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Introduction Interstitial lung disease (ILD) is a common and severe complication of systemic sclerosis (SSc), with a heterogeneous course. We aim to clarify whether ancillary baseline high-resolution computed tomography (HRCT) features can predict ILD progression.Material and Methods SSc patients followed in our center (2014-2025), with ILD on HRCT scan and a minimum follow-up of 24 months from ILD onset (defined as the first evidence on HRCT) were included. Patients without HRCT at SSc and ILD diagnosis were excluded. ILD progression was defined according to the ATS/ERS 2022 Guideline for progressive pulmonary fibrosis (PPF). 1 HRCT scans were evaluated by three experienced thoracic radiologists blinded to clinical and functional data. Baseline HRCT pattern was recorded along with ancillary features, including reticulation, consolidation, ground-glass opacities, emphysema, honeycombing, number and size of mediastinal lymph nodes (>10 mm), distribution of bronchiectasis, presence and diameter of esophageal dilatation, and the extent of ground-glass opacities and fibrotic changes. Clinical, serological and treatment data were collected at SSc and ILD diagnosis, and at last follow-up.Results Of 77 patients with SSc-ILD, 15 (19%) met criteria for PPF. No differences in demographic, serological and clinical features were observed between progressors and non-progressors. The lag time between SSc and ILD diagnosis was shorter in progressors (p=0.04).C reactive protein >5 mg/L at SSc diagnosis (p=0.01) and respiratory symptoms (p=0.001) at ILD onset were significantly more frequent in progressors vs. non-progressors. Progressors had significantly lower baseline forced vital capacity (p=0.01), total lung capacity (p=0.01) and diffusing capacity for carbon monoxide (p=0.004), although these associations did not remain significant in multivariate analysis.At baseline HRCT evaluation, radiological ILD patterns did not differ among groups, while ground glass opacities and fibrosis extent were significantly higher among progressors vs. non-progressors (p=0.0002 and p=0.0004, respectively). Mediastinal lymphadenopathy was more frequent (p=0.024), with higher number of enlarged lymph nodes (p=0.02) and lung lobes involved by bronchiectasis (p=0.01) in progressors vs. non-progressors (table 1). Fibrosis extent and mediastinal lymphadenopathy were confirmed as independent predictors of progression in multivariate analysis (OR 1.09 [95%CI 1.02–1.17]; p=0.011 and OR 5.2 [1.03–26.03], p=0.045).Conclusions Ancillary baseline HRCT features may predict SSc-ILD progression, helping to promptly identify high-risk patients and enabling earlier treatment to improve outcomes.Reference Raghu G, et al. Am J Respir Crit Care Med. 2022.Abstract P.123 Table 1Baseline radiological features in the overall population and categorized in progressor and non-progressor SSc-ILD