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. 2025 Aug 22.
doi: 10.1007/s11547-025-02067-y. Online ahead of print.

Unlocking the potential of radiomics in identifying fibrosing and inflammatory patterns in interstitial lung disease

Leonardo Colligiani #  1   2 , Chiara Marzi #  3 , Vincenzo Uggenti  1   2 , Sara Colantonio  4 , Laura Tavanti  5 , Francesco Pistelli  5 , Greta Alì  6 , Emanuele Neri  1 , Chiara Romei  1   2
Affiliations

Unlocking the potential of radiomics in identifying fibrosing and inflammatory patterns in interstitial lung disease

Leonardo Colligiani et al. Radiol Med. .

Abstract

Purpose: To differentiate interstitial lung diseases (ILDs) with fibrotic and inflammatory patterns using high-resolution computed tomography (HRCT) and a radiomics-based artificial intelligence (AI) pipeline.

Materials and methods: This single-center study included 84 patients: 50 with idiopathic pulmonary fibrosis (IPF)-representative of fibrotic pattern-and 34 with cellular non-specific interstitial pneumonia (NSIP) secondary to connective tissue disease (CTD)-as an example of mostly inflammatory pattern. For a secondary objective, we analyzed 50 additional patients with COVID-19 pneumonia. We performed semi-automatic segmentation of ILD regions using a deep learning model followed by manual review. From each segmented region, 103 radiomic features were extracted. Classification was performed using an XGBoost model with 1000 bootstrap repetitions and SHapley Additive exPlanations (SHAP) were applied to identify the most predictive features.

Results: The model accurately distinguished a fibrotic ILD pattern from an inflammatory ILD one, achieving an average test set accuracy of 0.91 and AUROC of 0.98. The classification was driven by radiomic features capturing differences in lung morphology, intensity distribution, and textural heterogeneity between the two disease patterns. In differentiating cellular NSIP from COVID-19, the model achieved an average accuracy of 0.89. Inflammatory ILDs exhibited more uniform imaging patterns compared to the greater variability typically observed in viral pneumonia.

Conclusion: Radiomics combined with explainable AI offers promising diagnostic support in distinguishing fibrotic from inflammatory ILD patterns and differentiating inflammatory ILDs from viral pneumonias. This approach could enhance diagnostic precision and provide quantitative support for personalized ILD management.

Keywords: Idiopathic pulmonary fibrosis; Interstitial lung disease; Machine learning; Non-specific interstitial pneumonia; Radiomics.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Pisa University Hospital (Date: 1st march 2021/No. 17368). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 3a and b.

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