Quantitative CT in Progressive Pulmonary Fibrosis: Clinical Utility and Meaningful Threshold Definition

This study evaluated the clinical utility of quantitative CT (QCT) in patients with progressive pulmonary fibrosis (PPF) and defined meaningful thresholds for predicting disease progression. Using AVIEW LTA software (Coreline Soft), 237 PPF patients were analyzed for lung volume, fibrosis extent, and texture features. An increase of 5% or more in fibrosis extent was identified as a significant predictor of progression, which is a more sensitive indicator than the conventional 10% threshold. Among texture features, kurtosis and skewness also showed significant associations with progression. QCT is a more objective and reproducible method than visual assessment and can be used as a valuable tool for early detection and treatment response monitoring in PPF. FS, defined as the sum of the extent of reticulation and honeycombing, was calculated using a deep learning-based QCT tool (Aview, version 1.1.44.27; Coreline Soft, Seoul, Republic of Korea) at baseline, 6-month, and 1-year HRCT scans. These findings suggest that quantitative imaging can provide more sensitive thresholds for disease progression compared to conventional visual assessment, supporting earlier detection of change and more precise monitoring over time in PPF. In this study, AVIEW Lung Texture Analysis (LTA) software was utilized to quantify fibrosis extent and texture features, supporting reproducible and standardized assessment across longitudinal CT scans.