Quantification differences between supine and prone CT in interstitial lung disease

To evaluate the measurement variability and reproducibility of prone imaging with quantitative computed tomography (QCT) compared with supine imaging with QCT in patients with interstitial lung disease (ILD).

Data from patients who underwent paired supine and prone computed tomography (CT) for ILD assessment between January 2021 and December 2023 were retrospectively analyzed. Lung abnormalities were quantified using deep learning-based software. Measurement variability and reproducibility were assessed using Bland-Altman analysis and intraclass correlation coefficients (ICC). Correlations of CT measurements with pulmonary function test (PFT) parameters were evaluated using Pearson's correlation and Steiger's Z-test. Linear and logistic regression analyses were conducted to identify factors associated with interpositional variability.

In 277 patients, QCT measurements showed high reproducibility between supine and prone CT across ILD subtypes (ICC > 0.75), with variability of approximately 2 % and 4 % in fibrosis extent and total ILD extent, respectively. Ground-glass opacity (GGO) showed the highest variability, particularly in extensive disease. In the prone position, honeycombing demonstrated stronger correlation with PFT parameters (diffusing capacity of the lungs for carbon monoxide: r = -0.456 vs. -0.391). Total lung volume (β = -0.955), total ILD extent (β = 0.604), and GGO extent (β = 0.475) were the strongest predictors of inter-positional variability. The hypersensitivity pneumonitis pattern was independently associated with greater variability in the total ILD extent (odds ratio, 11.121).

Prone CT measurements demonstrated high reproducibility and comparable correlation with PFT parameters, relative to supine CT measurements, with fibrosis extent variability of approximately 2 %. Prone CT may be reliable for single-time-point assessment; however, caution is warranted for longitudinal comparisons in advanced or GGO-dominant ILD.