Imaging in the diagnosis and management of fibrosing interstitial lung diseases.

High-resolution computed tomography (HRCT) plays a pivotal role in the diagnosis and management of interstitial lung diseases (ILDs), particularly given the approval of antifibrotic agents for conditions like idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. Diagnosing fibrotic pulmonary disorders through HRCT involves a detailed and methodical examination. The identification of specific lung tissue changes, including ground-glass opacities and reticulation, along with signs of fibrosis like honeycombing, traction bronchiectasis and lung volume loss, establishes clear HRCT patterns indicative of various ILDs. The reliability of these patterns in predicting pathological conditions depends largely on the clinical context. For instance, when a usual interstitial pneumonia pattern is present, the predictive value of this diagnosis is so high that a lung biopsy is considered to be redundant. This review intends to delineate the HRCT signs of fibrosis, elucidate the specific radiological patterns of fibrotic lung diseases, and identify the clinical circumstances under which these patterns emerge. Additionally, we introduce and discuss novel imaging techniques that hold promise for the diagnosis, screening and early detection of ILDs.

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Conflict of interest: M. Storman and C. Lederer have no conflicts of interests that relate to this article. D.L. Tarnoki and A.D. Tarnoki declare they have received funding outside the present work from the Bólyai scholarship of the Hungarian Academy of Sciences, from ÚNKP-20-5 and ÚNKP-21-5 New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development, and Innovation Fund, and from the Hungarian National Laboratory (under the National Tumor Biology Laboratory project, NLP-17). G.A. Margaritopoulos has received speaking fees from Boehringer Ingelheim. H. Prosch has received speaking fees from AstraZeneca, BMS, Boehringer Ingelheim, Janssen, MSD, Novartis, Roche, Sanofi, Siemens and Takeda, and has received research support from AstraZeneca, Boehringer Ingelheim, Siemens and the EU Commission (EU4Health, Horizon Europe Health).