Coronary magnetic resonance angiography in adolescents and young adults with Kawasaki disease

• Published in: Circulation (New York, N.Y.) Vol. 105; no. 8; pp. 908 - 911
• Main Authors: GREIL, Gerald F, STUBER, Matthias, BOTNAR, René M, KISSINGER, Kraig V, GEVA, Tal, NEWBURGER, Jane W, MANNING, Warren J, POWELL, Andrew J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 26.02.2002; American Heart Association, Inc
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Coronary Aneurysm - diagnosis; Coronary Aneurysm - etiology; Coronary Angiography; Coronary Disease - diagnosis; Coronary Disease - etiology; Coronary Stenosis - diagnosis; Coronary Stenosis - etiology; Coronary Vessels - pathology; Female; Humans; Magnetic Resonance Angiography; Male; Medical sciences; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - diagnosis; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Risk Assessment; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Human; Performance evaluation; Kawasaki syndrome; Immunopathology; Radiodiagnosis; Angiography; Coronary artery; Cardiovascular disease; Autoimmune disease; Exploration; Nuclear magnetic resonance imaging; Vascular disease; Vasculitis; Systemic disease; Adolescent; Young adult; Medical imagery; NMR angiography; Comparative study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/hc0802.105563

In patients with Kawasaki disease, serial evaluation of the distribution and size of coronary artery aneurysms (CAA) is necessary for risk stratification and therapeutic management. Although transthoracic echocardiography is often sufficient for this purpose initially, visualization of the coronary arteries becomes progressively more difficult as children grow. We sought to prospectively compare coronary magnetic resonance angiography (MRA) and x-ray coronary angiography findings in patients with CAA caused by Kawasaki disease. Six subjects (age 10 to 25 years) with known CAA from Kawasaki disease underwent coronary MRA using a free-breathing T2-prepared 3D bright blood segmented k-space gradient echo sequence with navigator gating and tracking. All patients underwent x-ray coronary angiography within a median of 75 days (range, 1 to 359 days) of coronary MRA. There was complete agreement between MRA and x-ray angiography in the detection of CAA (n=11), coronary artery stenoses (n=2), and coronary occlusions (n=2). Excellent agreement was found between the 2 techniques for detection of CAA maximal diameter (mean difference=0.4 +/- 0.6 mm) and length (mean difference=1.4 +/- 1.6 mm). The 2 methods showed very similar results for proximal coronary artery diameter (mean difference=0.2 +/- 0.5 mm) and CAA distance from the ostia (mean difference=0.1 +/- 1.5 mm). Free-breathing 3D coronary MRA accurately defines CAA in patients with Kawasaki disease. This technique may provide a non-invasive alternative when transthoracic echocardiography image quality is insufficient, thereby reducing the need for serial x-ray coronary angiography in this patient group.