ArticleAmerican journal of respiratory and critical care medicine2026
Meaningful thresholds for change in quantitative computed tomography-derived fibrosis extent in idiopathic pulmonary fibrosis.
Article in American journal of respiratory and critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleValidated thresholds for clinically meaningful change in quantitative computed tomography (QCT) for fibrosis extent across algorithms remain unclear in idiopathic pulmonary fibrosis (IPF).
objectivesTo evaluate minimal clinically important difference (MCID) for 1-year change in QCT metrics in IPF using different algorithms than previously reported and to identify prognostically meaningful thresholds for effective risk stratification.
methodsThis multicenter retrospective study included IPF patients with baseline and 1-year follow-up CT. Minimal clinically important differences for change in fibrosis score (ΔFS) derived from fully automated CT quantification were estimated using an anchor-based approach with 1-year changes in FVC and diffusing capacity for carbon monoxide (DLco), and a prognostic threshold was estimated using maximally selected log-rank statistics. Prognostic significance of ΔFS was evaluated in discovery and validation cohorts.
resultsThe discovery cohort included 524 patients (mean age = 66.8 years; 79% men), and the external validation cohort included 224 patients (mean age = 69.6 years; 83% men). Anchor-based MCIDs were 2.72% for FVC and 4.52% for DLco, with a prognostic threshold of 4.05%. In the discovery cohort, 1-year ΔFS were independently associated with transplant-free survival (TFS), with greater risk when ΔFS exceeded MCID or prognostic thresholds (all, P < .001). In the validation cohort, ΔFS remained associated with TFS (adjusted hazard ratio [aHR] = 1.11; 95% CI, 1.04-1.18), and all prespecified ΔFS thresholds were prognostic for overall TFS, with the prognostic threshold of ΔFS ≥ 4.05% showing the most consistent associations with overall (aHR = 2.78; 95% CI, 1.36-5.68) and 3-year TFS (aHR = 2.88; 95% CI, 1.11-7.48).
conclusionOne-year change in FS and its thresholds were significantly associated with TFS, supporting annual CT follow-up with predefined QCT thresholds for monitoring and risk stratification in IPF.
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