Therapeutic Response by Radiologic Pattern of Lung Injury in Myositis-Associated Interstitial Lung Disease: A Retrospective Cohort Study

<b>Radiologic phenotyping may predict therapeutic response in myositis-ILD</b> . This study demonstrates that an OP-predominant computed tomography (CT) pattern of lung injury is associated with greater improvement in lung function and radiologic signs of inflammation over 24 months on at least 6 months of immunomodulatory therapy compared with an NSIP-predominant pattern, suggesting that CT pattern may provide clinically meaningful prognostic information. <b>First study to integrate blinded qualitative radiologic adjudication with quantitative CT scoring in myositis-ILD</b> . By combining dual-radiologist review with Kazerooni quantitative scoring and longitudinal pulmonary function testing, this study offers a rigorous and multidimensional assessment of treatment response. <b>Expands risk stratification beyond antibody-based toward imaging-based phenotyping strategies</b> . In a heterogeneous population defined by diverse myositis-associated antibodies, this work introduces radiologic pattern as a practical and accessible framework for anticipating treatment responsiveness. <b>Provides hypothesis-generating data for precision management in myositis-ILD</b> . The findings support the concept that imaging-defined subgroups may exhibit differential therapeutic trajectories, laying groundwork for future multicenter studies integrating CT phenotype, antibody profile, and treatment strategy.