Comparison of ventilation-perfusion scintigraphy with MR angiography in patients with Swyer-James syndrome.

PURPOSE: The aim of this study was to establish the value of magnetic resonance angiography (MRA) in diagnosing) Swyer-James syndrome (SJS) and to compare MRA and ventilation-perfusion (V/Q) scan results in patients with established SJS.

METHODS: The V/Q scans and the MRA findings of 22 lungs of 11 patients with SJS (6 males, 5 females; age range: 17-69 years, mean: 38.4 years) were retrospectively studied. The perfusion scan was performed after the injection of Tc macroaggregated albumin. After 2 days, the ventilation scan was performed by using Tc diethylene triamine penta-acetic acid aerosol. The MRA was performed with a 1.5 T magnetic resonance unit. We compared the MRA and V/Q scan findings of the lungs of the patients.

RESULTS: The V/Q scans showed the characteristic pattern of a matched V/Q defect on the affected lungs. The MRA displayed a smaller pulmonary artery and markedly poor peripheral vasculature on the affected side in all patients. The MRA had a sensitivity of 84.6%, a specificity of 100% for the detection SJS. Interobserver variability was minimum as indicated by a weighted kappa statistic of 0.818.

CONCLUSION: This study indicates that the MRA is a fast, accurate, without radiation, and noninvasive technique for supporting the diagnosis of SJS. But, V/Q scans showed additional segmental perfusion/ventilation abnormalities on contralateral lung to reveal the segmental involvement of SJS. As a result, the MRA has no more any extra advantages for patient management.