A Quantitative Imaging Measure of Progressive Pulmonary Fibrosis
Jennifer M Wang1, Ayodeji Adegunsoye2, Janelle Vu Pugashetti1
1Division of Pulmonary and Critical Care Medicine.
Summary
Quantitative CT measures show promise in classifying progressive pulmonary fibrosis (PPF) and predicting survival in interstitial lung disease (ILD) patients. This approach may improve prognostic accuracy beyond current qualitative CT assessments.
Area of Science:
- Pulmonary Medicine
- Radiology
- Quantitative Imaging
Background:
- Progressive pulmonary fibrosis (PPF) significantly increases mortality in fibrotic interstitial lung disease (ILD).
- Current CT-based PPF criteria are qualitative and subject to inter-reader variability.
- Quantitative CT (qCT) offers a potential solution for objective PPF assessment.
Purpose of the Study:
- To assess the association between qCT measures of pulmonary fibrosis and transplant-free survival (TFS) in ILD patients.
- To develop and validate a quantitative CT measure for PPF (qctPPF).
Main Methods:
- Retrospective analysis of serial chest CT scans in 350 fibrotic ILD patients (including IPF).
- Utilized commercial software for qCT measurements of pulmonary fibrosis.
- Cox proportional hazard models assessed association with 2-year TFS; iterative modeling developed qctPPF; validation in an independent cohort (n=92).
Main Results:
- Increased ground glass opacity and decreased lung volume on qCT correlated with reduced TFS.
- qctPPF classification demonstrated a >3-fold increased hazard of death or transplant in both test and validation cohorts.
- qctPPF showed poor agreement with radiologist assessment but retained prognostic significance.
Conclusions:
- Changes in qCT measures are linked to significant clinical outcomes in ILD.
- qCT-based measures, including the developed qctPPF, can potentially enhance the classification of PPF.
- Quantitative CT analysis offers a more objective and prognostic tool for managing fibrotic ILD.
