Evaluating for systemic artery aneurysms using noncontrast magnetic resonance angiography in patients with Kawasaki disease: A report of two cases

Nonaka, Haruki; Masuda, Takanori; Nakaura, Takeshi; Tahara, Masahiro; Nitta, T.; Yoneyama, Masami; Okano, Mio; Morikawa, Yuko; Sato, Tomoyasu

doi:10.1016/j.radcr.2020.12.062

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…In addition to CAAs commonly seen in KD, non-coronary systemic artery aneurysms can also be a sequela of KD. In previous reports on SAAs in KD [ 3 – 5 , 7 , 8 , 10 ], most of SAAs occured in infants, and in patients with untreated KD, IVIG-resistant KD or severe refractory KD, which are all at a higher risk of developing CAAs. In this case, although there was somewhat of a delay in the diagnosis and treatment of the patient, on the 10th day of onset, he responded to one dose of IVIG.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of systemic artery aneurysms (SAAs) confirmed by angiography in untreated KD children has been reported to be approximately 2% [ 2 ], which was similar to a recent study conducted by our team in all the KD patients [ 3 ]. Previous literature [ 2 – 10 ], predominantly case reports, revealed that SAAs in KD patients were generally associated with coronary artery lesions, especially giant CAAs, and were more likely to occur in infants, in patients with untreated KD, intravenous immunoglobulin (IVIG) -resistant or severe refractory KD, which are all related to high risk of developing CAAs. In addition, thrombotic events related to SAAs are rarely reported.…”

Section: Introductionmentioning

confidence: 99%

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Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

et al. 2021

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Background Kawasaki disease (KD) is a systemic vasculitis that predominantly affects medium-sized arteries. In addition to well-known coronary artery aneurysms (CAAs), peripheral systemic artery aneurysms (SAAs) have also been sporadically reported. In the literatures, SAAs occurred mainly in untreated, intravenous immunoglobin (IVIG)-resistant, or severe refractory KD, and thrombotic events in SAAs were rarely reported. Case presentation A 10-month-old boy with a history of KD was referred to our hospital for suspected pseudoaneurysm of the axillary arteries. Four months prior to presentation, he had persistent fever, conjunctival congestion, and rash. On the 10th day of fever echocardiogram showed biliteral CAAs. He was then diagnosed with KD and given IVIG 2 g/kg and aspirin at a local hospital. His fever and symptoms soon subsided and he was discharged with low dose aspirin and dipyridamole. One month prior to presentation, his parents incidentally palpated swellings in his bilateral axillae. On admission, physical examination revealed a pulsatile swelling in his right axilla and a non-pulsatile swelling in the left with impalpable left brachial and radial pulses, cooler and less active left upper limb than the right one. While the pulses of other three limbs were normal. Ultrasound examination revealed giant bilateral axillary artery aneurysms (AAAs) with massive thrombus in the left. Angiography confirmed giant bilateral AAAs with left AAAs completely occluded and fine collateral vessels connecting to the distal brachial artery, in addition to giant bilateral multiple CAAs without stenoses. The patient was given intravenous prostaglandin for 10 days to allow for formation of collateral circulation, as well as aspirin, low molecular weight heparin (which was switched to warfarin before discharge) and metoprolol. At discharge, the temperature and movement of his left upper limb improved significantly. On follow-up at 7 months, his left upper limb further improved and was similar to the right with no occurrence of cardiovascular events. The images of CAAs and AAAs on echocardiogram and computerized tomography remained the same. Conclusions This case highlights the importance of evaluating peripheral SAAs in KD patients with CAAs, even if their course of treatment appears smooth. For both large non-aortic SAAs and CAAs in KD patients, antithrombotic therapy is of utmost importance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

et al. 2021

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“…Magnetic resonance imaging (MRI) is a modality that allows CA evaluation without the invasiveness of contrast media and radiation exposure, 18 which is useful for evaluating CAAs in patients with KD 19,20 . We have reported the usefulness of systemic artery (SA) imaging using electrocardiogram (ECG)‐gated three‐dimensional (3D) fast spin echo (FSE) in the diastolic phase for SAA evaluation 21,22 . This imaging method can capture SAAs quickly and easily, taking only about 2 min.…”

Section: Introductionmentioning

confidence: 99%

“…19,20 We have reported the usefulness of systemic artery (SA) imaging using electrocardiogram (ECG)-gated three-dimensional (3D) fast spin echo (FSE) in the diastolic phase for SAA evaluation. 21,22 This imaging method can capture SAAs quickly and easily, taking only about 2 min. Furthermore, head magnetic resonance angiography (MRA) is the most commonly used application of non-contrast MRA (NC-MRA) in clinical settings and is easily available at any institution.…”

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confidence: 99%

Non‐contrast magnetic resonance angiography for systemic artery evaluation in Kawasaki disease

Nonaka,

Tahara,

Sanada

et al. 2023

Pediatrics International

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BackgroundKawasaki disease (KD) is a systemic vasculitis; systemic arteries other than the coronary arteries should therefore also be evaluated. This study investigated the feasibility of evaluating coronary aneurysms, systemic artery aneurysms (SAAs), and cerebrovascular diseases in patients with KD using non‐contrast magnetic resonance angiography (NC‐MRA).MethodsCoronary artery protocols, including coronary magnetic resonance angiography (MRA) and vessel wall imaging, were performed in 57 examinations of 28 patients. Systemic artery protocol, including SAA scans and head MRA, along with coronary artery protocol, were performed in 42 examinations of 42 patients. The image quality of the SAAs was evaluated on a 4‐point scale. Examination time and sedation dosage were compared between the protocols. The presence of SAAs and cerebrovascular disease was also evaluated.ResultsThe image quality score of SAAs was 4 (interquartile range [IQR]: 4–4) for the aorta, 4 (IQR: 3–4) for the subclavian artery, 4 (IQR: 3–4) for the renal artery, and 3 (IQR: 3–4) for the iliac artery. No differences were found between examination time (47.0 [IQR: 43.0–61.0] min vs. 51.0 [IQR: 45.0–60.0] min, p = 0.48) and sedative dose (4.63 [IQR: 3.93–5.79] mg/kg vs. 4.21 [IQR: 3.56–5.71] mg/kg, p = 0.37) between the protocols. Systemic artery protocol detected SAAs in three patients (7.1%), and cerebrovascular disease was not detected.ConclusionsEvaluating the coronary and systemic arteries in patients with KD using NC‐MRA on a single examination was possible without compromising examination time or sedation dose. The systemic artery protocol was useful in finding SAAs.

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“…However, since those examination are intended for pediatric patients, there are concerns regarding radiation exposure and the use of contrast media [7] . Recently, we reported that non-contrast magnetic resonance angiography (NC-MRA) is a successful and minimally invasive method for evaluating SAA in KD patients [8] . With the application of electrocardiogram (ECG)-gated subtracted three-dimensional fast spin echo (3D-FSE), which is used to selectively visualize arteries, we detected signal loss within the aneurysm and poor detection of the brachial artery.…”

Section: Introductionmentioning

confidence: 99%

Pitfall for systemic artery aneurysms evaluation using electrocardiogram-gated subtracted three-dimensional fast spin echo sequence of magnetic resonance imaging in patients with Kawasaki disease

Evaluating for systemic artery aneurysms using noncontrast magnetic resonance angiography in patients with Kawasaki disease: A report of two cases

Cited by 4 publications

References 8 publications

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

Non‐contrast magnetic resonance angiography for systemic artery evaluation in Kawasaki disease

Pitfall for systemic artery aneurysms evaluation using electrocardiogram-gated subtracted three-dimensional fast spin echo sequence of magnetic resonance imaging in patients with Kawasaki disease

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