# Clustering analysis of HRCT parameters measured using a texture-based automated system: relationship with clinical outcomes of IPF

## TL;DR

This study uses automated CT analysis to identify clusters of IPF patients based on lung texture parameters, which are linked to different clinical outcomes and survival rates.

## Contribution

The study introduces a clustering approach using automated HRCT parameters to predict clinical outcomes in IPF patients.

## Key findings

- Three patient clusters were identified with distinct survival rates and clinical profiles.
- Reticulation had the strongest impact on survival, followed by honeycombing, consolidation, and emphysema.
- Cluster 2 had the lowest survival rate and was characterized by high reticulation and consolidation scores.

## Abstract

The extent of honeycombing and reticulation predict the clinical prognosis of IPF. Emphysema, consolidation, and ground glass opacity are visible in HRCT scans. To date, there have been few comprehensive studies that have used these parameters. We conducted automated quantitative analysis to identify predictive parameters for clinical outcomes and then grouped the subjects accordingly.

CT images were obtained while patients held their breath at full inspiration. Parameters were analyzed using an automated lung texture quantification system. Cluster analysis was conducted on 159 IPF patients and clinical profiles were compared between clusters in terms of survival.

Kaplan-Meier analysis revealed that survival rates declined as fibrosis, reticulation, honeycombing, consolidation, and emphysema scores increased. Cox regression analysis revealed that reticulation had the most significant impact on survival rate, followed by honeycombing, consolidation, and emphysema scores. Hierarchical and K-means cluster analyses revealed 3 clusters. Cluster 1 (n = 126) with the lowest values for all parameters had the longest survival duration, and relatively-well preserved FVC and DLCO. Cluster 2 (n = 15) with high reticulation and consolidation scores had the lowest FVC and DLCO values with a predominance of female, while cluster 3 (n = 18) with high honeycombing and emphysema scores predominantly consisted of male smokers. Kaplan-Meier analysis revealed that cluster 2 had the lowest survival rate, followed by cluster 3 and cluster 1.

Automated quantitative CT analysis provides valuable information for predicting clinical outcomes, and clustering based on these parameters may help identify the high-risk group for management.

The online version contains supplementary material available at 10.1186/s12890-024-03092-9.