arXiv:2509.23530v1 Announce Type: cross Abstract: Interstitial lung disease (ILD) is a leading cause of morbidity and mortality in systemic sclerosis (SSc). Chest computed tomography (CT) is the primary imaging modality for diagnosing and monitoring lung complications in SSc patients. However, its role in disease progression and mortality prediction has not yet been fully clarified. This study introduces a novel, large-scale longitudinal chest CT analysis framework that utilizes radiomics and deep learning to predict mortality associated with lung complications of SSc. We collected and analyzed 2,125 CT scans from SSc patients enrolled in the Northwestern Scleroderma Registry, conducting mortality analyses at one, three, and five years using advanced imaging analysis techniques. Death labels were assigned based on recorded deaths over the one-, three-, and five-year intervals, confirmed by expert physicians. In our dataset, 181, 326, and 428 of the 2,125 CT scans were from patients who died within one, three, and five years, respectively. Using ResNet-18, DenseNet-121, and Swin Transformer we use pre-trained models, and fine-tuned on 2,125 images of SSc patients. Models achieved an AUC of 0.769, 0.801, 0.709 for predicting mortality within one-, three-, and five-years, respectively. Our findings highlight the potential of both radiomics and deep learning computational methods to improve early detection and risk assessment of SSc-related interstitial lung disease, marking a significant advancement in the literature.