Clinical significance of ventilation/perfusion scans in collagen disease patients

The purpose of this study was to detect disturbances in pulmonary circulati on in collagen disease patients by means of a non-invasive technique, Metho ds: Ventilation/perfusion scans with Xe-133 gas and Tc-99m-macroaggregated albumin (MAA) were performed in 109 patients with various collagen diseases . Functional images of V, Vol, Q and V/Q ratio were obtained at total lung capacity. Wash-out time was calculated from the wash-out curve. Whole body scans were performed in 65 patients to evaluate intra-pulmonary shunts. Res ults: Increased V/Q areas were observed in 74 patients (67.9%), suggesting some impairment of pulmonary perfusion. Decreased perfusion, probably due t o vasculitis or intravascular microcoagulation, was observed often, even in patients without pulmonary fibrosis. Shunt ratios over 10% were observed i n 8 of the 65 patients (12.3%), indicating formation of PA-PV shunts second ary to peripheral vascular impairment. Wash-out time was prolonged in 37 pa tients (33.9%), shortened in 18 (16.5%), and within the normal range in 54 (49.6%). The prolonged and normal wash-out times in the patients with pulmo nary fibrosis may represent obstructive changes in the small airways superi mposed on the fibrosis. Conclusion: Ventilation/perfusion scans are a very useful tool for evaluating collagen lune diseases, and they might contribut e to treatment decisions for the patients.