative; TP, true positive; US, ultrasound.

Of the 23 included studies reporting on the diagnostic value of US in the detection of gout, 16 (69.6%) 20 23 28 29 31 32 34 40 48–55 reported on overall diagnosis, while several studies reported (additionally) on the diagnostic value of specific findings: 17 (73.9%) on double contour (DC) sign, 31 32 34 45 48–54 56–61 15 (65.2%) tophi, 20 31 32 34 48 49 51–54 56 57 59–61 11 (47.8%) aggregates, 20 32 45 48 49 51–54 56 57 5 (21.7%) erosions 20 48 51 56 57 and 3 (13.0%) 20 53 56 inflammation. Only affected joint(s) were assessed in 12/23 (52.2%) studies, 20 28 34 40 45 48 50 52 53 57 60–62 while 2/23 (8.7%) studies 49 55 assessed the symptomatic site as well as additional joints and in 5 studies 29 34 56 58 59 a predefined set of sites was assessed. The remaining four studies 23 31 32 51 were meta-analyses. In 12/16 (75%) and 10/16 (62.5%) studies reporting on overall diagnosis, a sensitivity 20 23 28 29 31 32 34 40 48 49 54 55 and specificity, 28 31 32 40 48 51–55 respectively, of ≥80% was reported. Sensitivity ranged from 61.1% to 100.0% and specificity from 60.0% to 100.0%. The frequency of studies with a sensitivity and specificity of ≥80%, respectively, was 5/17 (29.4%) 34 45 50 56 61 and 14/17 (82.4%) 31 32 45 48 51–54 56–61 for the DC sign, 0/15 (0%) and 15/15 (100%) 20 31 32 34 48 49 51–54 56 57 59–61 for tophi, 2/11 (18.2%) 20 56 and 7/11 (63.6%) 32 45 49 51–54 for aggregates, 0/5 (0%), 2/5 (40%) 51 57 for erosions and finally 2/3 (66.7%) 20 56 and 0/3 (0%) for inflammation ( figure 1 , online supplemental tables 2–9 ).

A specificity of ≥80% was found in all (3/3, 100%) 21 37 39 included studies assessing the diagnostic capacity of CT to diagnose gout, while a sensitivity of ≥80% was found in 1/3 (33.3%) 37 studies. All included studies assessed additional sites besides the symptomatic joint(s) by CT ( figure 1 , online supplemental table 2 ).

All (7/7, 100%) included studies assessing the value of CR to diagnose gout reported a specificity of ≥80%, while no (0/7, 0%) study reported a sensitivity of ≥80% ( figure 1 , online supplemental table 2 ).

The RoB was high in at least one area in 20/37 including diagnostic studies assessed by QUADAS-2, mostly due to patient selection. Among included SLRs, no high RoB was observed. ( online supplemental figure 5 )

RQ2: the ability of imaging modalities for monitoring inflammation, damage or crystal deposition in gout

For the second RQ, 30 papers were included, of which 11/30 (36.7%) studies investigated monitoring in gout by DECT, while US was assessed in 12/30 (40%) studies, CR in 7/30 (23.3%) studies and CT in 3/30 (10%) studies. In the majority (23/30, 76.7%) of the included studies, urate-lowering therapy (ULT) was initiated or increased, at least in one separately examined group ( table 1 ).

Studies using DECT to monitor crystal deposition in gout used either a (semi)quantitative score or the total monosodium urate (MSU)/tophi volume. All (11/11, 100%) studies found a significant decrease after 6 months to 3 years ( online supplemental table 3 ).

With regard to the studies investigating US, 8/8 (100%) reporting on the DC sign showed a reduction after 3–12 months, 5/6 (83.3%) 63–67 reporting on aggregates showed a reduction after 3–12 months and 8/10 (80%) 63 64 66 68–72 reporting on tophi showed a reduction after 3 months to 4 years. Four out of five studies (80%) reporting on inflammation (power Doppler (PD), grey scale, synovial thickness or Global OMERACT-European Alliance of Associations for Rheumatology (EULAR) Synovitis Score) 64 65 67 73 found a significant change after 3–12 months. The single study revealing no significant result assessed PD score after 4 weeks only. 74 Two studies assessed change in erosions after 3 and 6 months, respectively, and found no significant differences 64 67 ( online supplemental table 3 ).

In total, three studies 75–77 assessed change in the erosion score by CT after 1–2 years. Of these, a single (33.3%) study 76 found a significant increase after 1 year ( online supplemental table 3 ).

Change of damage over time assessed by CR was reported in 6/7 (85.7%) studies. Significant increases were found in two studies after 12 months. 76 77 One additional study 1/7 (14.3%) 78 found a significant decrease of tophi semiquantitatively assessed on CR after ULT initiation over a time of at least 18 months ( online supplemental table 3 ).

Only a single study assessing MRI changes over time was included, 79 reporting small numerical changes in the Rheumatoid Arthritis MRI Score from baseline with no statistical tests performed ( online supplemental table 3 ).

Included studies had good quality according to the NOS except for the missing control group in most studies. No RoB was found in the included RCTs for RQ 2 ( online supplemental figure 5 ).

RQ3: the ability of imaging modalities to predict disease severity outcome in gout

For RQ3, two studies were included, both of them using baseline CR for the prediction of disease severity outcome in gout 80 81 ( table 1 ).

One study 80 found the baseline damage score to be predictive of change in damage over 3 years while its erosion and joint space narrowing (JSN) subscores were not predictive. A second study 81 found no association between the baseline JSN and erosion score and health assessment questionnaire II 81 score after 1 year ( online supplemental table 10 ).

Included studies had good quality assessed by the NOS, however, a control group was missing in all included studies ( online supplemental figure 6 ).

RQ4: the ability of imaging modalities to predict treatment effect in gout

Three studies were included for RQ4 assessing the utility of baseline US (three studies) and DECT (one study) in predicting treatment effect in gout ( table 1 ). One study 82 found the absence of MSU crystal deposits, aggregates, DC sign and tophi assessed by US to be predictive of remission after 12 months in patients with ongoing ULT. In this study, neither baseline serum uric acid (SUA) nor the highest SUA level was predictive of remission. Two additional studies 83 84 found no significant association between baseline sonographic signs for crystal deposition and flare within 12 months ( table 2 ).

Overview of included studies for research question 4: predictive value of imaging methods for the treatment effect in gout

One study 84 additionally assessed the association of baseline DECT with flare within 6 months and found higher MSU volume in patients with flare compared with patients without flare ( table 2 ). Only one study 1 included a multivariate analysis to assess the predictive value of imaging as well as other factors on treatment effect in gout. Pascart et al 84 calculated a multivariate analyses including baseline US, DECT, ongoing ULT, baseline serum urate, comorbidities and other clinical variables. Only baseline MSU deposition assessed by DECT remained significant in the model. In another study, ongoing flare prophylaxis was significantly associated with remission after 12 months in a univariate analysis. Both C reactive protein and ongoing flare prophylaxis were included as covariates into a multivariate analysis assessing the predictive value of US. Except for a missing control group, the studies had good quality according to the NOS ( online supplemental figure 5 ).

Overview of included studies for research question 7: predictive value of imaging methods for the outcome of calcium pyrophosphate deposition (CPPD)

Calcium pyrophosphate deposition

Out of 687 records retrieved by the search, the full text of 116 manuscripts were assessed and 50 studies were finally included ( online supplemental figure 2 ) for RQ 5–7, that is, on diagnosis, monitoring and prediction of disease severity outcome, while no studies could be included for RQ8 on the prediction of treatment effect. Handsearch did not retrieve additional studies.

RQ5: diagnostic value of individual imaging methods in CPPD

44 studies were included ( online supplemental table 11 , figure 2 ), mostly presenting data on CR (23 studies) 17 40 55 85–103 and US (24 studies), 40 49 55 86–88 90–93 95 96 98 99 102–111 with only 6 studies on CT, 37 95 112–115 3 on DECT 37 40 116 and 2 on MRI. 117 118 The reference standard for making a diagnosis of CPPD was histology in 3 studies, 96 108 111 SFA in 13, 40 55 85 86 92 97–100 106 107 119 McCarty criteria in 19, 37 40 87–93 95 103 105 112–116 120 clinical diagnosis in 3 49 104 116 and evidence of CPPD on CR in 3. 94 117 118 There were 4 SLRs, 96 101 102 110 15 cross-sectional cohort studies, 40 49 55 86 95 97–99 106 108 109 111 112 117 119 19 case–control studies 37 85 87–94 100 103 107 113–116 118 120 and 2 longitudinal cohort studies. 17 104 The knee and the wrist were the most commonly investigated sites, with 17 93–96 98–100 105–108 111 116–119 and 8 17 37 89–92 112 120 studies assessing exclusively these areas, respectively.

Overview of included studies for research question 5: Diagnostic capacity of imaging methods for the diagnosis of calcium pyrophosphate deposition disease. CR, conventional radiograph; US, ultrasound.

Among studies assessing the performance of CR to diagnose CPPD, only 5/23 (21.7%) reported a sensitivity ≥80% (ranging from 0% to 100%) while 18/23 (78.3%) reported a specificity ≥80% (ranging from 40% to 100%). At the level of the knee, CR had a maximal sensitivity to diagnose CPPD in cohort studies of 75%, 96 while the minimal sensitivity was 13% 86 for CPP deposits of the knee.

Regarding the specific differentiation of CPPD from gout, at the level of the knee, the highest reported sensitivity (95% CI) to was 84% (73% to 91%) 93 for calcification of the menisci, while the lowest was 0% (0% to 18%) 100 for patellar tophus-like opacity; the highest specificity to differentiate CPPD from gout was 100% (82% to 100%) for popliteal tophus-like opacity, while the lowest was 74% (54% to 93%) for cartilage icing (deposition of CPP crystals on the surface of the cartilage) in the same population. 100 At the wrist, the highest sensitivity for making a diagnosis of CPPD was 86% (70% to 95%) for deposition at the triangular fibrocartilage complex 90 and the lowest was 44% (36% to 52%) for scaphotrapeziotrapezoidal osteoarthritis (OA). 120 At this site, specificity ranged from 100% (98% to 100%) for diagnosis of CPPD 17 to 40% for scaphotrapeziotrapezoidal OA. 89

A sensitivity ≥80% was found in 14/24 (58.3%) studies on US (range 0%–100%), while specificity was ≥80% in 23/24 (95.8%%) studies (range 4%–100%). At the level of the knee, sensitivity ranged from 100% 99 to 44% 111 for CPP deposition, while specificity (95% CI) ranged from 4% (0.1% to 20%) for joint effusion to 100% (95% to 100%) for crystal deposition in the hyaline cartilage. 98 At the wrist, however, the sensitivity ranged from 50% 92 to 95% (86%–99%) 91 and specificity from 85% (84%–95%) 91 to 92% 98 both for intraarticular CPP depositions. Two studies 87 103 assessed the Achilles tendon and the plantar fascia, reporting a high specificity, up to 100% for intratendineous calcifications, with lower sensitivities (58%) in both studies for Achilles tendon calcifications. Six studies assessed multiple joint sites, 55 85 86 91 104 109 with sensitivities ranging from 11% (2.8%–48%) 104 to 84% (69%-84%) 86 and specificities from 19% (5%–42%) 104 to 100% (85%–100%). 86 Studies assessing the symptomatic joint showed a sensitivity ranging from 0% (0%–41%) 49 to 91% (59%–100%) 40 and a specificity from 92% (74%–99%) 40 to 100% (92%–100%). 49

Three studies assessed the value of CT scan of the cervical spine to diagnose CPPD, 113–115 with sensitivities ranging from 67% (43%–85%) 113 to 72% (54%–87%) 114 and specificities from 94% (86%–98%) 114 to 100% (84%–100%). 113 CT scan of the peripheral joints (knees and wrist) was assessed in three studies, showing similar diagnostic performance. 37 95 112 Studies on MRI reported only sensitivity, ranging from 50% (41%–58%) 118 to 92% (61%–99%). 117 Studies on DECT demonstrated low sensitivity (from 23% (14%–36%) 37 to 55% (23%–83%) 40 ) but high specificity, ranging from 92% (74%–99%) 40 to 100% (66%-100%). 37

The assessment of the RoB via QUADAS-2 of the included studies highlighted some issues in the area of patient selection, with a high or unclear RoB in many studies. The remaining items of the QUADAS-2 were fulfilled satisfactorily, with low/unclear RoB. The SLRs included had mostly low RoB, with a single SLR 101 carrying higher risk ( online supplemental figure 6 ).

RQ6: the ability of imaging modalities for monitoring CPPD

A single longitudinal cohort study 121 dating back to 1993, enrolling 104 patients with probable CPPD, followed for 4–5 years was included. CR of multiple sites (knee, wrist, pelvis, shoulders, spine and symptomatic joints) was performed, reporting descriptive data. In this context, 68% of patients showed an increased extension of CPP deposits, and 19% developed CPP deposits at new sites ( online supplemental table 12 ). The study had good methodological quality according to the NOS for the items on selection and outcome assessment, but not for comparability ( online supplemental figure 6 ).

RQ7: the ability of imaging modalities to predict disease severity outcome in CPPD

Nine studies were included 118 122–129 ( table 3 ).

All but one study assessed CR, while the remaining evaluated MRI 118 ; none of the studies had a comparator. All studies had a longitudinal design, with six cohort studies 122 124–126 128 129 and three case–control studies. 118 123 127 Interestingly, the majority 6/9 (%) of studies pertained to large epidemiological OA cohorts. 118 122–126 Most of the studies assessed the knee, 118 122–127 while two studies evaluated multiple sites. 128 129 The follow-up varied between 2.26 129 and 10 years. 122 Two studies assessed CPPD as a risk factor for developing OA 122 126 and two studies as a risk factor for progression of existing OA, 124 128 all of them reporting no significant association. A single study evaluated CPPD to predict total knee replacement in OA, 124 without showing a significant predictive effect of imaging, while a second study assessed the risk of failure of knee replacement in patients with CPPD 127 and found no significant effect. Symptoms (pain in particular) were the outcome of interest in two studies, 123 129 of which one reported a significant increase in symptoms and pain in patients with CPPD, 129 while the other did not show any significant association. Finally, a single study assessed the impact of CPP depositions on MRI, 118 showing increased joint damage assessed by MRI in patients with depositions, while a second study did not show any association between CPP depositions on CR and cartilage damage on MRI. 125

The methodological quality of the included studies, assessed by the NOS, was overall good ( online supplemental figure 6 ).

RQ8: the ability of imaging modalities to predict treatment effect in CPPD

No studies on the value of imaging predict treatment effect in CPPD fulfilled the inclusion criteria and could be included in the final review.

Basic calcium phosphate deposition

Out of 1389 records retrieved by the search, the full text of 89 studies was assessed and 52 studies were finally included ( online supplemental figure 3 ) for RQs 9, 10 and 12, that is, on diagnosis, monitoring and prediction of treatment effect, while no studies were included for RQ11 on the prediction of disease severity outcome. Three of the included studies were retrieved by hand search of the references.

RQ9: diagnostic value of individual imaging in BCPD

Three studies were included, 17 130 131 a cohort study on CR of hand and wrist against clinical diagnosis, 17 130 a case–control study on MRI arthrography of the shoulder against diagnosis on CR and an SLR on US of the shoulder against surgery 131 ( online supplemental table 13 ). The detection of ≥6 BCP deposits yielded high sensitivity (100% (48%–100%)) and specificity (100% (98%–100%)) to diagnose BCPD. 17 In contrast MRI arthrography demonstrated lower sensitivity (54% (32%–76%)) and specificity (66% (52%–77%)). The RoB was high in the case–control study and low in the cohort study and the SLR ( online supplemental figure 7 ).

RQ10: the ability of imaging modalities for monitoring BCPD

42 studies assessed the value of imaging to monitor BCPD, 132–174 presenting data on CR in 38 studies 133 135–169 172 173 and on US in seven studies 132–134 139 170 171 173 ( online supplemental table 14 , figure 3 ). Study design included 4 SLRs, 139 164 172 173 26 RCTs on a variety of interventions, including, injection, aspiration, needling, extracorporeal shockwave therapy and systemic therapy, 132 136 137 140–142 144–157 160 161 166 169–171 and 12 cohort studies. 133–135 138 143 158 159 162 163 165 167 168 All studies but one on the hip, 158 assessed the shoulder, and in all studies the diagnosis of the condition was imaging based. 30 out of 38 (78.9%) studies on both US and CR showed a reduction in the size of depositions after the intervention, 132–134 138–144 146–157 159–164 168 170 171 while in 6/38 (15.8%) the depositions were unchanged; no study reported an increase in depositions 145 158 165–167 169 ( figure 2 ). Only 7/38 (18.4%) studies assessed imaging in relation to other clinical measures, 132–138 all of them suggesting an association between the clinical response to treatment and the size and reduction of the depositions. No study assessed the value of imaging over clinical measures for monitoring, or the optimal frequency of imaging. The ROB of the included RCTs was mostly high or unclear for the items regarding allocation concealment and blinding, while it was generally low for the remaining aspects. The methodological quality of the cohort studies, assessed by the NOS, was mostly acceptable for selection and outcome assessment, while it was lower for comparability ( online supplemental figure 7 ).

Overview of included studies for research question 10: The ability of imaging methods for monitoring inflammation and damage in basic calcium phosphate deposition (BCPD). CR, conventional radiograph; NSAIDs, non-steroideal anti-inflammatory drugs; SWT, shockwave therapy; US, ultrasound.

RQ12: the ability of imaging modalities to predict treatment effect in BCPD

11 studies, all on the shoulder, fulfilled the inclusion criteria 153 157 175–183 ( table 4 ).

Overview of included studies for research question 12: predictive value of imaging methods for assessing the treatment effect in basic calcium phosphate disease/ hydroxyapatite deposition disease (BCPD/HADD)

CR was assessed in nine studies, 153 157 175–180 183 US in five 179–183 and MRI in a single study. 178 Study design included one SLR without meta-analysis, whose references were reviewed, 176 two RCTs 153 179 and eight cohort studies. 157 175 177 178 180–183 Treatment included injections, aspiration, needling, lavage, extracorporeal shockwave therapy and radiotherapy. The results across studies were variable, with some suggesting that the morphology and size of the calcifications on CR and US could predict response to treatment, 157 177 180–182 184 while others yielded negative results. 153 175 178 179 183 One study on US and one on MRI investigating inflammatory changes suggested a predictive role, 178 181 while two US studies did not. 179 182 A single study reported a predictive role of acromial shape on CR. 175

The RoB of the RCTs and the SLR was low, while the methodological quality of cohort studies was good for selection and outcome assessment, and lower for comparability ( online supplemental figure 7 ).

Guided procedures and education

Rq13: the ability of imaging modalities for guiding procedures in cia.

No studies on the value of imaging to guide intra-articular and periarticular procedures in CiA, retrieved from the disease-specific search strategies, fulfilled the inclusion criteria and could be included in the final review.

RQ14: the ability of imaging modalities for patient education in CiA

Out of 254 retrieved studies, only 2 studies were finally included 185 186 ( online supplemental figure 4 ). No additional studies were retrieved by the disease-specific searches. The first study was an RCT on 60 patients with gout, who were shown generic or personal DECT images, as well as illustrations. The intervention reduced the perceived stigma of gout, the patients were more motivated to take medication and had a greater understanding of its importance. Personal images were perceived as being more useful. 185 The second study was a quasi-randomised study, recruiting people (with a small proportion of patients) at a supermarket, where they received a leaflet with images (including DECT) related to gout, or a leaflet with no images as the control intervention. Illness perception, perceived gout severity or perceived gout stigma did not vary between groups. Medical illustrations were perceived as more useful, while DECT images had a more limited impact on understanding, compared with the anatomical drawing 186 ( online supplemental table 15 ).

The included articles had high RoB related to the items of blinding, and low RoB with regard to the remaining aspects ( online supplemental figure 8 ).

Technical advances in imaging, with reference to both conventional imaging, such as CR and advanced imaging (US, CT including DECT, MRI), along with increased availability in the last years, have led to significant developments also in the context of CiA. This SLR provides an overview of the available evidence of the use of imaging in this field, serving as the basis for the work of an international task force to develop recommendations for clinical practice.

Most of the evidence for the role of imaging in clinical practice was found for gout. The majority of the diagnostic studies for gout retrieved by this SLR assessed DECT and/or US. All included DECT studies and all but one included US studies were published after 2010 reflecting recent advances and an increasing interest in this field. Most studies assessing the diagnostic utility of DECT reported good sensitivity and specificity, which further underlines the importance and value of DECT. A lower sensitivity was found in 3/5 included studies in patients with shorter disease duration. This should be kept in mind when interpreting DECT results of patients with suspected gout and recent onset of symptoms. Further studies are needed to assess the sensitivity of various imaging methods to detect gout in patients with short disease duration.

The majority (12/16 (75%) and 10/16 (62%), respectively) of studies assessing the utility of US to diagnose gout found a sensitivity and specificity of ≥80%. Interestingly, when the specific features were assessed, DC sign, which is the only sonographic feature included in the 2015 American College of Rheumatology (ACR)/EULAR classification criteria, 8 had a sensitivity of ≥80% in only about one-third of the studies which investigated this feature. This implies that it might be useful to assess several sonographic features associated with gout, in particular tophi, erosions or synovitis to increase sensitivity without losing specificity. CR, primarily referring to the feature of radiographically detected ‘gout-related’ erosions is included in the 1977 ACR criteria 187 as well as the 2015 ACR/EULAR criteria. 8 Most included studies assessing the detection of erosions both by US and CR found high specificity but lower sensitivity.

All included studies assessing DECT or DC in US found a significant decrease in crystal deposition in patients who initiated or were receiving ULT. Some, but not all included studies found an increase in erosions detected by CR. This non-significant result might be explained by the short observation period of mostly 2 years. The amount of baseline crystal deposition detected by US or DECT predicted flares within 6–12 months in two included studies. Both studies observed no association of SUA levels with subsequent flares, while only one study included a direct comparison by calculating a multivariate analysis. The benefit or added value of a regimen with target SUA levels needs to be assessed in future studies. Cipolletta et al 82 suggest performing a sonographic examination on patients to assess crystal deposition and consider this information in the management of these patients.

In the context of CPPD, our SLR confirmed a significant body of evidence of the diagnostic applications of imaging, in particular with regard to US and CR, while CT was specifically applied to cervical involvement. A potential role of imaging for this purpose had already been recognised in the EULAR recommendations presented in 2011, with CR being an additional tool to support diagnosis, and US being recognised as a promising technique. 2 In the following years, many studies have investigated the role of both CR and US for diagnosing CPPD, demonstrating high diagnostic accuracy for the detection of crystal deposition in both hyaline cartilage and fibrocartilage. This applies especially to the wrist and the knee, which were the joints assessed more frequently. In particular, both CR and US displayed high specificity, while sensitivity was more variable with fair to good values. These results were consistent throughout studies adopting different reference standards, including SFA and histology. Although many studies adopted a case–control design, leading to an overestimation of accuracy, there were several studies with low RoB, supporting the validity of the results. The enrolment of consecutive patients with a suspect diagnosis in future studies will provide further high-quality evidence in this field. The result of our SLR supports the use of CR and US as imaging methods to confirm the diagnosis of CPPD, in the context of clinical presentation in order to define if CPPD is the cause of symptoms or a concurrent condition.

While there is abundant evidence of the applications of imaging to diagnose CPPD, studies on sequential imaging to monitor changes in crystal deposition are scarce, most likely as a consequence of the absence of effective treatment. The same considerations apply to studies assessing the prognostic and predictive role of CPPD as shown by imaging, where a few studies in the setting of OA led to conflicting results on the application of CR.

When assessing the literature regarding BCPD, the amount of published evidence was low. The number of diagnostic studies was very limited, with three studies on different techniques with suboptimal design leading to inconsistent results. Future research should follow a cohort design, enrolling consecutive patients. On the other hand, there were many RCTs and cohort studies reporting data on the follow-up for calcific deposition at the level of the rotator cuff, without a specific focus on correlation with clinical findings. No information on the optimal interval to repeat imaging could be retrieved and there was no possibility to compare different techniques. We found a few studies reporting a possible predictive role of imaging for the response to treatment for rotator cuff calcifications, however, once again, the results did not allow to draw solid conclusions. Studies included for follow-up and prediction did not account for possible confounders; this aspect should be addressed in future research.

Interestingly, there were no studies addressing the accuracy of imaging-guided intra-articular or periarticular procedures in CiA. While it has been demonstrated that imaging guidance enhances accuracy in other conditions, a specific conclusion for these diseases cannot be drawn due to lack of data. 188

A new field of application of imaging is also represented by its use to improve patient’s understanding of their condition. Our SLR identified two studies, showing a potential positive impact of presenting DECT images to improve patient understanding of gout, thus opening the way to research in this area. 185 186

The results of this SLR highlight the increasing interest in the application of imaging in CiA, including both long-established methods such as CR or CT but also modern techniques, in particular US and DECT. While we found a relevant amount of information on the diagnosis of gout and CPPD, evidence of BCPD was more limited and there was a lack of predictive and prognostic studies throughout all CIA conditions, with no studies addressing imaging-guided interventions. Imaging was also tested as a potential tool for patient education. As the interest in CiAs, including the use of imaging, continues to grow, it is expected that in a few years’ time it will be necessary to repeat this review, as relevant research has been published already after the completion of the SLRs presented here. Despite this possible limitation, our results will support the development of the first EULAR recommendations on the use of imaging for the clinical management of CiA and will underpin the areas in which additional research will be needed.

Ethics statements

Patient consent for publication.

Not applicable.

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MAD’A and VN-C are joint senior authors.

IG and GS are joint first authors.

Handling editor Kimme L Hyrich

X @DrPeterMandl

Contributors IG: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. GS: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. BW: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. GF: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. PM: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. MAD’A: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. VN-C: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. All authors contributed and finally approved the current manuscript.IG and GS accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish together with the senior authors (MD and VN-C) and the convenors of the taskforce (GF and PM). BW accepts responsibility for the search strategy.

Funding This study was reported by EULAR.

Competing interests VN-C: consulting fees: ABBvie, Galapagos, Lilly, Novartis, Lilly, Pfizer, UCB; honoraria: Abbvie, Fresenius, Lilly, Novartis, Pfizer, UCB; ASAS. MAD’A: consulting fees: Novartis, BMS, Janssen, Amgen, Boehringer Ingelheim, AbbVie, Astra-Zeneca, Pfizer, UCB, Eli Lilly; honoraria: Novartis, BMS, Janssen, Amgen, Boehringer Ingelheim, AbbVie, Astra-Zeneca, Pfizer, UCB, Eli Lilly. The other authors have no competing interests to declare.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Introduction, case report, author contributions, conflict of interest statement, intrarenal neurofibroma: unveiling a diagnostic challenge—a case report and literature review.

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Mahmoud Mustafa, Abdelkarim Barqawi, Amir Aghbar, Ibraheem Alami, Honood Abu Ras, Intrarenal neurofibroma: unveiling a diagnostic challenge—a case report and literature review, Journal of Surgical Case Reports , Volume 2024, Issue 5, May 2024, rjae285, https://doi.org/10.1093/jscr/rjae285

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A 53-year-old male patient presented with an incidental finding of a left kidney mass after being evaluated for elevated serum creatinine without having any symptoms. The left kidney mass was confirmed by ultrasound, computed tomography ‘CT’ scan and magnetic resonance imaging ‘MRI’. A left radical nephrectomy was done, and histopathology confirmed the presence of intrarenal neurofibroma with no evidence of malignancy.

Neurofibroma is an uncommon benign tumor arising in peripheral nerves, and rarely occurs in the kidneys and parapelvic areas [ 1 , 2 ]. Only eight cases were reported, the first of which was in 1967 [ 1–5 ]. A diagnostic dilemma has been faced in the preoperative diagnosis of kidney neurofibroma as it mimics renal cell carcinoma (RCC) or transitional cell carcinoma (TCC). Solitary neurofibroma occurs without a genetic, mutational or syndromic manifestations [ 1 , 4 ]. In this report, we are presenting a case of a 53-year-old male patient with an incidental finding of a left kidney mass, who underwent radical nephrectomy, and the histopathological result was consistent with neurofibroma.

A 53-year-old male patient with a past medical history of hypertension for 10 years, diabetes mellitus (DM) for 20 years and ischemic heart disease with previous percutaneous coronary intervention was incidentally found to have elevated serum creatinine (1.6 mg/dl) as part of routine follow-up evaluation for DM. The patient reported previous normal serum creatinine with no history of hematuria, abdominal pain, weight loss, anorexia or decreased oral intake. Moreover, there was no history of prior surgical or endourological interventions and no family history of kidney tumors.

As part of his evaluation for his elevated serum creatinine, abdominal ultrasound showed the presence of a large, well-defined hypoechoic medullary lesion with internal heterogeneity and minimal vascularity measuring about 6.7 × 7.4 cm 2 and abutting the inner aspect of the left renal cortex. Renal computed tomography (CT) scan without contrast demonstrated a well-defined rounded soft tissue density mass lesion measuring about 6.7 × 6.4 × 7.9 cm 3 in the lower aspect of the left renal medulla ( Fig. 1A and B ).

(A) CT scan axial section and (B) CT scan coronal section. Showing left kidney well-defined rounded soft tissue density mass lesions measuring about 6.7 cm in the lower aspect of the renal medulla. (C) MRI axial section, and (D) MRI coronal section. Showing left kidney large well defined rounded hypointense on T1W and heterogenous hyperintense on T2W images focus seen in the lower aspect of the medulla of the left kidney measuring about 6.8 cm approximately, resulting in mild calyceal dilatation.

As the serum creatinine was elevated, preventing the use of contrast material with the CT scan, abdomen magnetic resonance imaging ‘MRI’ with gadolinium IV contrast showed a large, well-defined rounded lesion, hypointense on T1W and heterogeneous hyperintense on T2W image, with a focus seen in the lower aspect of the medulla of the left kidney measuring about 6.8 × 7.5 cm 2 approximately, resulting in mild calyceal dilatation. After IV contrast administration, it showed mild heterogeneous enhancement, more marked in the delayed images. Two para-aortic small solid lymph nodes, the biggest measuring 1.2 cm, were detected. Chest imaging showed no evidence of distant metastasis ( Fig. 1C and D ).

The left kidney mass was suspicious for malignancy, for which the patient underwent left radical nephrectomy with the removal of the suspicious para-aortic lymph nodes ( Fig. 2 ). The histopathology report showed a final diagnosis of neurofibroma with no malignancy. Para-aortic lymph nodes were also free of malignancy. Histopathological description of the sample showed a 6 × 6 × 5 cm 3 tumor that was located in the lower pole of the removed kidney, encapsulated with yellowish cut surfaces, and was limited to the kidney and did not invade the Gertoa’s fascia. Tumor cells were focally positive for S100 and negative for smooth muscle actin ‘SMA’ and desmin. The pathological findings in the remaining part of the kidney included glomerulosclerosis, interstitial fibrosis and tubular atrophy ( Fig. 3 ). Neurofibroma in our case was truly intrarenal, and this can be demonstrated in Figs 2 and 3 , where tumorous tissues appear adjacent to normal kidney tissues.

(A) Gross images of the harvested left kidney with the tumor located in the lower pole. (B) Cross-section of the harvested specimen showing a well-demarcated circumscribed mass located inside renal parenchyma at the lower aspect of the left renal medulla.

Multiple histopathology sections showing intrarenal neurofibroma with normal kidney tissues. (A) and (B) show the tumor located inside renal parenchyma, juxta to the renal cortical parenchyma. (C) The image show spindle cell tumor with serpentine wavy nuclei arranged in a fascicular pattern.

Neurofibroma is a benign tumor rarely affecting the kidney, and few cases have been reported worldwide [ 1 ]. They tend to be solitary, localized and circumscribed [ 2 ]. Different clinical presentations have been described for the few reported cases of neurofibroma, ranging from no symptoms to flank pain or hematuria (depending on the lesion's extent within the kidney). All of the reported cases of renal or parapelvic neurofibroma had a preoperative diagnostic challenge in confirming the nature of the kidney mass, given its imaging resemblance to RCC or TCC, and thus all of the cases were treated radically [ 1 ]. Involvement of renal sinuses, calyces or upper ureters has also been reported, making preoperative diagnosis more challenging.

In our case, there was a suspicion of RCC based on preoperative imaging, including a CT scan and MRI, which favored our decision to proceed with radical nephrectomy. To our knowledge, most of the reported cases in the literature have also been managed similarly, given the diagnostic dilemma of preoperative diagnosis. Therefore, histopathological examination remains the only way to establish the diagnosis of kidney neurofibroma [ 4 ].

After reviewing all of the eight reported cases [ 1–5 ], there was no radiological suspicion related or specific to neurofibroma during the standard preoperative imaging techniques. Except for two patients who presented with hematuria, the remaining patients presented with pain. In our case, the patient’s diagnosis was incidental. The average age of presentation in all the reported cases ranged from 33 to 59 years, with no predominance in certain genders (four males, three females, and one unknown gender). The volume of the lesions in the reported cases did not exceed 10 cm, which did not raise any special suspicion during the workup, for which there was no deviation from the standard preoperative evaluation for renal RCC. Regarding the location of the tumor, in six out of the eight reported cases, the tumor was located in the renal sinus; the remaining two were located in the retroperitoneum and lower pole. In our case, the lesion was located in the lower aspect of the left renal medulla. Thus, a high index of suspicion is required for any patient with a mass in the renal sinus; ureteroscopy with or without biopsy should be done to distinguish the upper TCC from other renal masses, thus avoiding unnecessary ureterectomy and bladder cuff excision if TCC is ruled out.

Histologically, the examined tumor in the removed kidney in our patient showed an encapsulated lesion with yellowish cut surfaces and was limited to the kidney and did not invade the Gertoa’s fascia. Tumor cells were focally positive for S100 and negative for SMA and desmin, making other mesenchymal tumors, such as solitary fibrous tumor, unlikely. Thus, immunohistochemistry is vital in formulating a final diagnosis [ 2 ].

Neurofibroma of the kidneys is a rare benign tumor with a limited propensity to affect the kidney and parapelvic spaces. No imaging pathognomic findings have been described to help differentiate it from RCC or TCC, making diagnosis challenging and based mainly on histopathological examination. However, a preoperative ureteroscopy with biopsy may determine the nature of the tumor, thus avoiding unnecessary nephrectomy.

All authors made substantial contributions to conception and design. They have all agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

None declared.

This research did not receive any kind of funds.

A written signed consent was obtained from the patient for the purpose of this article publication and its attached images.

Singh BP , Krishnaswamy SA , Singhai A , Sankhwar S . Parapelvic solitary neurofibroma of the kidney . Case Rep 2015 ; 2015 : bcr2014208357 .

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Mondal SK , Mallick MG , Bandyopadhyay R , Mondal PK . Neurofibroma of kidney: an uncommon neoplasm and diagnostic dilemma with solitary fibrous tumor . J Cancer Res Ther 2010 ; 6 : 388 – 90 .

Corbellini C , Vingiani A , Maffini F , et al.  Retroperitoneal pararenal isolated neurofibroma: report of a case and review of literature . Ecancermedicalscience 2012 ; 6 : 253 .

Eljack S , Rosenkrantz A , Das K . CT and MRI appearance of solitary parapelvic neurofibroma of the kidney . Br J Radiol 2010 ; 83 : e108 – e10 .

Kostakopoulos A , Chorti M , Protogerou V , Kokkinou S . Solitary neurofibroma of kidney: clinical, histological and chromosomal appearance . Int Urol Nephrol 2003 ; 35 : 11 – 3 .

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Case report article, old woman with sheehan's syndrome suffered severe hyponatremia following percutaneous coronary intervention: a case report and review of literature.

• 1 School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
• 2 Cardiology Department and Experimental Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China
• 3 Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng, Shandong, China
• 4 Department of Cardiology, Shandong Corps Hospital of Chinese People’s Armed Police Forces, Jinan, China

Glucocorticoid deficiency can lead to hypoglycemia, hypotension, and electrolyte disorders. Acute glucocorticoid deficiency under stress is very dangerous. Here, we present a case study of an elderly patient diagnosed with Sheehan's syndrome, manifesting secondary adrenal insufficiency and secondary hypothyroidism, managed with daily prednisone and levothyroxine therapy. She was admitted to our hospital due to acute non-ST segment elevation myocardial infarction. The patient developed nausea and limb twitching post-percutaneous coronary intervention, with subsequent diagnosis of hyponatremia. Despite initial intravenous sodium supplementation failed to rectify the condition, and consciousness disturbances ensued. However, administration of 50 mg hydrocortisone alongside 6.25 mg sodium chloride rapidly ameliorated symptoms and elevated blood sodium levels. Glucocorticoid deficiency emerged as the primary etiology of hyponatremia in this context, exacerbated by procedural stress during percutaneous coronary intervention. Contrast agent contributed to blood sodium dilution. Consequently, glucocorticoid supplementation emerges as imperative, emphasizing the necessity of stress-dose administration of glucocorticoid before the procedure. Consideration of shorter intervention durations and reduced contrast agent dosages may mitigate severe hyponatremia risks. Moreover, it is crucial for this patient to receive interdisciplinary endocrinologist management. In addition, Sheehan's syndrome may pose a risk for coronary atherosclerotic disease.

Introduction

In developed countries, studies have revealed varying prevalence rates of Sheehan's syndrome (SHS) among women, ranging from 0.0051% ( 1 ) to 3.1% ( 2 ). There were also studies showing that the prevalence of SHS ranged from 1% to 2% among women who experienced hypotension due to blood loss of 1–2 L ( 3 , 4 ). Contrastingly, in undeveloped nations, the prevalence varies from 3.1% to 27.6% ( 5 – 7 ). The diagnostic journey for SHS patients spans a considerable duration of 7–19 years from symptom onset to definitive diagnosis ( 8 ). Sheehan's syndrome arises from ischemic necrosis of the anterior pituitary gland triggered by postpartum hemorrhage ( 8 ), leading to pituitary hormone dysfunction, including insufficient secretion of growth hormone, thyroid stimulating hormone, gonadotropin, prolactin, and adrenocorticotropin (ACTH) ( 7 , 9 ). Predominant symptoms are associated with dysfunction of the gonads, thyroid, and adrenal cortex due to insufficient secretion of gonadotropins, thyroid stimulating hormones, and ACTH, respectively. The latter is the most prominent and sometimes life-threatening. Supplementing various deficient hormones is the primary treatment for SHS.

Glucocorticoids, pivotal adrenal cortex hormones, play crucial roles in regulating glucose metabolism, blood pressure, and electrolyte balance. Deficiency in glucocorticoids can lead to hypoglycemia, hypotension, and electrolyte disturbances. Lifetime glucocorticoid replacement therapy stands as a cornerstone in managing SHS patients. Fluctuations in neuroendocrine system activity necessitate adjustments in glucocorticoid supplementation, while metabolic disruptions from other etiologies also dictate dosage alterations. Inadequate comprehension of these dynamics among healthcare professionals may impact the prognosis of SHS patients and predispose them to risks. Surgical treatments, including interventional procedures, represent significant stressors in medical care. Failure to administer preoperative stress doses of glucocorticoids to SHS patients can engender serious consequences. To our knowledge, this article represents the first documented case of severe hyponatremia in an SHS patient following percutaneous coronary intervention (PCI).

Case presentation

A 70-year-old female patient presented with paroxysmal exertional chest tightness persisting for one month, alleviated by a few minutes of rest. Forty years ago, the patient suffered from postpartum hemorrhage, without blood transfusion, subsequently developing lactation failure and amenorrhea. Five years later, she was diagnosed with SHS at the Affiliated Hospital of Shandong University. Management included 5 mg of prednisone acetate in the morning for secondary adrenal insufficiency, and 50 ug of levothyroxine for secondary hypothyroidism. Apart from medication adherence, the patient lacked awareness regarding adrenal insufficiency. The patient had a decade-long history of hypertension, controlled with 5 mg of telmisartan and 5 mg of amlodipine daily. This patient had a weight of 46 kl, a height of 1.57 m, and a BMI of 18.66 kg/m 2 . Upon hospital admission, her vital signs were stable with a blood pressure of 122/58 mmHg, and a heart rate of 65 beats per minute. Physical examination revealed no pulmonary rales, cardiac murmurs, lower limb edema. Laboratory finding indicated elevated blood troponin I (0.5487 ng/ml, 0–0.0175 ng/ml), normal blood sodium (141.5 mmol/L, 137 mmol/L–147 mmol/L), and elevated fasting total cholesterol (6.28 mmol/L, 3 mmol/L–5.7 mmol/L). Thyroid function tests revealed low level of free thyroxine (FT4) (6.77 pmol/L, 7.98 pmol/L–16.02 pmol/L), with normal levels of free triiodothyronine (FT3) and thyroid stimulating hormone. Electrocardiogram indicated sinus bradycardia. We diagnosed the patient with acute non-ST segment elevation myocardial infarction (NSTEMI) and performed percutaneous coronary angiography (CAG) and intravascular ultrasound (IVUS) examination. We found that the stenosis degree was 40%, 80%, and 60%, 98%, and almost completely occluded, respectively, in the left main trunk (LM), the proximal and middle segments of the left anterior descending branch (LAD), the proximal segments of the left circumflex branch (LCX), and the middle segment of the right coronary artery (RCA) ( Figures 1A–C ). The minimum lumen area at the distal stenosis of the LM was 4.51 mm 2 ( Figure 1E ), the plaque load at the most severe stenosis of the proximal LAD was 80%, with a minimum lumen area of 2.88 mm 2 ( Figure 1F ). Due to the patient's refusal to undergo coronary artery bypass grafting, two stents were inserted in the middle segment of the RCA ( Figure 1D ). The intervention lasted for 2 h, including coronary angiography, bilateral intravascular ultrasound examination, patient involvement in treatment decision-making based on examination results, and subsequent coronary intervention treatment, utilizing 130 ml of iodixanol. The patient did not experience any chest discomfort, but was nervous and had a blood pressure rise to 190/100 mmHg, managed with sublingual nifedipine tablets and intravenous isosorbide nitrate. Following percutaneous intervention (PCI), the patient experienced a sequence of symptoms from the 12th to the 50th h, including nausea and loss of appetite, profuse sweating, mild limb twitching, and drowsiness in sequence ( Table 1 ). Limb twitching persisited for 18 h from the 38th to the 56th h post-PCI. On the 24th h post-PCI, the patient was diagnosed with hyponatremia ( Table 1 ), and 2%−3% sodium chloride was intermittently administered intravenously. Despite increased sodium chloride supplementation, symptoms persisted until administration of hydrocortisone, leading to symptom resolution and rapid improvement in blood sodium levels ( Table 1 ). By the 62nd h post-PCI, symptoms of hyponatremia completely resolved, with blood sodium level increasing from 114.2 mmol/L to 132 mmol/L ( Table 1 ). At the 86th h post-PCI, blood sodium level returned to normal. After 40 h, blood tests revealed low levels of cortisol (2.76 ug/dl, 6.7ug/dl–22.6 ug/dl), ACTH (4.26 pg/ml, 10.1 pg/ml–57.6 pg/ml), FT3 (3.41 pmol/L, 3.53 pmol/L−7.37 pmol/L), and FT4 (7.12 pmol/L, 7.98 pmol/L–16.02 pmol/L). Following discharge, the patient continued oral medication with 2.5 mg prednisone acetate and 50 ug levothyroxine sodium daily, as well as dual antiplatelet drugs, statins, and antihypertensive agents. During the next nine-month follow-up period, the patient did not experience ischemic symptoms or hyponatremia.

Figure 1 . Coronary angiography ( A – D ) and intravascular ultrasound examination ( E and F ) in an elderly patient with Sheehan's syndrome. ( A ) The stenosis degree is 40%, 80%, and 60%, respectively, at the end of the left main trunk, the proximal and middle segments of the left anterior descending branch. ( B ) The stenosis degree is 98% at the proximal segments of the left circumflex branch. ( C ) The stenosis degree is almost completely occluded at the middle segment of the right coronary artery. ( D ) Two stents are inserted in the middle segment of the RCA. ( E ) The minimum lumen area at the distal stenosis of the left main trunk is 4.51 mm 2 . ( F ) The plaque load at the most severe stenosis of the proximal left anterior descending branch is 80%, and the minimum lumen area is 2.88 mm 2 .

Table 1 . Timeline of changes in symptoms, blood sodium titers, and hyponatremia treatment in this patient at 12, 24, 38, 50, 56, 62 and 86 h after percutaneous intervention. normal titer blood sodium reference value: 137 mmol/L to 147 mmol/L.

SHS and hyponatremia

Sheehan's syndrome is characterized by insufficient secretion of ACTH due to pituitary necrosis, resulting in decreased synthesis and secretion of adrenocortical hormones, particularly glucocorticoids. Glucocorticoids play a vital role in regulating sodium and water excretion and maintaining electrolyte balance in the body. Insufficient glucocorticoid levels lead to diminished renal free water clearance, causing water retention and dilutional hyponatremia, resulting in reduced plasma osmolality. Furthermore, despite low osmolality, there is inappropriate secretion of antidiuretic hormone (vasopressin) due to the absence of cortisol's tonic inhibition ( 10 ).

Clinical presentation and management

In this case, the patient had a medical history of a SHS diagnosis, presenting with secondary adrenal insufficiency and secondary thyrotrophin deficiency necessitating hormone replacement therapy. Secondary adrenal insufficiency arises from pituitary impairment, causing decreased production of ACTH and subsequent reduction in adrenal stimulation, leading to decreased cortisol production. Glucocorticoid deficiency emerged as the primary mechanism of hyponatremia in this patient. During the 2-h of coronary diagnosis and treatment, the patient was anxious, had high blood pressure, and was in a severe stress state, which required additional cortisol to cope with. The specific amount could be evaluated by a specialist doctor. However, due to secondary adrenal insufficiency, the patient could not suddenly increase the secretion of glucocorticoids to copy with the stress. Additionally, glucocorticoids were not pre increased before the procedure. Therefore, the patient was at risk of acute and severe adrenal cortical hormone deficiency, leading to excessive sodium loss, water retention, and subsequent hyponatremia.

Treatment response

Despite intravenous supplementation of 24.05 g sodium chloride within 26 h, hyponatremia persisted, accompanied limb twitching and drowsiness, indicating an exacerbation of hyponatremia and the formation of hypotonic brain edema. Administration of 50 mg hydrocortisone effectively relieved excessive sodium excretion and water retention. Even with 6.25 g sodium chloride treatment, the patient's symptoms almost disappeared after 6 h, and blood sodium increased from 114.2 mmol/L to 132 mmol/L after 12 h. The subsequent increase in blood sodium levels highlights the importance of glucocorticoid replacement therapy in managing hyponatremia secondary to SHS.

Management considerations

The case underscores the importance of preoperative stress dose glucocorticoid therapy in SHS patients undergoing procedures such as PCI. However, we were unaware the importance. Additionally, awareness of the potential for contrast agents to induce dilutional hyponatremia and stress response caused by PCI is crucial. Lack of endocrinologist consultation before the procedure and inadequate patient education regarding adrenal insufficiency contributed to the suboptimal management of this patient. Inappropriately administered sublingual nifedipine treatment, intended to manage transient hypertension, not only increased the risk of acute cardiovascular and cerebrovascular disease, but also increased the risks of further activating the sympathetic nervous ( 11 ) and exacerbating stress. Therefore, the interdisciplinary management involving endocrinologists is crucial for optimizing the treatment for patients with complex endocrine disorders like SHS, facilitating appropriate examinations, treatment and health education to prevent adrenal crisis and improve long-term outcomes ( 12 , 13 ).

Prolonged limb twitching and sodium correction

Unlike the transient symptoms of epilepsy, the patient experienced persistent limb twitching for up to 18 h, possibly due to prolonged lower blood sodium levels. This prolonged imbalance could have led to sustained electrical instability in brain cells, resulting in repetitive abnormal electro-discharge and impaired brain function, posing significant risks to the patient. However, our approach to correcting hyponatremia may not have followed optimal guidelines. Our method of correcting hyponatremia may not have followed the best guidelines. The target value for increasing serum sodium was not set to not exceed 8–10 mmol/L/24 h ( 14 ). Our treatment rapidly increased the patient's blood sodium from 114 mmol/L to 132 mmol/L in 12 h, and then continued to supplement with hypertonic sodium chloride. Within 26 h after identifying hyponatremia, 24.05 g of sodium chloride was administered intravenously. These treatments are unreasonable, and the overly rapid correction of hyponatremia may be a risk factor for osmotic demyelination syndrome. Proper management should aim to increase blood sodium concentration gradually, with close monitoring to prevent such complications.

Other proposed mechanisms of hyponatremia

Contrast agents have been implicated in inducing hyponatremia, particularly in women ( 15 – 18 ). Following administration, the contrast agents elevate the osmotic pressure of extracellular fluid, leading to passive water transfer of intracellular to extracellular compartments and resultant diluted hyponatremia ( 15 , 16 ). Sweating caused by sympathetic nerve stimulation and sweating caused by adverse reactions to iodixanol injection may also contribute to sodium loss.

Role of hypothyroidism

The patient's thyroid hormone levels were low before and after the procedure, indicating the presence of secondary hypothyroidism. Hypothyroidism may have contributed to hyponatremia mainly through the reduced ability to excretal free water, caused by higher levels of ADH. The elevation in ADH levels is largely due to the decrease in cardiac output that stimulates the carotid sinus baroreceptors, prompting the release of ADH. In addition, hypothyroidism can promote hyaluronic acid deposition in extravascular tissues, leading to increased water retention and reduced blood volume. This not only reduces glomerular filtration, but also increases the secretion of antidiuretic hormone, thereby increasing the risk of diluted hyponatremia ( 19 – 22 ). Therefore, optimizing levothyroxine therapy to restore normal thyroid hormone levels may help mitigate the risk of hyponatremia in such cases.

SHS and coronary artery disease

Previous studies have indicated a higher mortality rate in patients with pituitary dysfunction, primarily attributed to cardiovascular diseases ( 23 – 25 ). Due to chronic inflammation, dyslipidemia, and abdominal obesity, patients with SHS tend to develop coronary artery disease (CAD) ( 26 ). This NSTEMI patient suffered from severe coronary atherosclerosis, with traditional risk factors including hypertension and hypercholesterolemia. Long-term oral administration of glucocorticoids may be associated with hypertension and hyperlipidemia in such patients ( 27 , 28 ). In addition, hypothyroidism, which is common in SHS, can also contribute to hyperlipidemia ( 29 ).

Although severe hyponatremia following PCI in SHS patients is not extensively reported, there are cases of female patients exhibiting life-threatening adrenal dysfunction post-PCI ( 30 , 31 ). The lowest blood sodium level in these cases is 122 mmol/L, and there is no hypoglycemia. Glucocorticoids have good therapeutic effects. The difference is that these patients exhibit significant hypotension, shock, and even Takotsubo syndrome ( 30 , 31 ).

Conclusions

The deficiency of glucocorticoids caused by secondary adrenal insufficiency is the primary mechanism for severe hyponatremia in this patient with SHS. The stress induced by PCI exacerbates glucocorticoid deficiency. The contrast agent further contributes to dilutional hyponatremia. The preoperative stress dose of glucocorticoid is crucial to avoid this complication. Glucocorticoids were crucial in correcting severe hyponatremia in this SHS patient with secondary adrenal insufficiency. Shortening the duration of PCI and minimizing the dosage of contrast agents may be beneficial for preventing severe hyponatremia. Meanwhile, it is also crucial for this SHS patient to receive interdisciplinary management involving endocrinologists before and after the procedure. Additionally, SHS may serve as a potential risk factor for CAD.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by Ethics Committee of Liaocheng People's Hospital. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author contributions

JG: Data curation, Writing – review & editing. YW: Data curation, Formal Analysis, Investigation, Writing – original draft, Writing – review & editing, Software, Methodology, Project administration, Supervision. AZ: Writing – review & editing. HP: Writing – review & editing, Data curation. FW: Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article.

The work was supported by Shandong Province Traditional Chinese Medicine Science and Technology Development Plan Project (No. 20190906).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: Sheehan’s syndrome, percutaneous coronary intervention, severe hyponatremia, glucocorticoid deficiency, stress, contrast agent, coronary atherosclerotic disease

Citation: Gao J, Wang Y, Zhang A, Pang H and Wang F (2024) Old woman with Sheehan's syndrome suffered severe hyponatremia following percutaneous coronary intervention: a case report and review of literature. Front. Cardiovasc. Med. 11:1353392. doi: 10.3389/fcvm.2024.1353392

Received: 15 December 2023; Accepted: 17 April 2024; Published: 29 April 2024.

Reviewed by:

© 2024 Gao, Wang, Zhang, Pang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Yuehai Wang [email protected]

† These authors have contributed equally to this work

This article is part of the Research Topic

Case Reports in General Cardiovascular Medicine: 2023