A Quantitative Imaging Measure of Progressive Pulmonary Fibrosis.

ABSTRACT:

Rationale

Progressive pulmonary fibrosis (PPF) is common in patients with fibrotic interstitial lung disease (ILD) and leads to high mortality. While PPF guideline criteria include computed tomography (CT)-based progression, these measures are qualitative and prone to inter-reader variability. Quantitative CT (qCT) measurements have the potential to overcome this limitation.

Objectives

The objectives of this study were to determine whether changes in qCT measures of pulmonary fibrosis are associated with transplant-free survival (TFS) in a diverse ILD cohort and establish a quantitative CT measure of PPF (qctPPF).

Methods

A retrospective cohort analysis was performed in individuals with fibrotic ILD including idiopathic pulmonary fibrosis (IPF) (n=350) who underwent serial chest CT for clinical indications. Commercially available software was used to generate qCT measures of pulmonary fibrosis, which were tested for association with two-year TFS using a multivariable Cox proportional hazard model. Iterative modeling was then performed to develop a composite qctPPF measure. Results were validated in an independent ILD cohort (n=92).

Measurements and main results

Increasing ground glass opacity and decreasing lung volume showed consistent association with decreased TFS across cohorts when modeled continuously and dichotomously. qctPPF classification was associated with >3-fold increased hazard of death or transplant in the test (HR 4.41; 95% CI 2.77-7.03) and validation (HR 3.54; 95% CI 1.62-7.71) cohorts. Agreement between qctPPF and radiologist-determined PPF was poor (=0.20), with qctPPF classification maintaining prognostic significance when discordant with radiologist interpretation.

Conclusions

Changes in qCT measures are associated with clinically relevant outcomes and could improve PPF classification.

SUBMITTER: Wang JM 

PROVIDER: S-EPMC12378963 | biostudies-literature | 2025 Jul

REPOSITORIES: biostudies-literature