Search Results (73)

Background/Objectives: Interstitial lung disease (ILD) is frequently complicated by pulmonary hypertension (PH), which is associated with reduced exercise capacity and poor prognosis. Early and accurate non-invasive detection of PH remains a clinical challenge. This study evaluated whether combining quantitative CT analysis of lung fibrosis with cardiac MRI-derived measures of right ventricular (RV) function improves the diagnostic accuracy of PH in patients with ILD. Methods: We retrospectively analyzed 72 ILD patients who underwent chest CT, cardiac MRI, and right heart catheterization (RHC). Lung fibrosis was quantified using a Gaussian Histogram Normalized Correlation (GHNC) software that computed the proportions of diseased lung, ground-glass opacity (GGO), honeycombing, reticulation, consolidation, and emphysema. MRI was used to assess RV end-systolic volume (RVESV), ejection fraction, and RV longitudinal strain. PH was defined as a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg and pulmonary vascular resistance ≥ 3 Wood units on RHC. Results: Compared to patients without PH, those with PH (n = 21) showed significantly reduced RV strain (−13.4 ± 5.1% vs. −16.4 ± 5.2%, p = 0.026) and elevated RVESV (74.2 ± 18.3 mL vs. 59.5 ± 14.2 mL, p = 0.003). CT-derived indices also differed significantly: diseased lung area (56.4 ± 17.2% vs. 38.4 ± 12.5%, p < 0.001), GGO (11.8 ± 3.6% vs. 8.65 ± 4.3%, p = 0.005), and honeycombing (17.7 ± 4.9% vs. 12.8 ± 6.4%, p = 0.0027) were all more prominent in the PH group. In receiver operating characteristic curve analysis, diseased lung area demonstrated an area under the curve of 0.778 for detecting PH. This increased to 0.847 with the addition of RVESV, and further to 0.854 when RV strain was included. Combined models showed significant improvement in risk reclassification: net reclassification improvement was 0.700 (p = 0.002) with RVESV and 0.684 (p = 0.004) with RV strain; corresponding IDI values were 0.0887 (p = 0.03) and 0.1222 (p = 0.01), respectively. Conclusions: Combining CT-based fibrosis quantification with cardiac MRI-derived RV functional assessment enhances the non-invasive diagnosis of PH in ILD patients. This integrated imaging approach significantly improves diagnostic precision and may facilitate earlier, more targeted interventions in the management of ILD-associated PH. Full article

Background/Objectives: Spread through air spaces (STAS) is defined as the spread of tumor cells into the parenchymal alveolar space beyond the margins of the main tumor, and it is associated with worse clinical outcomes in resected lung adenocarcinoma. This study aimed to evaluate the preoperative computed tomography (CT) findings of primary lung adenocarcinoma in surgically resected T1 cases and to compare CT findings with and without STAS. Methods: A total of 145 patients were included in this study. The following factors were evaluated on CT images: nodule type (pure ground-glass nodule [GGN], part-solid nodule, or solid nodule), margin (smooth or irregular), the presence of lobulation, spicula, cavity, calcification, central low attenuation, peripheral opacity (well-defined or ill-defined), air bronchogram, satellite lesions, pleural retraction, pulmonary emphysema, and interstitial pneumonia; CT values (maximum, minimum, and mean); volume (tumor and solid component); and diameter (tumor and solid component). CT criteria were compared between the presence and absence of STAS. Results: Lobulation and central low attenuation were significantly more frequent in patients with STAS (p < 0.05). The mean CT value, and the volume, rate, and diameter of the solid component were significantly larger in cases with STAS (p < 0.05). A multiple logistic regression analysis identified central low attenuation as an indicator of the presence of STAS (p < 0.001; odds ratio, 3.993; 95% confidence interval, 1.993–8.001). Conclusions: Quantitative and qualitative analyses are useful for differentiating between the presence and absence of STAS. Full article

Background/Objectives: This study aims to distinguish radiological differences between primary idiopathic Usual Interstitial Pneumonia (UIP) and secondary UIP patterns Methods: This retrospective study included patients with HRCT findings consistent with a UIP pattern. Final diagnoses were established via multidisciplinary discussion and classified as primary UIP/IPF or secondary UIP, following the 2022 ATS/ERS/JRS/ALAT guidelines. An expert thoracic radiologist (>10 years of experience), blinded to clinical data, reviewed the earliest available HRCT assessing key imaging features: honeycombing (micro-, macro- or exuberant), fibrosis distribution (symmetry, anterior-upper lobe sign, etc.), ground-glass opacities (GGO), dilatation of esophagus. Additionally, AI software AVIEW Build 1.1.46.28-win Coreline (©Coreline Soft Co., Ltd. All Rights Reserved). performed lung texture analysis, quantifying total lung volume and radiological patterns. Statistical analysis was performed to reveal results. Results: Among 53 cases, 31 were classified as IPF and 22 as secondary UIP cases. The expert radiologist achieved a diagnostic sensitivity of 82.9%, specificity of 889%, with a positive predictive value of 93.5%—in distinguishing between primary and secondary UIP. Primary UIP cases exhibited typical hallmark radiological features, including uniform honeycombing with cranio-caudal distribution (90.3%). Reticulations contributed significantly to the fibrotic texture, maintaining a consistent cranio-caudal gradient and axial symmetry (84.8%). Secondary UIP displayed more significant radiological heterogeneity, including patchy fibrosis with irregular GGO distribution (84.5% versus 53.33%); other findings—such as exuberant honeycombing, four corner sign and wedge-shaped fibrosis—were mainly observed in secondary pattern with respective percentages of 31.8%, 9% and 49%. Conclusions: Experienced thoracic radiologists, leveraging hallmark imaging features, play a critical role in improving diagnostic accuracy between primary and secondary UIP patterns. Full article

Nitrofurantoin, a commonly prescribed antibiotic for urinary tract infections, has been associated with rare but potentially serious pulmonary toxicity, which can present in acute, subacute, or chronic forms. Acute toxicity typically manifests in the form of hypersensitivity pneumonitis, which is characterized by fever, dyspnea, and eosinophilia, often resolving rapidly after drug discontinuation. However, chronic toxicity can lead to interstitial lung disease with progressive fibrosis, causing significant and sometimes irreversible pulmonary impairment. The pathophysiology of nitrofurantoin-induced lung injury is thought to involve oxidative stress, immune-mediated mechanisms, and direct cytotoxic effects; however, the exact pathways remain incompletely understood. Clinical diagnosis is challenging due to nonspecific symptoms that often resemble other respiratory conditions, leading to delays in recognition and treatment. Radiographic findings vary, with acute cases showing diffuse ground-glass opacities, while chronic cases may demonstrate reticular interstitial changes and fibrosis. The discontinuation of nitrofurantoin is the primary intervention, but corticosteroids may be beneficial, particularly in chronic cases with persistent inflammation or fibrosis, though their efficacy remains uncertain. Given the risk of long-term respiratory complications, heightened awareness among healthcare providers is essential for early diagnosis and intervention. Future research is needed to better define risk factors, improve diagnostic criteria, and explore alternative treatment strategies that mitigate the potential for pulmonary toxicity while maintaining effective antimicrobial therapy. This review explores the pathophysiology, clinical presentation, diagnostic challenges, and management strategies for nitrofurantoin-induced pulmonary toxicity. Full article

Tuffaceous fillings are a significant component of the Permian Kuishan sandstone in the North China Platform, and their complex diagenetic processes have a notable impact on the development of clastic rock reservoirs. This study, based on microscopic analysis of reservoirs and combined with quantitative analytical techniques such as electron probe microanalysis, homogenization temperatures of fluid inclusions, micro-area carbon-oxygen isotope analysis, and laser Raman spectroscopy, investigates the influence of tuffaceous interstitial material dissolution on reservoir development in the Permian Kuishan sandstone of the Gaoqing buried hill in the Jiyang Depression, Bohai Bay Basin. The results indicate that the dissolution intensity of tuffaceous interstitial materials can be classified into three levels: strong, moderate, and weak. In the strong dissolution zone, associated fractures and dissolution pores significantly contribute to reservoir porosity, with a positive correlation between dissolution plane porosity and total plane porosity. The reservoir space is characterized by a network of dissolution pores and fractures. The moderate dissolution zone is marked by the development of authigenic quartz, feldspar, and clay minerals, which do not effectively enhance porosity and permeability. The weak dissolution zone contains well-preserved volcanic glass shards, crystal fragments, and clay minerals, representing non-reservoir development sections. Lithology, sedimentary facies, diagenesis, and fractures collectively control the quality of the Permian Kuishan sandstone reservoir in the Gaoqing buried hill of the Jiyang Depression, Bohai Bay Basin. The advantageous zones for reservoir development in this area can be effectively predicted using thickness maps of the Kuishan sandstone, planar distribution maps of sedimentary facies, and fracture prediction maps derived from ant-tracking and coherence algorithms. Full article

Magnesium silicate (MgSiO₃) is widely utilized in glass manufacturing, with its performance influenced by structural modifications. In this study, we employ classical and density functional theory (DFT) simulations to investigate the defect and dopant characteristics of MgSiO₃. Our results indicate that a small amount of Mg-Si anti-site defects can exist in the material. Additionally, MgO Schottky defects are viable, requiring only slightly more energy to form than anti-site defects. Regarding the solubility of alkaline earth dopant elements, Ca preferentially incorporates into the Mg site without generating charge-compensating defects, while Zn exhibits a similar behavior among the 3D block elements. Al and Sc are promising dopants for substitution at the Si site, promoting the formation of Mg interstitials or oxygen vacancies, with the latter being the more energetically favorable process. The solution of isovalent dopants at the Si site is preferred by Ge and Ti. Furthermore, we analyze the electronic structures of the most favorable doped configurations. Full article

Background/Objectives: This study compared chest high-resolution computed tomography (HRCT) findings between patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive and antibody-negative progressive pulmonary fibrosis (PPF) with polymyositis/dermatomyositis (PM/DM). Methods: Of the 85 patients with PM/DM-interstitial lung disease (ILD), 17 were anti-MDA5 antibody-positive, and 68 were antibody-negative. Among these, 5 anti-MDA5 antibody-positive and 9 antibody-negative cases met the criteria for PPF and were enrolled in the study. The chest HRCT findings and the duration from treatment initiation to the appearance of key fibrotic changes were analyzed. Results: In the anti-MDA5-positive group, all patients were diagnosed with PPF within 6 months of treatment initiation, compared to only 22.2% in the anti-MDA5-negative group. While there was no difference between the anti-MDA5 antibody-positive and antibody-negative groups in terms of chest HRCT findings associated with PPF, the duration to the appearance of increased traction bronchiectasis and bronchiolectasis, and new ground-glass opacity with traction bronchiectasis was significantly shorter in the anti-MDA5-positive group (p = 0.016 and p = 0.023, respectively). The appearance of new fine reticulations and increased coarseness of reticular abnormalities tended to be shorter in the anti-MDA5 antibody-positive group than in the antibody-negative group. Conclusions: Pulmonary fibrosis in patients with anti-MDA5 antibody-positive ILD can rapidly progress within 6 months, despite immunosuppressive therapy. Frequent HRCT monitoring and early combination therapy with antifibrotic agents are crucial for managing the progression of fibrosis. Full article

Background/Objectives: Even today, interstitial lung disease (ILD) is diagnosed by chest high-resolution computed tomography (lung HR-CT). Large amounts of data are available about the usefulness of transthoracic lung ultrasound (LUS) in ILD. This study aimed to evaluate the transthoracic LUS capacity to discriminate different ILD patterns in systemic sclerosis (SSc) patients, such as usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) with ground glass opacification/opacity (GGO), and NSIP with GGO and reticulations, as well as the possibility of identifying progressive fibrosing ILD. Methods: We enrolled SSc-patients attending the outpatient Clinic of the Rheumatology Unit of Policlinico of Foggia and the Rheumatology Unit of Policlinico of Bari who satisfied these inclusion criteria: age older than 18 years; the satisfaction of ACR/EULAR 2013 classification criteria for SSc; chest HR-CT scan within three months before or three months after transthoracic LUS evaluation; and availability of recent and complete pulmonary function test. The exclusion criteria were as follows: history or recent reactivation of chronic obstructive pulmonary disease, lung cancer, lung infection, heart failure, pulmonary oedema, pulmonary arterial hypertension, acute respiratory distress syndrome and diffuse alveolar haemorrhage and thoracic surgery. All enrolled SSc-patients underwent transthoracic LUS, performed by an experienced sonographer. The ILD diagnosis and the respective patterns were assessed by chest HR-CT, which still represents the best diagnostic tool. Results: ILD was observed in 99 (63.5%) patients. Of these, 25% had the UIP pattern and 75% the NSIP pattern (46 with GGO, 28 with GGO and reticulations). By receiver operating characteristic (ROC) curve analysis, higher values of accuracy, sensitivity, specificity, and negative clinical utility index (CUI) were found for pleural line irregularity (0.84 (95% CI: 0.75–0.91), 96%, and 73.6%, p = 0.0001; 0.72), and pleural line thickness (0.84 (95% CI: 0.74–0.91), 72%, and 96.4%, p = 0.0001; 0.85) for detecting the UIP pattern. The best performance among transthoracic LUS signs for NSIP with the GGO pattern was observed for B-lines (accuracy: 0.88 (95% CI: 0.80–0.93), sensitivity: 93.4% and specificity: 82.4, p = 0.0001; CUI+: 0.75, CUI−: 0.77). LUS signs with higher accuracy, sensitivity, and specificity for NSIP with GGO and reticulations were pleural line irregularity (0.89 (95% CI: 0.80–0.95), 96.4%, and 82.4%, p = 0.0001) with CUI−: 0.72, and B-lines (0.89 (95% CI: 0.80–0.95), 96.4%, 82.4%, p = 0.0001), with CUI+: 0.80 and CUI−: 0.70. Furthermore, a total number of B-lines > 10 maximises LUS performance with 92.3% sensitivity, and an accuracy of 0.83 (p = 0.0001) for detecting the NSIP pattern, particularly GGO. A sample-restricted analysis (66 SSc patients) evidenced the presence of progressive fibrosing ILD in 77% of these patients. By binary regression analysis, the unique LUS sign associated with progressive fibrosing ILD was the presence of pleural line irregularity (OR: 3.6; 95% CI 1.08–11.9; p = 0.036). Conclusions: Our study demonstrated that transthoracic LUS presented a high capacity to discriminate the different patterns of SSc-ILD. Therefore, the hypothesis that transthoracic LUS is an effective screening method for the evaluation of the presence of SSc-ILD and establishing the correct timing of chest HR-CT, in order to avoid patients receiving excessive exposure to ionising radiation, is supported. Full article

Background: Antibodies against Ku have been described in patients with various connective tissue diseases. The objective of this study was to describe the clinical, functional, and imaging characteristics of interstitial lung disease in patients with anti-Ku antibodies. Methods: This single-center, retrospective observational study was conducted at a tertiary referral institution. Patients with positive anti-Ku antibodies and interstitial lung disease identified between 2007 and 2022 were included. Clinical, immunological, functional, and imaging data were systematically reviewed. Results: Nineteen patients (ten females) with a mean age of 59 ± 12.6 years were included. The most frequent associated diagnosis was systemic sclerosis (42%), followed by rheumatoid arthritis (26%), Sjögren syndrome, undifferentiated connective tissue disease, and overlap between systemic sclerosis and idiopathic inflammatory myopathy (scleromyositis). Imaging revealed frequent septal and intralobular reticulations and ground-glass opacities, with nonspecific interstitial pneumonia as the predominant pattern (53%). The mean forced vital capacity was 82% ± 26 of the predicted value, and the mean diffusing capacity for carbon monoxide was 55% ± 21. Over the first year of follow-up, the mean annual forced vital capacity decline was 140 mL/year (range: 0–1610 mL/year). The overall survival rate was 82% at 5 years and 67% at 10 years. Conclusions: Most patients with interstitial lung disease and anti-Ku antibodies presented with dyspnea, a mild-to-moderate restrictive ventilatory pattern, and reduced diffusing capacity for carbon monoxide. The CT pattern was heterogeneous but was consistent with nonspecific interstitial pneumonia in half of the patients. Full article

Background and Objectives: Thin-section CT (TSCT) is currently the most sensitive imaging modality for detecting bronchiectasis. However, conventional TSCT or HRCT may overlook subtle lung involvement such as alveolar and interstitial changes. Artificial Intelligence (AI)-based analysis offers the potential to identify novel information on lung parenchymal involvement that is not easily detectable with traditional imaging techniques. This study aimed to assess lung involvement in patients with bronchiectasis using the Bronchiectasis Radiologically Indexed CT Score (BRICS) and AI-based quantitative lung texture analysis software (IMBIO, Version 2.2.0). Methods: A cross-sectional study was conducted on 45 subjects diagnosed with bronchiectasis. The BRICS severity score was used to classify the severity of bronchiectasis into four categories: Mild, Moderate, Severe, and tractional bronchiectasis. Lung texture mapping using the IMBIO AI software tool was performed to identify abnormal lung textures, specifically focusing on detecting alveolar and interstitial involvement. Results: Based on the Bronchiectasis Radiologically Indexed CT Score (BRICS), the severity of bronchiectasis was classified as Mild in 4 (8.9%) participants, Moderate in 14 (31.1%), Severe in 11 (24.4%), and tractional in 16 (35.6%). AI-based lung texture analysis using IMBIO identified significant alveolar and interstitial abnormalities, offering insights beyond conventional HRCT findings. This study revealed trends in lung hyperlucency, ground-glass opacity, reticular changes, and honeycombing across severity levels, with advanced disease stages showing more pronounced structural and vascular alterations. Elevated pulmonary vascular volume (PVV) was noted in cases with higher BRICSs, suggesting increased vascular remodeling in severe and tractional types. Conclusions: AI-based lung texture analysis provides valuable insights into lung parenchymal involvement in bronchiectasis that may not be detectable through conventional HRCT. Identifying significant alveolar and interstitial abnormalities underscores the potential impact of AI on improving the understanding of disease pathology and disease progression, and guiding future therapeutic strategies. Full article

Objectives: To investigate the relationship between COVID-19 pneumonia outcomes and three chest CT analysis approaches. Methods: Patients with COVID-19 pneumonia who underwent chest CT were included and divided into survivors/non-survivors and intubated/not-intubated. Chest CTs were analyzed through a (1) Total Severity Score visually quantified by an emergency (TSS1) and a thoracic radiologist (TSS2); (2) density mask technique quantifying normal parenchyma (DM_Norm 1) and ground glass opacities (DM_GGO1) repeated after the manual delineation of consolidations (DM_Norm2, DM_GGO2, DM_Consolidation); (3) texture analysis quantifying normal parenchyma (TA_Norm) and interstitial lung disease (TA_ILD). Association with outcomes was assessed through Chi-square and the Mann–Whitney test. The TSS inter-reader variability was assessed through intraclass correlation coefficient (ICC) and Bland–Altman analysis. The relationship between quantitative variables and outcomes was investigated through multivariate logistic regression analysis. Variables correlation was investigated using Spearman analysis. Results: Overall, 192 patients (mean age, 66.8 ± 15.4 years) were included. TSS was significantly higher in intubated patients but only TSS1 in survivors. TSS presented an ICC of 0.83 (0.76; 0.88) and a bias (LOA) of 1.55 (−4.69, 7.78). DM_Consolidation showed the greatest median difference between survivors/not survivors (p = 0.002). The strongest independent predictor for mortality was DM_Consolidation (AUC 0.688), while the strongest independent predictor for the intensity of care was TSS2 (0.7498). DM_Norm 2 was the singular feature independently associated with both the outcomes. DM_GGO1 strongly correlated with TA_ILD (ρ = 0.977). Conclusions: The DM technique and TA achieved consistent measurements and a better correlation with patient outcomes. Full article

Background/Objectives: Integrating the cytotoxic drug busulfan into a high-dose chemotherapy regimen prior to autologous hematopoietic stem cell rescue in patients with high-risk neuroblastoma has improved the survival of children battling this deadly disease. Busulfan-induced toxicities can, however, be severe. Here, we describe the diagnosis and successful treatment of acute pulmonary injury by total-body-weight-adjusted busulfan therapy in two children with high-risk neuroblastoma. Case series: Patient 1 developed life-threatening biphasic acute respiratory failure on days +60 and +100 after busulfan therapy, requiring intubation and invasive mechanical ventilation. Despite intensive anti-inflammatory and immunomodulatory therapy, including systemic corticosteroids, topical inhalation regimens, azithromycin, nintedanib and extracorporal photopheresis, patient 1 required extended intensive care measures and non-invasive respiratory support for a total of 20 months. High-resolution computed tomography showed diffuse intra-alveolar and interstitial patterns. Patient 2 developed partial respiratory failure with insufficient oxygen saturation and dyspnea on day +52 after busulfan therapy. Symptoms were resolved after 6 months of systemic corticosteroids, topical inhalation regimens and azithromycin. High-resolution computed tomography showed atypical pneumonic changes with ground-glass opacities. While both patients fully recovered without evidence of pulmonary fibrosis, cancer therapy had to be paused and then modified until full recovery from busulfan-induced lung injury. Conclusions: Busulfan-induced lung injury requires prompt diagnosis and intervention. Symptoms and signs are nonspecific and difficult to differentiate from other causes. Therapeutic busulfan drug level monitoring and the identification of patients at risk for drug overdosing through promoter polymorphisms in the glutathione S-transferase alpha 1 gene encoding the main enzyme in busulfan metabolism are expected to reduce the risk of busulfan-induced toxicities. Full article

Background: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major complication of rheumatoid arthritis (RA), but effective treatment remains an unmet need in its management. Our aim was to evaluate the therapeutic efficacy of abatacept for RA-ILD. Methods: This observational retrospective study included patients with RA-ILD treated with abatacept between 2012 and 2021. Indices of RA disease activity and interstitial lung disease (Disease Activity Score in 28 joints using C-reactive Protein [DAS28-CRP], Simplified Disease Activity Index [SDAI], Clinical Disease Activity Index [CDAI], serum Krebs von den Lungen-6 levels, % forced vital capacity [%FVC], and semi-quantified chest high-resolution computed tomography scores) were evaluated before and 1 year after the start of abatacept administration. Results: Overall, 38 patients were included. DAS28-CRP, SDAI, and CDAI were significantly improved (all with p < 0.0001). Total ground-glass opacity scores were decreased in both patients with usual interstitial pneumonia (UIP)-like patterns and with non-UIP-like patterns (p = 0.008 and <0.002, respectively). Total fibrosis scores were also decreased in the UIP-like pattern group (p < 0.042). The %FVC remained stable. Conclusions: Abatacept significantly improves RA disease activity and reduces pulmonary inflammation in patients with RA-ILD. Full article

Much of the lithospheric subcontinental mantle (SCLM) sampled in the Calatrava Volcanic Field (CVF) shows refertilization by alkaline metasomatic agents. The Cerro Pelado and El Palo ultramafic xenolith suites record the best evidence of this type of metasomatism in this volcanic field. Several groups of peridotite (lherzolite, wehrlite, and dunite) and pyroxenite (clinopyroxenite and websterite) xenoliths have been distinguished. Despite having scarce phlogopites and amphiboles as modal metasomatic phases, all studied xenoliths present a variable cryptic metasomatism, highlighted by the strong Fe-Ti enrichment and fractionated REE patterns in the most evolved wehrlite and pyroxenite varieties. They show a common trend of an Fe-Ti-Ca increase, whereas the pyroxenites are more depleted in Fe compared to the lherzolites and wehrlites. Trace-element (REE and multi-trace) patterns are roughly similar among them, suggesting different interactions and refertilization degrees by alkaline silicate melts. The same Sr–Nd isotopic EAR composition, combined with trace-element chemistry of metasomatic xenolith phases and phenocrysts from the Calatrava volcanics, highlights the main role of this magmatism in percolation processes beneath Central Iberia. These mantle xenoliths also show variable amounts of interstitial glass that originated by in situ partial melting, favored by the enriched chemical nature of cryptically metasomatized clinopyroxene during their volcanic transport. This alkaline-refertilized mantle type represents the main domain within the SCLM beneath Central Iberia, as was also recorded in other Western European Cenozoic volcanic fields. Full article

Introduction: Lung ultrasound (LUS) is widely used in clinical practice for identifying interstitial lung diseases (ILDs) and assessing their progression. Although high-resolution computed tomography (HRCT) remains the gold standard for evaluating the severity of ILDs, LUS can be performed as a screening method or as a follow-up tool post-HRCT. Minimum training is needed to better identify typical lesions, and the integration of innovative artificial intelligence (AI) automatic algorithms may enhance diagnostic efficiency. Aim: This study aims to assess the effectiveness of a novel AI algorithm in automatic ILD recognition and scoring in comparison to an expert LUS sonographer. The “SensUS Lung” device, equipped with an automatic algorithm, was employed for the automatic recognition of the typical ILD patterns and to calculate an index grading of the interstitial involvement. Methods: We selected 33 Caucasian patients in follow-up for ILDs exhibiting typical HRCT patterns (honeycombing, ground glass, fibrosis). An expert physician evaluated all patients with LUS on twelve segments (six per side). Next, blinded to the previous evaluation, an untrained operator, a non-expert in LUS, performed the exam with the SensUS device equipped with the automatic algorithm (“SensUS Lung”) using the same protocol. Pulmonary functional tests (PFT) and DLCO were conducted for all patients, categorizing them as having reduced or preserved DLCO. The SensUS device indicated different grades of interstitial involvement named Lung Staging that were scored from 0 (absent) to 4 (peak), which was compared to the Lung Ultrasound Score (LUS score) by dividing it by the number of segments evaluated. Statistical analyses were done with Wilcoxon tests for paired values or Mann–Whitney for unpaired samples, and correlations were performed using Spearman analysis; p < 0.05 was considered significant. Results: Lung Staging was non-inferior to LUS score in identifying the risk of ILDs (median SensUS 1 [0–2] vs. LUS 0.67 [0.25–1.54]; p = 0.84). Furthermore, the grade of interstitial pulmonary involvement detected with the SensUS device is directly related to the LUS score (r = 0.607, p = 0.002). Lung Staging values were inversely correlated with forced expiratory volume at first second (FEV1%, r = −0.40, p = 0.027), forced vital capacity (FVC%, r = −0.39, p = 0.03) and forced expiratory flow (FEF) at 25th percentile (FEF25%, r = −0.39, p = 0.02) while results directly correlated with FEF25–75% (r = 0.45, p = 0.04) and FEF75% (r = 0.43, p = 0.01). Finally, in patients with reduced DLCO, the Lung Staging was significantly higher, overlapping the LUS (reduced median 1 [1–2] vs. preserved 0 [0–1], p = 0.001), and overlapping the LUS (reduced median 18 [4–20] vs. preserved 5.5 [2–9], p = 0.035). Conclusions: Our data suggest that the considered AI automatic algorithm may assist non-expert physicians in LUS, resulting in non-inferior-to-expert LUS despite a tendency to overestimate ILD lesions. Therefore, the AI algorithm has the potential to support physicians, particularly non-expert LUS sonographers, in daily clinical practice to monitor patients with ILDs. The adopted device is user-friendly, offering a fully automatic real-time analysis. However, it needs proper training in basic skills. Full article