Comparison of the Quantitative CT Imaging Biomarkers of Idiopathic Pulmonary Fibrosis at Baseline and Early Change with an Interval of 7 Months

Rationale and Objectives: Median survival of patients with idiopathic pulmonary fibrosis (IPF) is 2-5 years. Sensitive imaging metrics can play a role in detecting early changes in therapeutic development. The aim of the present study was to compare known computed tomography (CT) histogram kurtosis and a classifier-based quantitative score to assess baseline severity and change over time in patients with IPF. Materials and Methods: A total of 57 patients with at least baseline and paired follow-up scans were selected from an imaging database of standardized CT scans obtained from patients with IPF. CT histogram measurement of kurtosis and quantitative lung fibrosis (QLF) and quantitative interstitial lung disease (QILD) scores from a classification algorithm were calculated. Spearman rank correlations were used to assess associations between baseline severity and changes for all CT-derived measures compared to forced vital capacity (FVC) and carbon monoxide diffusion capacity (DLCO) (percent predicted). Results: At baseline, mean (+/- SD) of kurtosis was 2.43 (+/- 1.83). Mean (+/- SD) values of QLF and QILD scores were 20.7% (+/- 13.4) and 43.3% (+/- 20.0), respectively. All baseline histogram indices and QLF and QILD scores were correlated well with baseline FVC and DLCO. When assessing associations with changes in FVC and DLCO over time, only QLF score was statistically significant (p = -0.57; P < .0001 for FVC and p = -0.34; P = .025 for DLCO), whereas kurtosis was not. Conclusions: Classifier-model-derived scores (QLF and QILD), based on a set of texture features, are associated with baseline disease extent and are also a sensitive measure of change over time. A QLF score can be used for measuring the extent of disease severity and longitudinal changes.