How to image Kawasaki disease: A validation of different imaging techniques

Mavrogeni, Sophie; Papadopoulos, George; Karanasios, Evangelos; Cokkinos, Dennis V.

doi:10.1016/j.ijcard.2007.02.035

Cited by 42 publications

(38 citation statements)

References 37 publications

(34 reference statements)

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“…As is also suggested in a recent review by Mavrogeni et al, 26 we believe that CMRI will not substitute echocardiography in the future but may be performed as a second step after echocardiography during the follow-up of patients with KD. Bland-Altman analysis showed good agreement between echocardiography and CMRI for maximal coronary artery diameter and maximal CAA diameter.…”

Section: Other Imaging Modalitiesmentioning

confidence: 80%

“…27,28 The radiation burden of CT angiography is again an important drawback, although the radiation dose has already been reduced greatly with recent improvements. 26 Further developments may result in CT angiography being another reasonable alternative for detailed coronary artery evaluation, although perfusion and lateenhancement studies are not possible with CT angiography.…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

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Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Tacke

Kuipers

Groenink

et al. 2011

Circ: Cardiovascular Imaging

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Background-Kawasaki disease (KD) is the most common cause of acquired coronary artery disease in childhood. In KD, the American Heart Association recommends echocardiography for routine coronary artery surveillance and nuclear perfusion scans and conventional coronary angiography in select patients. Cardiac MRI (CMRI) may be a noninvasive and radiation-free alternative. We applied CMRI during the follow-up of patients with KD and assessed the performance of CMRI compared with echocardiography. Methods and Results-Patients with KD aged Ն8 years were consecutively included. Sixty-three patients (median age, 14.6 years; 74.6% male sex) underwent a comprehensive CMRI protocol including adenosine stress testing to evaluate coronary artery anatomy, ischemia, and myocardial infarction. All patients underwent CMRI without significant complications. On CMRI, 23 coronary artery aneurysms (CAAs) were identified in 15 patients. CMRI detected thrombus formation in 6 CAAs in 4 patients, wall motion disturbances and ischemia in 4 patients, and delayed hyperenhancement indicating myocardial infarction in 5 patients. Wall motion and perfusion abnormalities were noted in territories supplied by affected coronary arteries. CMRI results were compared with recent echocardiography findings. In 6 of the 15 patients with CAAs on CMRI, CAAs were not detected by echocardiography. Conclusions-A comprehensive CMRI protocol including adenosine stress testing is feasible to identify coronary artery pathology, ischemia, and myocardial infarction in former patients with KD and compares favorably with echocardiography. CMRI may be used as a noninvasive and radiation-free imaging method for coronary artery surveillance during the long-term follow-up of patients with KD. (Circ Cardiovasc Imaging. 2011;4:712-720.)

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Section: Other Imaging Modalitiesmentioning

confidence: 80%

Section: Other Imaging Modalitiesmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Tacke

Kuipers

Groenink

et al. 2011

Circ: Cardiovascular Imaging

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“…TTE is the main imaging modality in children to evaluate proximal coronary artery disease and direction of flow [32,33]. However, visualisation of the distal coronary artery segments using TTE is limited owing to deterioration of the acoustic window [20,33,34].…”

Section: Discussionmentioning

confidence: 99%

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

Duan¹,

Wang²,

Cheng³

et al. 2012

BJR

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Objectives: The aim of this study was to prospectively evaluate the initial application and value of prospective electrocardiogram (ECG)-triggered dual-source CT coronary angiography (DSCTCA) in the diagnosis of infants and children with coronary artery aneurysms due to Kawasaki disease. Methods: 19 children [12 males; mean age 13.47 months, range 3 months to 5 years; mean heart rate 112 beats per minute (bpm), range 83-141 bpm] underwent prospective ECG-triggered DSCTCA with free breathing. Subjective image quality was assessed on a five-point scale (1, excellent; 5, non-diagnostic) by two blinded observers. The location, number and size of each aneurysm were observed and compared with those of transthoracic echocardiography (TTE) performed within 1 week. Interobserver agreement concerning the subjective image quality was evaluated with Cohen's k-test. Bland-Altman analysis was used to evaluate the agreement on measurements (diameter and length of aneurysms) between DSCTCA and TTE. The average effective dose required for DSCTCA was calculated for all children. Results: All interobserver agreement for subjective image quality assessment was excellent (k50.87). The mean¡standard deviation (SD) aneurysm diameter with DSCTCA was 0.76¡0.36 cm and with TTE was 0.76¡0.39 cm. The mean¡SD aneurysm length with DSCTCA was 2.06¡1.35 cm and with TTE was 2.00¡1.22 cm. The BlandAltman plot for agreement between DSCTCA and TTE measurements showed good agreement. The mean effective dose was 0.36¡0.06 mSv. Conclusion: As an alternative diagnostic modality, prospective ECG-triggered DSCTCA with excellent image quality and low radiation exposure has been proved useful for diagnosing infants and children with coronary artery aneurysms due to Kawasaki disease. Advances in knowledge: Prospective ECG-triggered DSCTCA for infants and children allows rapid, accurate assessment of coronary aneurysms due to Kawasaki diseases, compared with TTE.

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“…X-ray coronary angiography is the classic technique to evaluate coronary arteries more exactly, but it is an invasive and radiation method. MRI has proven to be a valuable tool to evaluate the coronary artery origin and proximal course in children and adults with KD [17,18]. It also has the advantage of simultaneous perfusion, function, and viability evaluation [17].…”

Section: Discussionmentioning

confidence: 99%

“…MRI has proven to be a valuable tool to evaluate the coronary artery origin and proximal course in children and adults with KD [17,18]. It also has the advantage of simultaneous perfusion, function, and viability evaluation [17]. However, there are limitations to reliably detect coronary artery lesions and perfusion defects in small children with higher heart rates.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of acute changes in coronary artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions

et al. 2009

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Objective To investigate the long-term outcome of initially dilated/aneurysmatic coronary arteries in Kawasaki disease (KD) and to define risk factors for significant myocardial ischemia during follow-up, we retrospectively followed all pediatric patients with proven acute coronary changes due to KD in our institution. Methods and results Since 1981, 38 children have been identified with coronary changes due to KD. The median age was 1.2 years (0.1-12.8). In 37 patients therapy with intravenous immunoglobulin was initiated within 9 days (1-30) after the beginning of KD. All received aspirin and three additionally received steroids. Median follow-up was 8.5 years (0.5-24.8). We defined two groups: A aneurysm/ ectasia of the coronary artery B5.0 mm (n = 23) and B aneurysm size [5.0 mm (n = 15). During follow-up, all coronary aneurysms of group A regressed to normal size, whereas in 14 patients of group B (93%) the aneurysms persisted or even increased in size. Four patients of group B developed severe coronary stenosis at the proximal and/or distal end of the aneurysm and needed an intervention (endovascular balloon dilation and stent implantation (n = 2) or bypass surgery (n = 2)) after a median time interval of 9.8 years (1.0-15.6) after KD. They all had ECG changes preceding the intervention about 1 year in advance. Maximum aneurysm size [5 mm was a statistical significant predictive risk factor for myocardial ischemia. Conclusions After KD, patients with a coronary aneurysm size [5.0 mm need close follow-up assessments because of an elevated risk for the development of coronary stenotic lesions. In case of new and even unspecific ECG changes, coronary imaging modalities (angiography, MRI) have to be considered. Therapy options vary from percutaneous catheter interventions to bypass surgery and have to be selected individually for each patient.

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How to image Kawasaki disease: A validation of different imaging techniques

Cited by 42 publications

References 37 publications

Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

Long-term follow-up of acute changes in coronary artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions

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