Magnetic resonance angiography isequivalent to X-Ray coronary angiography for the evaluation of coronary arteries in kawasaki disease

Mavrogeni, Sophie; Papadopoulos, George; Douskou, Marouso; Kaklis, Savas; Seimenis, Ioannis; Baras, Panagiotis; Nikolaidou, Polixeni; Bakoula, Chryssa; Karanasios, Evangelos; Manginas, Athanasios; Cokkinos, Dennis V.

doi:10.1016/j.jacc.2003.08.052

Cited by 141 publications

(15 citation statements)

References 22 publications

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“…The gold standard for coronary anatomy is a conventional angiography, though this technique is invasive and exposes the patient to radiation. The role of cardiac MRI (cMRI) has been established over the past years [81, 122]. Using this modality, evaluation of the anatomy as well as cardiac function is possible.…”

Section: Coronary Artery Aneurysmsmentioning

confidence: 99%

Dissecting Kawasaki disease: a state-of-the-art review

et al. 2017

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Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. The diagnosis is based on the presence of persistent fever and clinical features including exanthema, lymphadenopathy, conjunctival injection, and changes to the mucosae and extremities. Although the etiology remains unknown, the current consensus is that it is likely caused by an (infectious) trigger initiating an abnormal immune response in genetically predisposed children. Treatment consists of high dose intravenous immunoglobulin (IVIG) and is directed at preventing the development of CAA. Unfortunately, 10–20% of all patients fail to respond to IVIG and these children need additional anti-inflammatory treatment. Coronary artery lesions are diagnosed by echocardiography in the acute and subacute phases. Both absolute arterial diameters and z-scores, adjusted for height and weight, are used as criteria for CAA. Close monitoring of CAA is important as ischemic symptoms or myocardial infarction due to thrombosis or stenosis can occur. These complications are most likely to arise in the largest, so-called giant CAA. Apart from the presence of CAA, it is unclear whether KD causes an increased cardiovascular risk due to the vasculitis itself. Conclusion: Many aspects of KD remain unknown, although there is growing knowledge on the etiology, treatment, and development and classification of CAA. Since children with previous KD are entering adulthood, long-term follow-up is increasingly important. What is known: • Kawasaki disease (KD) is a pediatric vasculitis with coronary artery damage as its main complication. • Although KD approaches its 50th birthday since its first description, many aspects of the disease remain poorly understood. What is new: • In recent years, multiple genetic candidate pathways involved in KD have been identified, with recently promising information about the ITPKC pathway. • As increasing numbers of KD patients are reaching adulthood, increasing information is available about the long-term consequences of coronary artery damage and broader cardiovascular risk.

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Section: Coronary Artery Aneurysmsmentioning

confidence: 99%

Dissecting Kawasaki disease: a state-of-the-art review

et al. 2017

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“…Greil et al first demonstrated equivalence of MRI with conventional angiography in detecting coronary aneurysms, stenosis and complete occlusions using a free-breathing, T2-prepared, 3D bright-blood sequence with navigator gating and tracking [56]. Subsequently, Mavrogeni et al confirmed complete agreement between conventional angiography and this MRA technique in demonstrating coronary ectasia and aneurysms [57]. Using bright-blood and dark-blood imaging, Suzuki et al replicated the equivalence of MRI with conventional angiography and superiority over echocardiography in detecting aneurysms and stenosis in patients ranging from 4 months to 37 years [58].…”

Section: Introductionmentioning

confidence: 99%

CMR in inflammatory vasculitis

Raman

Aneja

Jarjour

2012

Journal of Cardiovascular Magnetic Resonance

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Vasculitis, the inflammation of blood vessels, can produce devastating complications such as blindness, renal failure, aortic rupture and heart failure through a variety of end-organ effects. Noninvasive imaging with cardiovascular magnetic resonance (CMR) has contributed to improved and earlier diagnosis. CMR may also be used in serial evaluation of such patients as a marker of treatment response and as an indicator of subsequent complications. Unique strengths of CMR favoring its use in such conditions are its abilities to noninvasively visualize both lumen and vessel wall with high resolution. This case-based review focuses on the large- and medium-vessel vasculitides where MR angiography has the greatest utility. Because of increasing recognition of cardiac involvement in small-vessel vasculitides, this review also presents evidence supporting greater consideration of CMR to detect and quantify myocardial microvascular disease. CMR’s complementary role amidst traditional clinical, serological and other diagnostic techniques in personalized care for patients with vasculitis is emphasized. Specifically, the CMR laboratory can address questions related to extent and severity of vascular involvement. As ongoing basic and translational studies better elucidate poorly-defined underlying molecular mechanisms, this review concludes with a discussion of potential directions for the development of more targeted imaging approaches.

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“…Coronary artery disease (CAD) in paediatric patients may occur after surgery for congenital heart disease involving the coronary arteries, after surgery for congenital coronary anomalies or in patients with an inflammatory disease affecting the mid- and small-size arteries such as Kawasaki disease or Takayasu arteritis [1-3]. Therefore assessment of myocardial ischemia is important not only in the adult population, but increasingly in the paediatric population as well, in which early detection and therapy of CAD may help preventing irreversible myocardial dysfunction [4].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

Buechel

Balmer

Bauersfeld

et al. 2009

Journal of Cardiovascular Magnetic Resonance

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AimsAs coronary artery disease may also occur during childhood in some specific conditions, we sought to assess the feasibility and accuracy of perfusion cardiovascular magnetic resonance (CMR) in paediatric patients.Methods and resultsFirst-pass perfusion CMR studies were performed under pharmacological stress with adenosine and by using a hybrid echo-planar pulse sequence with slice-selective saturation recovery preparation. Fifty-six perfusion CMR examinations were performed in 47 patients. The median age was 12 years (1 month-18 years), and weight 42.8 kg (2.6-82 kg). General anaesthesia was required in 18 patients. Mean examination time was 67 ± 19 min. Diagnostic image quality was obtained in 54/56 examinations. In 23 cases the acquisition parameters were adapted to patient's size. Perfusion CMR was abnormal in 16 examinations. The perfusion defects affected the territory of the left anterior descending coronary artery in 11, of the right coronary artery in 3, and of the circumflex coronary artery in 2 cases. Compared to coronary angiography, perfusion CMR showed a sensitivity of 87% (CI 52-97%) and a specificity of 95% (CI 79-99%).ConclusionIn children, perfusion CMR is feasible and accurate. In very young children (less than 1 year old), diagnostic image quality may be limited.

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Magnetic resonance angiography isequivalent to X-Ray coronary angiography for the evaluation of coronary arteries in kawasaki disease

Abstract: In conclusion, MRA is a reliable diagnostic tool, equivalent to XCA for coronary artery aneurysm identification in patients with KD. Magnetic resonance angiography may prove to be of great value for the serial non-invasive evaluation of these patients.

Cited by 141 publications

References 22 publications

Dissecting Kawasaki disease: a state-of-the-art review

Dissecting Kawasaki disease: a state-of-the-art review

CMR in inflammatory vasculitis

Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

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