• Stephen M Humphries, Ayodeji Adegunsoye, M Kristen Demoruelle, Wei KamMichelle LiMLDepartment of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; Center for Interstitial Lung Disease, National Jewish Health, Denver, CO, USA., Isabelle Amigues, Tami J Bang, Shawn D Teague, David A Lynch, Jonathan H Chung, Mary E Strek, Jeffrey J Swigris, and Joshua J Solomon.
• Department of Radiology, National Jewish Health, Denver, CO, USA.
• Chest. 2024 Nov 9.

BackgroundQuantitative chest computed tomography (CT) may be a useful predictor of outcome in rheumatoid arthritis-related interstitial lung disease (RA-ILD).Research QuestionWhat is the utility of deep learning-based lung fibrosis quantitation on CT in assessing disease severity, predicting mortality and identifying progression in RA-ILD?Study Design And MethodsCT scans on a primary cohort of 289 and a validation cohort of 50 individuals with RA-ILD were assessed quantitatively by using the data-driven texture analysis (DTA) method. We examined associations between quantitative scores for extent of lung fibrosis and pulmonary function and survival.ResultsDTA fibrosis score at baseline showed moderate negative correlation with forced vital capacity (FVC) percentage predicted (primary cohort rho=-0.55, validation cohort rho= -0.50, p<0.001 for both), and diffusing capacity for carbon monoxide (DLCO) percentage predicted (primary cohort rho=-0.67, validation cohort rho=-0.65, p<0.001 for both). Longitudinal change in DTA fibrosis score was associated with changes in FVC and DLCO in the primary cohort (rho=-0.46 and rho=-0.43, respectively, p<0.001 for both). Cox multivariable models adjusted for potentially influential variables showed that the baseline DTA fibrosis score was significantly associated with mortality risk (primary cohort hazard ratio [HR] 1.04, 95% confidence interval [1.03, 1.05], p<0.001; validation cohort HR 1.06, 95% confidence interval [1.01, 1.11], p=0.026). In the primary cohort increase in DTA fibrosis score on sequential scans was associated with increased risk of mortality (HR 1.04, 95% confidence interval [1.01, 1.06], p=0.003) independent of baseline DTA extent.InterpretationIn two cohorts of patients with RA-ILD, quantitative assessment of lung fibrosis on CT was associated with worse lung function at baseline and risk of mortality. Increase in DTA-derived lung fibrosis score on sequential scans was associated with subsequent risk of mortality. Quantitative CT should be considered for use as a clinical and research outcome assessment tool in RA-ILD.Copyright © 2024. Published by Elsevier Inc.

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