PROGNOSTIC VALUE OF HIGH-RESOLUTION COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF FIBROTIC INTERSTITIAL LUNG DISEASE: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n57-047Keywords:
Interstitial Lung Diseases, Pulmonary Fibrosis, Tomography X-Ray Computed, PrognosisAbstract
Introduction: Fibrotic interstitial lung diseases represent a heterogeneous group of chronic pulmonary disorders characterized by progressive fibrosis, irreversible architectural distortion, and substantial morbidity and mortality. High-resolution computed tomography has become central to the diagnostic workup of these conditions and is increasingly recognized as a tool for prognostic stratification beyond its diagnostic role. Specific radiological patterns and quantitative imaging features have been associated with disease progression, functional decline, and survival outcomes across different fibrotic interstitial lung disease subtypes.
Objective: The main objective of this systematic review was to evaluate the prognostic value of high-resolution computed tomography findings in patients with fibrotic interstitial lung disease. Secondary objectives included assessing the association between specific radiological patterns and mortality, disease progression, and functional decline; evaluating the prognostic role of quantitative high-resolution computed tomography metrics; comparing prognostic performance across different fibrotic interstitial lung disease subtypes; and examining the consistency of high-resolution computed tomography prognostic markers with current clinical guidelines.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Eligible studies evaluated prognostic outcomes associated with high-resolution computed tomography features in fibrotic interstitial lung disease. Study selection, data extraction, and risk of bias assessment were performed independently by reviewers, and results were synthesized narratively with structured comparison of outcomes. Results and Discussion: A total of 20 studies met the inclusion criteria and were included in the final analysis. Consistent associations were observed between high-resolution computed tomography patterns such as usual interstitial pneumonia, extent of fibrosis, traction bronchiectasis, and quantitative fibrosis scores with increased mortality and accelerated functional decline. Emerging evidence supports the incremental prognostic value of quantitative imaging techniques, although heterogeneity in methodology and outcome definitions remains a limitation.
Conclusion: High-resolution computed tomography provides meaningful prognostic information in fibrotic interstitial lung disease and should be considered an integral component of longitudinal disease assessment. Radiological markers, particularly fibrosis extent and specific structural features, offer clinically relevant insights that may support individualized risk stratification and therapeutic decision-making.
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