High-resolution computed tomography (HRCT) plays a pivotal role in the diagnosis and
management of interstitial lung diseases (ILDs), particularly given the approval of
antifibrotic agents for conditions like idiopathic pulmonary fibrosis and progressive
pulmonary fibrosis. Diagnosing fibrotic pulmonary disorders through HRCT involves
a detailed and methodical examination. The identification of specific lung tissue
changes, including ground-glass opacities and reticulation, along with signs of fibrosis
like honeycombing, traction bronchiectasis and lung volume loss, establishes clear
HRCT patterns indicative of various ILDs. The reliability of these patterns in predicting
pathological conditions depends largely on the clinical context. For instance, when
a usual interstitial pneumonia pattern is present, the predictive value of this diagnosis
is so high that a lung biopsy is considered to be redundant. This review intends to
delineate the HRCT signs of fibrosis, elucidate the specific radiological patterns
of fibrotic lung diseases, and identify the clinical circumstances under which these
patterns emerge. Additionally, we introduce and discuss novel imaging techniques that
hold promise for the diagnosis, screening and early detection of ILDs.
