Computed Tomographic Biomarkers in Idiopathic Pulmonary Fibrosis. The Future of Quantitative Analysis

[...]in the absence of an ideal endpoint such as mortality, the substitution of a validated biomarker for a clinical endpoint (i.e., a surrogate endpoint) that can reliably predict the effect of the therapy can significantly improve the efficiency of IPF clinical trials (8-10). [...]it is not yet clear how HRCT pattern and extent can help inform management decisions in an individual patient. Kurtosis describes the sharpness of the histogram peak and is inversely proportional to the thickness of the two tails of the histogram. Because lung fibrosis or inflammation causes an increase in the amount of soft tissue in the lung, it will increase mean lung attenuation and thereby decrease the sharpness of the histogram peak (kurtosis) and the degree of leftward skewness of the curve (Figure 1). [...]the availability of a noncontrast, volumetric thin high-resolution CT dataset with a CT kernel that does not alter local HU accuracy is essential to accurate feature extraction.