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For a secondary objective, we analyzed 50 additional patients with COVID-19 pneumonia. We performed semi-automatic segmentation of ILD regions using a deep learning model followed by manual review. From each segmented region, 103 radiomic features were extracted. Classification was performed using an XGBoost model with 1000 bootstrap repetitions and SHapley Additive exPlanations (SHAP) were applied to identify the most predictive features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model accurately distinguished a fibrotic ILD pattern from an inflammatory ILD one, achieving an average test set accuracy of 0.91 and AUROC of 0.98. The classification was driven by radiomic features capturing differences in lung morphology, intensity distribution, and textural heterogeneity between the two disease patterns. In differentiating cellular NSIP from COVID-19, the model achieved an average accuracy of 0.89. Inflammatory ILDs exhibited more uniform imaging patterns compared to the greater variability typically observed in viral pneumonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Radiomics combined with explainable AI offers promising diagnostic support in distinguishing fibrotic from inflammatory ILD patterns and differentiating inflammatory ILDs from viral pneumonias. This approach could enhance diagnostic precision and provide quantitative support for personalized ILD management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11547-025-02067-y","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T07:18:52Z","timestamp":1755847132000},"page":"1797-1807","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Unlocking the potential of radiomics in identifying fibrosing and inflammatory patterns in interstitial lung disease"],"prefix":"10.1007","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6217-4933","authenticated-orcid":false,"given":"Leonardo","family":"Colligiani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1791-3573","authenticated-orcid":false,"given":"Chiara","family":"Marzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0340-0069","authenticated-orcid":false,"given":"Vincenzo","family":"Uggenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2022-0804","authenticated-orcid":false,"given":"Sara","family":"Colantonio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tavanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5612-6364","authenticated-orcid":false,"given":"Francesco","family":"Pistelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9258-3466","authenticated-orcid":false,"given":"Greta","family":"Al\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-4559","authenticated-orcid":false,"given":"Emanuele","family":"Neri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3023-8784","authenticated-orcid":false,"given":"Chiara","family":"Romei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"issue":"10354","key":"2067_CR1","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/S0140-6736(22)01052-2","volume":"400","author":"M Wijsenbeek","year":"2022","unstructured":"Wijsenbeek M, Suzuki A, Maher TM (2022) Interstitial lung diseases. 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Approval was granted by the Ethics Committee of Pisa University Hospital (Date: 1st march 2021\/No. 17368).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 3a and b.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}