Quantitative CT in the real-world evaluation of progressive pulmonary fibrosis; the REVISE PPF multicentre observational study
In brief
Quantitative CT detected progression earlier in 47% to 83% of fibrosis cases
Across three centers, quantitative CT detected progression before clinical diagnosis in 47% to 83% of 200 patients with progressive pulmonary fibrosis, by an average of 220 to 847 days. But 42% to 67% of clinically stable patients also crossed imaging thresholds, so the tool may support closer monitoring rather than establish progression on its own.
- Journal
- Annals of the American Thoracic Society (Q1)
- Published
- 14 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ayodeji Adegunsoye, Anna J Podolanczuk, Teja Kulkarni, Christian Rennison-Jones, Steven Rothenberg, Kristin Berger, et al.
- PMID
- 42873574
- DOI
- 10.1093/annalsats/aaoag320
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 17 October 2026): qCT identified progression earlier than clinical diagnosis in ILD
Abstract
RATIONALE AND OBJECTIVE: We assessed whether an FDA-cleared quantitative CT (qCT) tool (Brainomix, e-Lung) identifies progressive pulmonary fibrosis (PPF) earlier than routine clinical diagnosis and evaluated the prognostic value of baseline and serial imaging biomarkers. METHODS: Multicentre retrospective study involving University of Alabama (UAB), Weill Cornell Medicine (WCM) and University of Chicago (UChicago); n = 509. HRCTs were analysed with e-Lung to derive Weighted Reticulovascular Score (WRVS, %), Total Disease Extent (TDE, %), and e-Lung Volume (mL). Prespecified progression thresholds were an absolute WRVS increase of ≥ 3 percentage points, an absolute TDE increase of ≥ 1.5 percentage points, and a relative e-Lung Volume decline of ≥ 10%, over less than 2 years. We compared the earliest qCT progression date with recorded clinical PPF diagnoses, assessed clinically stable controls, and modelled associations with future PPF and mortality using adjusted time-varying Cox models. RESULTS: Among 200 patients with PPF and serial HRCTs meeting the prespecified timing criterion, qCT identified progression earlier in 78% (UAB), 83% (WCM), and 47% (UChicago), with mean lead times of 434, 847, and 220 days, respectively. Among 187 clinically stable patients meeting the same serial-imaging criterion, progression thresholds were met in 67%, 56%, and 42%, respectively. High-risk baseline WRVS (≥15%) predicted future PPF (OR 4.09, 2.48, and 2.30) and mortality (HR 2.03 pooled UAB/WCM; 2.75 UChicago). Per 1-percentage-point increase, adjusted mortality HRs were 1.15 and 1.19 for WRVS and 1.05 and 1.04 for TDE in pooled UAB/WCM and UChicago, respectively. Threshold crossings were also associated with mortality (WRVS: HR 6.50 pooled UAB/WCM, 4.05 UChicago; TDE: 7.60 and 3.26; e-Lung Volume: 8.20 and 2.59). CONCLUSION: qCT detects radiological progression months to years before clinical PPF diagnoses. Integrating e-Lung into ILD pathways could accelerate treatment decisions and personalize follow-up.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.