To evaluate whether distribution measures of CT-based attenuation histograms in inspiration and expiration can indicate alveolar collapse and serve as a predictive marker in patients with idiopathic pulmonary fibrosis (IPF). This single-center retrospective longitudinal study analyzed CT scans of IPF patients in inspiration and expiration. The patient population was divided into two subgroups based on their status 3 years after baseline CT (death or transplantation versus clinical surveillance). Attenuation histograms in inspiration and expiration were created and analyzed. A Mann-Whitney U test was conducted to assess the difference of CT-derived histogram measures (including skewness) between the two subgroups. Logistic regression was applied to model the ability to distinguish between subgroups using baseline forced vital capacity (FVC%) and CT-derived histogram measures. The study included 66 patients (mean age 69.5 ± 10.9 years, 58 males). After the individual three-year observation period, 37 patients were still alive while 29 had either died or received a transplantation. The two patient subgroups were significantly different in terms of all CT-derived histogram measures and the baseline FVC%. A logistic regression model that only included the CT-derived histogram measure skewness had a better predictive performance (AUC = 0.793, 95% CI = 0.685-0.900) compared to the FVC% model alone (0.708, 0.581-0.836). Whereas further evaluation is needed, paired inspiratory/expiratory attenuation histogram analysis offers a promising approach as a prognostic imaging marker to improve outcome prediction and assess alveolar collapse in IPF.
Copyright: © 2026 Scharm et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.