What question did this study set out to answer?

This study aims to evaluate how effectively the e-Lung quantitative CT algorithm can identify and risk-stratify patients with progressive pulmonary fibrosis.

May 20, 2026

A95-01 Use of Quantitative CT in the Real-world Evaluation of Progressive Pulmonary Fibrosis: The Retrospective Evaluation in the United States of E-lung in PPF (REVISE PPF) Multicenter Observational Study

Key Points

This study aims to evaluate how effectively the e-Lung quantitative CT algorithm can identify and risk-stratify patients with progressive pulmonary fibrosis.
Multicenter retrospective analysis involving 509 patients from three specialized interstitial lung disease centers.
Comparison of local clinical diagnoses of PPF to e-Lung algorithm outputs to assess timing and accuracy of diagnoses.
Evaluated risk associations between qCT scores and mortality.
e-Lung identified radiological progression earlier than clinical diagnoses in 78% to 83% of patients at 14 to 28 months.
Baseline WRVS≥15% was linked to future PPF development: OR ranged from 2.30 to 4.09 across cohorts.
Increased WRVS and TDE were associated with significantly elevated mortality risk, with HR values indicating strong risk.

Abstract

Abstract Rationale The Retrospective EValuation in the US of e-Lung in PPF (REVISE PPF) study is a multicenter retrospective study designed to evaluate the ability of a commercially available quantitative CT (qCT) algorithm (e-Lung, Brainomix, Oxford) to expedite the diagnosis of progressive pulmonary fibrosis (PPF) and to risk-stratify patients at increased risk of mortality and PPF. Methods Patients from 3 specialist interstitial lung disease (ILD) centers were studied: University of Alabama at Birmingham (UAB), Weill Cornell Medicine (WCM) and University of Chicago (UChicago). e-Lung qCT biomarkers of ILD severity evaluated were the weighted reticulovascular score (WRVS), a measure of peripheral fibrosis, and ILD total disease extent (TDE). Comparison was made between time to local clinical diagnosis of PPF versus time to surpassing e-Lung thresholds for radiological progression on serial CT (WRVS ≥3% and TDE ≥1.5%). Associations between i) high risk baseline qCT fibrosis scores (WRVS≥15%), ii) e-Lung defined radiological progression and future PPF diagnosis and mortality were established. Results 509 patients were included of whom 267 (52%) had a diagnosis of PPF. In patients with serial CT, e-Lung identified radiologic progression earlier than the clinical PPF diagnosis in 78% (UAB), 83% (WCM) and 52% (UChicago) of patients at a mean time of 14 months, 28 months and 8 months respectively. Baseline WRVS≥15% was associated with future development of PPF in all 3 cohorts: UAB odds ratio (OR) 4.09 (95% CI: 2.07-8.11, p 0.0001), WCM OR 2.48 (95% CI: 1.26-4.86, p 0.01)), and UChicago OR 2.30 (95% CI: 1.16-4.57, p = 0.017). Patients with WRVS increase ≥3% on serial CT were at increased risk of death: HR 6.92, (95% CI: 2.26 - 21.24, p 0.001) in pooled UAB/WCM and HR 5.86, (95% CI: 3.45 - 9.93, p 0.001) in UChicago cohorts. Patients with TDE increase ≥1.5% were also at increased risk of death: HR 16.41 95% CI 3.36 - 80.20; p 0.001 in pooled UAB/WCM and HR 4.75 95% CI 2.90 - 7.78; p 0.0001 in UChicago cohorts. Conclusion In diverse cohorts of patients with ILD from three specialist US centers, e-Lung was able to stratify patients at risk of future progression from a baseline CT and identified patients with radiologic evidence of progressive pulmonary fibrosis up to 28 months earlier than local clinical diagnoses. e-Lung qCT biomarkers used to identify earlier progression were also linked to increased mortality risk. These data support the prospective evaluation of e-Lung in routine ILD clinical practice. This abstract is funded by: Brainomix

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Cite This Study

Podolanczuk et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0d50dcf03e14405aa9cefe https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.2388

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