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Updated: Jan 9, 2026
Unilateral Lung Volume Analysis Using Micro-CT for Enhanced Assessment of Pulmonary Fibrosis in Preclinical Models
Published on: June 20, 2025
Quantitative CT Imaging in Progressive Pulmonary Fibrosis: Clinical Usefulness and Meaningful Threshold Definition
Sohee Park1, Min-Ju Kim2, Jang Ho Lee3
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Background:
Although quantitative CT imaging offers objective evaluation of radiologic progression in non-idiopathic pulmonary fibrosis (IPF) fibrosing interstitial lung disease (ILD), clinically meaningful thresholds for defining progressive pulmonary fibrosis (PPF) remain unclear.
Research Question:
What are the minimal clinically important differences (MCIDs) in quantitative CT imaging-based fibrosis score (FS) changes over 1 year and 6 months, and do these thresholds predict outcomes and enhance risk stratification in defining PPF among patients with non-IPF fibrosing ILD?
Study Design And Methods:
This retrospective study included patients with non-IPF fibrosing ILD who underwent volumetric CT imaging at baseline and the 1-year follow-up. FS was calculated using a deep learning-based quantitative CT imaging algorithm. The MCID for FS change was determined using anchor-based methods, referencing absolute 1-year FVC change. The association of FS change MCID with transplant-free survival (TFS) and its alignment with PPF criteria were analyzed using Cox regression. Concordance between quantitative CT imaging-based and visual assessments was also assessed.
Results:
Among 476 patients, the 1-year and 6-month MCIDs were 2.24% and 1.34%, respectively. Exceeding the 1-year MCID was independently associated with poorer TFS (adjusted hazard ratio [HR], 3.01; 95% CI, 2.19-4.14). Quantitative CT imaging-based progression provided additional risk stratification in patients with discordant PPF criteria, including those with disagreement on visual progression (P = .02). Patients with both visual and quantitative CT imaging-based progression showed worse outcomes than those with visual progression alone (P < .001). FS changes of more than the 6-month MCID were also associated with worse outcome (adjusted HR, 2.82; 95% CI, 1.57-5.04).
Interpretation:
Quantitative CT imaging-based PPF definition using 1-year change in FS was prognostic across patients with non-IPF fibrosing ILDs and enhanced risk stratification in patients with discordant PPF assessments.
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