Assessment of alveolar epithelial permeability with Tc-99m DTPA aerosol scintigraphy in patients with Sjogren syndrome

Abstract

Sjögren's syndrome (SjS) is a systemic autoimmune disease that mainly affects the exocrine glands and usually presents as persistent dryness of the mouth and eyes. Lung disease in SjS has been reported to occur early following clinical presentation of the disease. In this study, technetium-99m diethylene triamine penta-acetic acid (Tc-99m DTPA) aerosol inhalation scintigraphy was used to assess the pulmonary membrane permeability in patients with primary SjS. A total of 18 patients with primary SjS and 13 healthy controls were investigated. Clinical evaluation, chest X-ray examination, pulmonary function tests, Tc-99m DTPA aerosol scintigraphy were performed in all the cases. The presence of respiratory symptoms (dyspnea and cough), duration of sicca symptoms were recorded. The clearance half time of Tc-99m DTPA radioaerosols in patients with SjS (20.49 +/- 2.56 min) was faster when compared to normal controls (42.32 +/- 13.28 min) (P = 0.000) which means that there is a significant increase in lung permeability in patients with SjS compared to the controls. There is also a significant difference between PI of patients with SjS (0.34 +/- 0.09) and that of controls (0.42 +/- 0.07) (P = 0.012). According to the results of our preliminary study, one can detect pulmonary involvement by Tc-99m DTPA aerosol inhalation scintigraphy in patients with primary SjS.

Pulmonary manifestations of Sjögren's syndrome

“…In another study, a ventilation scan was used to document airway permeability function in 18 SS patients and 13 healthy volunteers. Technetium clearance was increased in the SS patients, indicating pulmonary permeability dysfunction [32]. Fifty percent of SS patients report having dry cough day and night, impairing their quality of life [33].…”

“…Data on follow-up of bronchiolitis lesions and of pulmonary function tests are currently lacking. Some studies showed that the bronchial and bronchiolar disease is stable in SS [11,32,42]. Lymphoid infiltration may be associated with an atelectasis responsible for a middle lobe syndrome [43].…”

“…Mialon et al evaluated 18 primary SS patients for a period ranging from 26 to 137 months and reported a reduction in MEF25 values in 72% of patients, a finding consistent with the development of peripheral airways obstruction[32]. Most studies have reported a frequency of 22 to 46% of distal airway disease in SS[12,26,41].…”

Association between Sjogren's Syndrome and Respiratory Failure: Put Airway, Interstitia, and Vessels Close Together: A National Cohort Study

“…The risk of RF increases with the number of SS exacerbations and admissions [41] . These findings imply a positive association between the incidence of RF and recurrent airway inflammation [29] , [42] , interstitial fibrosis [11] , [41] , alveolitis [43] , and chronic pulmonary arterial hypertension [18] , [40] , all of which may cause impairment or damage the airways [28] , [42] , interstitia/aleveoli [11] , [41] , [43] , and pulmonary vessels [40] . These findings indicate poor control as a critical factor for the incidence of RF in patients with SS [19] , [28] , [44] , [45] .…”

Assessment of lung toxicity caused by bleomycin and amiodarone by Tc-99m HMPAO lung scintigraphy in rats

“…A wide range of radiopharmaceuticals, including Tc-99m diethylenetriaminepentaacetate (Tc-99m DTPA) [23–26], gallium 67 (Ga-67) [23, 27, 28], I-123 metaiodobenzylguanidine (MIBG) [29], I-123 iodoamphetamine (IMP), I-123 N , N , N -trimethyl- N -[2-hydroxy-3-methyl-5 iodobenzyl-1,3 propanediamine (HIPDM) and Tc-99m HMPAO [1–5, 29–33] are used to determine microvascular injuries in the lungs. I-123 MIBG, I-123 IMP, I-123 HIPDM and Tc-99m HMPAO are able to show the endothelial injury in the lungs scintigraphically [3–5].…”