Dixon Giles, Thould Hannah, Wells Matthew, Tsaneva-Atanasova Krasimira, Scotton Chris J, Gibbons Michael A, Barratt Shaney L, Rodrigues Jonathan C L
Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.
Eur Respir Rev. 2025 Apr 30;34(176). doi: 10.1183/16000617.0194-2024. Print 2025 Apr.
The unpredictable trajectory and heterogeneity of interstitial lung disease (ILDs) make prognostication challenging. Current prognostic indices and outcome measures have several limitations. Quantitative computed tomography (qCT) provides automated numerical assessment of CT imaging and has shown promise when applied to the prognostication and disease monitoring of ILD. This systematic review aims to highlight the current evidence underpinning the prognostic value of qCT in predicting outcomes in ILD.
A comprehensive search of four databases (Medline, EMCare, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature)) was conducted for studies published up to and including 22 November 2024. A modified CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) checklist was used for data extraction. The risk of bias was assessed using a Quality in Prognostic Studies template.
The search identified 1134 unique studies, of which 185 studies met inclusion and exclusion criteria. Commonly studied ILD subtypes included idiopathic pulmonary fibrosis (41%, n=75), mixed subtypes (26%, n=48) and systemic sclerosis ILD (16%, n=30). Numerous studies showed significant prognostic signals, even when adjusted for common covariates and/or significant correlation between serial qCT biomarkers and conventional outcome measures. Heterogenous and nonstandardised reporting methods meant that direct comparison or meta-analysis of studies was not possible. Studies were limited by the use of retrospective methodology without prospective validation and significant study attrition.
qCT has shown efficacy in the prognostication and disease monitoring of a range of ILDs. Hurdles exist to widespread adoption including governance concerns, appropriate algorithm anchoring and standardisation of image acquisition. International collaboration is underway to address these hurdles, paving the way for regulatory approval and ultimately patient benefit.
间质性肺疾病（ILDs）的不可预测病程和异质性使得预后评估具有挑战性。当前的预后指标和结局测量方法存在若干局限性。定量计算机断层扫描（qCT）可对CT成像进行自动数值评估，并且在应用于ILD的预后评估和疾病监测时已显示出前景。本系统评价旨在突出当前支持qCT在预测ILD结局方面预后价值的证据。
对四个数据库（Medline、EMCare、Embase和CINAHL（护理及相关健康文献累积索引））进行全面检索，查找截至2024年11月22日（含该日）发表的研究。使用改良的CHARM（预测模型研究系统评价的关键评估和数据提取清单）清单进行数据提取。使用预后研究质量模板评估偏倚风险。
检索共识别出1134项独特研究，其中185项研究符合纳入和排除标准。常见的ILD亚型包括特发性肺纤维化（41%，n = 75）、混合亚型（26%，n = 48）和系统性硬化症相关ILD（16%，n = 30）。许多研究显示出显著的预后信号，即使在对常见协变量进行调整和/或系列qCT生物标志物与传统结局测量之间存在显著相关性时也是如此。报告方法的异质性和非标准化意味着无法对研究进行直接比较或荟萃分析。研究受到回顾性方法使用且无前瞻性验证以及显著的研究损耗的限制。
qCT在一系列ILD的预后评估和疾病监测中已显示出有效性。广泛采用存在障碍，包括管理问题、合适算法的锚定以及图像采集的标准化。国际合作正在进行以克服这些障碍，为监管批准并最终使患者受益铺平道路。
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