HYE JU LEE
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- Etiological profile and main imaging findings in patients with granulomatous diseases who underwent lung biopsy(2021) OLIVEIRA, Camila Vilela de; HORVAT, Natally; TESTAGROSSA, Leonardo de Abreu; ROMAO, Davi dos Santos; RASSI, Marina Bastos; LEE, Hye JuY Background: Granulomatous Lung Diseases (GLD) encompasses a wide range of infectious and non-infectious conditions characterized by chronic inflammatory response. However, different GLD may share similar imaging findings. In this context, the purpose of this study was to outline the etiological profile and their imaging features in patients with GLD who underwent lung biopsy. Methods: Patients with granulomatous lesions in lung biopsies and previous chest CT performed from 2014 to 2017 at our institution had imaging data reviewed by three blinded radiologists. The imaging features were analyzed according to the Fleischner Society glossary. Categorical data were represented by absolute (n) and relative (%) frequency. The contingency matrices were analyzed by Pearson's Chi-square test. Interreader agreement was assessed by calculating the intraclass correlation coefficient, using kappa (kappa) statistic. Results: Thirty-eight of 75 (50.7%) patients were women with a mean age of 59 +/- 39 years. Infection was the most common cause of GLD (47/75, 62.7%) and Histoplasma capsulatum (27/75, 36%) was the most prevalent etiology. Nodular pattern was the most common imaging feature in histoplasmosis cases (25/27, 92.6%), whereas it occurred in half of cases (24/48) of GLD of other causes (p < 0.05). Among patients with tuberculosis, the second etiology of GLD in our study population, the most common imaging pattern was centrilobular micronodules (3/7, 42.9%), significantly more frequent than in other causes of GLD (6/68, 8.8%). Interreader agreement in detecting imaging features was almost perfect (kappa = 0.88-1.00), except the nodular pattern, which had substantial agreement (kappa = 0.73). Conclusions: In our study population, the main etiologies found in patients with granulomatous disease who underwent lung biopsy were fungal or mycobacterial disease, specially histoplasmosis and tuberculosis, and nodular pattern with focal distribution was the most common imaging finding which was detected with substantial interreader agreement.
- Quantitative analysis of pulmonary perfusion with dual-energy CT angiography: comparison of two quantification methods in patients with pulmonary embolism(2023) LEE, Hye Ju; WANDERLEY, Mark; RUBIN, Vivian Cardinal da Silva; ALCALA, Glasiele Cristina; COSTA, Eduardo Leite Vieira; PARGA, Jose Rodrigues; AMATO, Marcelo Britto PassosThe study aimed to evaluate a quantification method of pulmonary perfusion with Dual-Energy CT Angiography (DE-CTA) normalized by lung density in the prediction of outcome in acute pulmonary embolism (PE). In this prospective study with CTA scans acquired with different breathing protocols, two perfusion parameters were calculated: %PBV (relative value of PBV, expressed per unit volume) and PBVm (PBV normalized by lung density, expressed per unit mass). DE-CTA parameters were correlated with simplified pulmonary embolism severity index (sPESI) and with outcome groups, alone and in combinationwith tomographic right-to-left ventricular ratios (RV/LV). PBVm showed significant correlation with sPESI. PBVm presented higher accuracy than %PBV In the prediction of ICU admission or death in patients with PE, with the best performance when combined with RV/LV volumetric ratio.
- Lobar pulmonary perfusion quantification with dual-energy CT angiography: Interlobar variability and relationship with regional clot burden in pulmonary embolism(2022) LEE, Hye Ju; WANDERLEY, Mark; RUBIN, Vivian Cardinal da Silva; RODRIGUES, Ana Clara Tude; DINIZ, Amanda Rocha; PARGA, Jose Rodrigues; AMATO, Marcelo Britto PassosPurpose: Semi-automated lobar segmentation tools enable an anatomical assessment of regional pulmonary perfusion with Dual-Energy CTA (DE-CTA). We aimed to quantify lobar pulmonary perfusion with DE-CTA, analyze the perfusion distribution among the pulmonary lobes in subjects without cardiopulmonary diseases and assess the correlation between lobar perfusion and regional endoluminal clots in patients with acute pulmonary embolism (PE). Methods: We evaluated 151 consecutive subjects with suspected PE and without cardiopulmonary comorbidities. DE-CTA derived perfused blood volume (PBV) of each pulmonary lobe was measured applying a semi-automated lobar segmentation technique. In patients with PE, blood clot location was assessed, and CT-based vascular obstruction index of each lobe (CTOIlobe) was calculated and classified into three groups: CTOIlobe= 0, low CTOIlobe (1-50%) and high CTOIlobe (>50%). Results: Among patients without PE (103/151, 68.2%), median lobar PBV was 13.7% (IQR 10.2-18.0%); the right middle lobe presented lower PBV when compared to all the other lobes (p < .001). In patients with PE (48/151, 31.8%), lobar PBV was 12.6% (IQR 9.6-15.7%), 13.7% (IQR 10.1-16.7%) and 6.5% (IQR 5.1-10.2%) in the lobes with CTOIlobe= 0, low CTOIlobe and high CTOIlobe scores, respectively, with a significantly decreased PBV in the lobes with high CTOIlobe score (p < .001). ROC analysis of lobar PBV for prediction of high CTOIlobe score revealed AUC of 0.847 (95%CI 0.785-0.908).
bookPart Tromboembolismo pulmonar(2017) LEE, Hye JuconferenceObject Respiratory Symptoms and Altered Physical Exam in Rheumatoid Arthritis Patients with Subclinical Interstitial Lung Abnormalities(2018) KAWANO-DOURADO, L.; SAWAMURA, M. V. Y.; BONFIGLIOLI, K.; ARIMURA, F. E.; LEE, H. J.; RANGEL, D. A. S.; CARVALHO, C. R. R.; DOYLE, T. J.; ROSAS, I. O.; KAIRALLA, R. A.bookPart Doenças mediastinais(2017) LEE, Hye Ju; YANATA, Elaine- Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis(2020) KAWANO-DOURADO, Leticia; DOYLE, Tracy J.; BONFIGLIOLI, Karina; SAWAMURA, Marcio V. Y.; NAKAGAWA, Renato H.; ARIMURA, Fabio E.; LEE, Hye J.; RANGEL, Diana Arrais de Souza; BUENO, Cleonice; CARVALHO, Carlos R. R.; SABBAG, Maria Laura; MOLINA, Camila; ROSAS, Ivan O.; KAIRALLA, Ronaldo A.BACKGROUND Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes. RESEARCH QUESTION. What are baseline characteristics associated with RA-ILD progression? STUDY DESIGN AND METHOD! We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified. RESULTS. Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement. INTERPRETATION. Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longi- tudinal studies of RA-ILA are necessary.