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Further Characterization of Computed Tomographic and Clinical Features for Staging and Prognosis of Idiopathic Pulmonary Fibrosis in West Highland White Terriers

Florence Thierry, Ian Handel, Gawain Hammond, Lesley G. King, Brendan M. Corcoran, Tobias Schwarz.

Background
Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal interstitial lung disease of unknown etiology, with a known predisposition in West Highland White Terriers (WHWTs). In humans, computed tomography (CT) plays a crucial role in disease staging and prognosis, but its utility in dogs remains unclear. This study aimed to establish descriptive CT criteria for diagnosing and staging IPF in WHWTs and to evaluate correlations between CT findings, clinical severity, and survival time.

Methods
A retrospective, cross-sectional study included WHWTs diagnosed with IPF based on clinical signs, CT findings, bronchoscopy, and bronchoalveolar lavage (BAL) results. Control WHWTs without respiratory disease were also included. CT scans were graded for severity using a standardized scoring system based on lung patterns. Clinical severity was assessed using a scoring system for cough, dyspnea, exercise intolerance, and crackles. Survival data were recorded, and statistical correlations between CT severity, clinical severity, and survival time were analyzed.

Results
Twenty-one WHWTs with IPF and 11 control dogs were included. The most common CT finding was a ground-glass pattern (76%), followed by focal reticular and mosaic ground-glass patterns (48%). Dogs with IPF had significantly higher lung attenuation values (-563 HU) than control dogs (-761 HU, P < 0.001). The severity of CT changes was positively correlated with clinical severity (ρ = 0.48, P = 0.029) and negatively associated with survival time (ρ = -0.56, P = 0.025). Dogs with mild CT changes had a longer median survival (255 days) than those with severe changes.

Limitations
The retrospective nature of the study limited standardization of imaging protocols. Histopathological confirmation was available in only six dogs, and not all dogs underwent echocardiography to assess for concurrent pulmonary hypertension. Additionally, some CT scans lacked high-resolution imaging, potentially affecting detection of subtle lung changes.

Conclusions
CT findings are valuable in characterizing IPF in WHWTs and may provide prognostic information. Dogs with milder CT changes tend to have longer survival times, supporting the use of CT as a staging tool. Future studies should explore the role of CT in monitoring disease progression and treatment response.

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