• Nicola Sverzellati, Mario Silva, Valeria Seletti, Carlotta Galeone, Stefano Palmucci, Sara Piciucchi, Carlo Vancheri, Venerino Poletti, Sara Tomassetti, Ronald Karwoski, and Brian J Bartholmai.
• Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Padiglione Barbieri, V. Gramsci 14, Parma, Italy. nicola.sverzellati@unipr.it.
• Eur Radiol. 2020 May 1; 30 (5): 2669-2679.

ObjectivesTo test HRCT with either visual or quantitative analysis in both short-term and long-term follow-up of stable IPF against long-term (transplant-free) survival, beyond 2 years of disease stability.MethodsFifty-eight IPF patients had FVC measurements and HRCTs at baseline (HRCT0), 10-14 months (HRCT1) and 22-26 months (HRCT2). Visual scoring, CALIPER quantitative analysis of HRCT measures, and their deltas were evaluated against combined all-cause mortality and lung transplantation by adjusted Cox proportional hazard models at each time interval.ResultsAt HRCT1, a ≥ 20% relative increase in CALIPER-total lung fibrosis yielded the highest radiological association with outcome (C-statistic 0.62). Moreover, the model combining FVC% drop ≥ 10% and ≥ 20% relative increase of CALIPER-total lung fibrosis improved the stratification of outcome (C-statistic 0.69, high-risk category HR 12.1; landmark analysis at HRCT1 C-statistic 0.66, HR 14.9 and at HRCT2 C-statistic 0.61, HR 21.8). Likewise, at HRCT2, the model combining FVC% decrease trend and ≥ 20% relative increase of CALIPER-pulmonary vessel-related volume (VRS) improved the stratification of outcome (C-statistic 0.65, HR 11.0; landmark analysis at HRCT1 C-statistic 0.62, HR 13.8 and at HRCT2 C-statistic 0.58, HR 12.6). A less robust stratification of outcome distinction was also demonstrated with the categorical visual scoring of disease change.ConclusionsAnnual combined CALIPER -FVC changes showed the greatest stratification of long-term outcome in stable IPF patients, beyond 2 years.Key Points• Longitudinal high-resolution computed tomography (HRCT) data is more helpful than baseline HRCT alone for stratification of long-term outcome in IPF. • HRCT changes by visual or quantitative analysis can be added with benefit to the current spirometric reference standard to improve stratification of long-term outcome in IPF. • HRCT follow-up at 12-14 months is more helpful than HRCT follow-up at 23-26 months in clinically stable subjects with IPF.

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