Visual and fully-automated CT analysis in acute exacerbations of idiopathic pulmonary fibrosis (IPF)

Introduction: CT is essential in diagnosis of acute exacerbation of IPF (AE) showing new ground-glass abnormalities (GGO) along to reticular pattern (RE). However, quantification is subject to inter-reader variability and limited reproducibility. Aim of this work was to compare visual scoring (VS) to fully automated computer-aided quantification of sequential CTs in patients with and without AE. Methods: Paired follow-up non-enhanced thin-section CT were analyzed using LUng FIbrosis quantification Tool (LUFIT) in 49 IPF patients (pt). Longitudinal VS assessment was performed by an experienced chest radiologist. Spearman correlation was applied for 40th and 80th percentile (PERC) histogram of lung density (reflecting RE and GGO respectively) and VS. Results: 30pt with AE (FVC 67% ±18, DLCO 35% ±13) and 19pt without AE (NoAE) (FVC 81% ±24, DLCO 49% ±16) at follow-up were included, resulting in serial analysis of 98 paired CT data-sets. Automated CT analysis ran unattended and successfully. In pt experiencing AE, GGO increased +6% in VS and +29HU (40th PERC) in LUFIT (p Conclusions: In IPF patients, LUFIT analysis identified typical changes during AE successfully and provided quantification of acute inflammation (GGO) and fibrosis (RE). Fully automated quantification of CT is easy to perform, time effective, correct, and reliable in patients suffering from IPF.