Evaluation of radiological lung pattern and disease progression in patients with asbestosis compared to patients with idiopathic pulmonary fibrosis.

OBJECTIVES: This study aimed to compare lung patterns and disease progression in asbestosis and idiopathic pulmonary fibrosis (IPF) using qualitative and quantitative high-resolution computed tomography (HRCT) analysis. METHODS: HRCT scans were obtained at baseline (T0) and follow-up (T1) in 17 patients with asbestosis and 17 with IPF, after a median follow-up of 35 months (IQR=3) and 35 months (IQR=13), respectively. Lung parenchyma was segmented using CALIPER software, which quantifies reticulations (RET), ground-glass opacities (GGO), and honeycombing (HC), providing an interstitial lung disease (ILD) score based on the percentage of affected lung volume. Disease progression was defined as the change in ILD score from T0 to T1, normalized per year (DeltaILD/year). A comparative analysis was performed between the groups. Additionally, qualitative HRCT features at T0 were reviewed to identify distinguishing radiological signs. RESULTS: Patients with asbestosis showed significantly slower disease progression (median DeltaILD/year = 0.70%/month; IQR=1.27) compared to IPF (median = 2.06%/month; IQR=4.80) (p = 0.024). Subpleural lines (both <5 mm and >5 mm from pleura), pleural plaques, and pleural thickening were more common in asbestosis, whereas hypertrophic mediastinal fat and honeycombing predominated in IPF. CONCLUSION: Quantitative HRCT analysis with CALIPER effectively demonstrated slower progression in asbestosis compared to IPF. Specific imaging features, including subpleural lines and pleural involvement, distinguished asbestosis, while honeycombing and mediastinal fat hypertrophy were typical of IPF.