Objective: To predict the postoperative pulmonary function using ventilation-perfusion scintigraphy and explore its feasibility in evaluating surgical risk for lung cancer patients with borderline pulmonary functions (forced expiratory volume in 1 second [FEV1] < 2.0L for pneumonectomy or <1.5L for lobectomy).Methods: Twenty lung cancer patients (52-86 yrs, 4F, 16M) with borderline pulmonary functions were included in the study.Planar ventilation scans with 99mTc-diethylenetriamine pentaacetic acid (DTPA) aerosol and perfusion scans with 99mTc-macroaggregated albumin (MAA) were performed pre-surgery.Pulmonary function test was performed 1 week pre-surgery for all patients and 2 months post-surgery for twelve patients.Postoperative FEV1 (ppoFEV1) values were calculated using Neuhaus equations and compared to measured FEV1 values post-surgery.Results: There was no significant statistical difference between ventilation ppoFEV1 values and perfusion ppoFEV1values: (1.153±0.227) L vs (1.204±0.210) L (n=20, t=0.045, P>0.05).No significant statistical difference exists between ventilation ppoFEV1 values and postoperative measured FEV1 values: (1.238±0.200) L vs (1.28±0.146) L (n=12, t=0.557, P>0.05), nor is statistical difference observed between perfusion ppoFEV1 values and postoperative measured FEV1 values: (1.302±0.161) L vs (1.28±0.146) L (n=12, t=0.288, P>0.05).Both ventilation ppoFEV1 values and perfusion ppoFEV1 values fairly correlated with postoperative measured FEV1 values (r=0.765, 0.674, P<0.01).Conclusion: Ventilation-perfusion scans can predict postoperative pulmonary function and help evaluate risk of surgery for lung cancer patients with borderline pulmonary functions.