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Singhal M, Pilania RK, Gupta P, Johnson N, Singh S. Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease. World J Clin Pediatr 2023; 12:97-106. [PMID: 37342454 PMCID: PMC10278081 DOI: 10.5409/wjcp.v12.i3.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Nameirakpam Johnson
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
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CT coronary angiogram in children with Kawasaki patients: experience in 52 patients. Cardiol Young 2022; 32:1994-1998. [PMID: 35707919 DOI: 10.1017/s1047951122000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND CT is an accepted non-invasive imaging tool to assess the coronary arteries in adults; however, its utilisation in children is limited by high heart rate and lack of standardised protocol. We sought to assess diagnostic quality and factors that affect image quality of CT in assessing coronary artery lesions in Kawasaki patients less than 18 years of age. METHODOLOGY CT coronary angiography was performed on patients with Kawasaki disease diagnosed with coronary aneurysm or suspected to have coronary stenosis. Studies were performed using electrocardiogram-gated protocols. General anaesthesia was used in patients who were not cooperative for breathing control. Heart rate, image quality, and effective radiation dose were documented. RESULTS Fifty-two Kawasaki patients underwent CT coronary angiography to assess coronary artery lesions. Median heart rate was 88 beats per minute (range 50-165 beats/minute). Image quality was graded as excellent in 34 (65%) patients, good in 17 (32%), satisfactory in 1, and poor in 1 patient. Coronary artery aneurysm was found in 25 (bilateral = 6, unilateral = 19, multiple = 11). Thrombus was found in 11 patients resulting in partial and total occlusion in 8 and 3 patients, respectively. Coronary stenosis was noted in 2 patients. The effective radiation dose was 1.296 millisievert (median 0.81 millisievert). Better diagnostic imaging quality was significantly related to lower heart rate (p = 0.007). CONCLUSION Electrocardiogram-triggered CT coronary angiography provides a good diagnostic assessment of coronary artery lesions in children with Kawasaki disease.
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Tai IH, Hsieh KS, Kuo HC. Beaded Coronary Aneurysm in Kawasaki Disease. CHILDREN 2022; 9:children9101463. [PMID: 36291399 PMCID: PMC9600750 DOI: 10.3390/children9101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
Kawasaki disease (KD) is a febrile systemic vasculitis that mainly affects children aged under five years old. The aneurysm formation of the coronary artery is the most common complication after KD. We report a case with multiple coronary aneurysm formation and a special pattern ofbeaded aneurysm after KD and review the form ofcoronary aneurysms in different diseases.
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Affiliation(s)
- I-Hsin Tai
- Department of Pediatric Cardiology, China Medical University Children’s Hospital, China Medical University, Yude Road, North District, Taichung City 40447, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Yude Road, North District, Taichung City 40447, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatric Cardiology, China Medical University Children’s Hospital, China Medical University, Yude Road, North District, Taichung City 40447, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Yude Road, North District, Taichung City 40447, Taiwan
| | - Ho-Chang Kuo
- Department of Paediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, #.259, Wenhua 1st Rd., Guishan Dist., Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Correspondence: or ; Tel.: +886-7-7317123 (ext. 8320); Fax: +886-7-7352225
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Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis. Radiol Cardiothorac Imaging 2021; 3:e200550. [PMID: 34778780 DOI: 10.1148/ryct.2021200550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.
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Affiliation(s)
- Jenica Thangathurai
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Mariya Kalashnikova
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Masato Takahashi
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Jerold S Shinbane
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
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Xu YM, Chu YQ, Li XM, Wang C, Ma QM, Yu XN, Yu XY, Chen R, Xing YL, Yu XX, Sun L, Cui XZ, Wang H. The Complementary Relationship Between Echocardiography and Multi-Slice Spiral CT Coronary Angiography in the Diagnosis of Coronary Artery Thrombosis in Children With Kawasaki Disease. Front Pediatr 2021; 9:670887. [PMID: 34277518 PMCID: PMC8278001 DOI: 10.3389/fped.2021.670887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022] Open
Abstract
Aim: To compare the diagnostic values by using transthoracic echocardiography (ECHO) and multi-slice spiral CT coronary angiography (CTCA) for identifying coronary artery thrombosis in children with Kawasaki disease (KD). Methods: Total 97 KD children with coronary artery dilation complications in our hospital from June 2012 to December 2020 were included in the study. CTCA and ECHO were performed after over 1 month of illness. Results: Coronary artery thrombosis was found in 14 out of 97 patients. Among them, 10 were identified as positive by CTCA, 9 were identified as positive by ECHO, and 5 were identified as positive by both CTCA and ECHO. Conclusion: Both CTCA and ECHO can be used to diagnose coronary artery thrombosis. ECHO has advantage in identifying low-density thrombus, and CTCA is better for the clot in distal coronary artery. They can complement each other.
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Affiliation(s)
- Yun-Ming Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan-Qiu Chu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue-Mei Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ce Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quan-Mei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Na Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xian-Yi Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rui Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan-Lin Xing
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue-Xin Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Zhe Cui
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Wang T, Wang C, Zhou KY, Wang XQ, Hu N, Hua YM. Incomplete Kawasaki disease complicated with acute abdomen: A case report. World J Clin Cases 2020; 8:5457-5466. [PMID: 33269284 PMCID: PMC7674722 DOI: 10.12998/wjcc.v8.i21.5457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis characterized by unknown etiology.
CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD. He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy. Ultrasound examination at early onset revealed a giant coronary artery aneurysm. The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest. He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery. After the operation, the cardiac output increased, and the symptoms of heart failure resolved. Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure, and normal growth was obtained.
CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm . Nevertheless, some issues still need specific attention.
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Affiliation(s)
- Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Kai-Yu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Xiao-Qin Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
| | - Na Hu
- Department of Medical Imaging, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Min Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610065, Sichuan Province, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases of Sichuan Province, Chengdu 610041, Sichuan Province, China
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Wang T, Wang C, Zhou KY, Wang XQ, Hu N, Hua YM. Incomplete Kawasaki disease complicated with acute abdomen: A case report. World J Clin Cases 2020. [PMID: 33269284 DOI: 10.12998/wjcc.v8.i21.5457.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic vasculitis characterized by unknown etiology. CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD. He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy. Ultrasound examination at early onset revealed a giant coronary artery aneurysm. The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest. He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery. After the operation, the cardiac output increased, and the symptoms of heart failure resolved. Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure, and normal growth was obtained. CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm . Nevertheless, some issues still need specific attention.
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Affiliation(s)
- Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Kai-Yu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Qin Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Na Hu
- Department of Medical Imaging, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Min Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology. Eur Radiol 2019; 30:432-441. [PMID: 31428828 PMCID: PMC6890577 DOI: 10.1007/s00330-019-06367-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
Abstract
Background Kawasaki disease (KD) is a vasculitis with formation of coronary artery aneurysms (CAAs) that can lead to myocardial ischemia. Echocardiography is the primary imaging modality for the coronary arteries despite limited visualization. Coronary angiography (CAG) is the gold standard yet invasive with high-radiation exposure. To date however, state-of-the-art CT scanners enable high-quality low-dose coronary computed tomographic angiography (cCTA) imaging. The aim of our study in KD is to report (i) the diagnostic yield of cCTA compared to echocardiography, and (ii) the radiation dose. Methods and results We collected data of KD patients who underwent cCTA. cCTA findings were compared with echocardiography results. In 70 KD patients (median age 15.1 years [0.5–59.5 years]; 78% male; 38% giant CAA), the cCTA identified 61 CAAs, of which 34 (56%, with a Z score > 3, in 22 patients) were not detected by echocardiography. In addition, the left circumflex (aneurysmatic in 6 patients) was always visible upon cCTA and not detected upon echocardiography. Calcifications, plaques, and/or thrombi were visualized by cCTA in 25 coronary arteries (15 patients). Calcifications were seen as early as 2.7 years after onset of disease. In 5 patients, the cCTA findings resulted in an immediate change of treatment. The median effective dose (ED) in millisievert differed significantly (p < 0.01) between third-generation dual-source and other CT scanners (1.5 [0.3–9.4] (n = 56) vs 3.8 [1.7–20.0] (n = 14)). Conclusions The diagnostic yield of third-generation dual-source cCTA combined with reduced radiation exposure makes cCTA a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for KD. Key Points • cCTA is a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for Kawasaki disease. • Kawasaki disease patients with proven coronary artery involvement on echocardiography require additional imaging.
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Kantarcı M, Güven E, Ceviz N, Oğul H, Sade R. Vascular imaging findings with high-pitch low-dose dual-source CT in atypical Kawasaki disease. ACTA ACUST UNITED AC 2019; 25:50-54. [PMID: 30644368 DOI: 10.5152/dir.2018.18092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Determining the presence of aneurysms, thrombosis, and stenosis is very important for the diagnosis of atypical Kawasaki disease (AKD) and in the follow-up of AKD patients with aneurysms. We aimed to demonstrate high-pitch low-dose dual-source computed tomography (CT) angiography findings in pediatric patients with AKD. METHODS Over a 5-year period, high-pitch low-dose CT angiography was performed to determine vascular aneurysms or occlusions in 17 patients who had suspected AKD. The patients ranged from 2 months of age to 11.3 years, with a mean age of 3 years. The American Heart Association's criteria were used to diagnose AKD. RESULTS We did not detect any vascular problems in 6 of the patients, and they were not included in our study. Arterial aneurysms were present in 11 patients (aged 2 months to 11.3 years; mean age, 4.2 years; 7 males). In one patient, there was also a thrombus at an arterial aneurysm. Coronary artery aneurysms were detected in 7 patients and systemic artery aneurysms were detected in 7 patients. Three patients had both systemic and coronary aneurysms. CONCLUSION Our results suggest that high-pitch low-dose dual-source CT can detect all types of aneurysms, stenosis and occlusions of vessels in patients with AKD who were not previously diagnosed. This useful, easy, robust and fast technique may be preferred to diagnose AKD.
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Affiliation(s)
- Mecit Kantarcı
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Elif Güven
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Naci Ceviz
- Department of Pediatric Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Hayri Oğul
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Recep Sade
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
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Goh YG, Ong CC, Tan G, Liang CR, Soomar SM, Terence Lim CW, Quek SC, Teo LSL. Coronary manifestations of Kawasaki Disease in computed tomography coronary angiography. J Cardiovasc Comput Tomogr 2018; 12:275-280. [PMID: 29426687 DOI: 10.1016/j.jcct.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/10/2017] [Indexed: 12/31/2022]
Abstract
Coronary arteritis in Kawasaki disease can lead to serious complications such myocardial infarction and sudden death. The identification of coronary manifestations with a method that is minimally invasive and of low radiation exposure is therefore important in paediatric patients with Kawasaki disease. Coronary CT angiography can be an attractive alternative to invasive coronary angiography. This paper describes imaging techniques for coronary CT angiography in pediatric patients and demonstrates the spectrum of cardiovascular manifestations in patients with Kawasaki disease.
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Affiliation(s)
- Yong Geng Goh
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Grace Tan
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Sanah Merchant Soomar
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Chee Wen Terence Lim
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Swee Chye Quek
- Division of Paediatric Cardiology, Khoo Teck Puat-National University Children's Medical Institution National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074
| | - Li San Lynette Teo
- Department of Diagnostic Imaging, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore 119074.
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Abstract
Kawasaki disease is a medium vessel vasculitis which may be associated with coronary artery abnormalities. Recognition of these abnormalities depends upon various imaging modalities. While two-dimensional echocardiography remains the first line modality to identify coronary artery abnormalities, it is subject to several fallacies and is operator dependent. Computed tomography coronary angiography is rapidly emerging as a useful imaging modality for better characterization of dilatations, ectasia and aneurysms in the mid- and distal segments of coronary arteries. It provides precise details in terms of aneurysm size and morphology. In this review we here described the importance of computed tomography coronary angiography and have also given a brief description of magnetic resonance coronary angiography.
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Affiliation(s)
- Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Singhal M, Gupta P, Singh S, Khandelwal N. Computed tomography coronary angiography is the way forward for evaluation of children with Kawasaki disease. Glob Cardiol Sci Pract 2017; 2017:e201728. [PMID: 29564349 PMCID: PMC5856970 DOI: 10.21542/gcsp.2017.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is an acute idiopathic vasculitis affecting infants and children. Coronary artery abnormalities and myocarditis are the major cardiovascular complications of KD. Coronary artery abnormalities develop in 15–25% of untreated KD. Two-dimensional transthoracic echocardiography has hitherto been considered the modality of choice for evaluation of children with KD. There are, however, several limitations inherent to echocardiography - including limited evaluation of distal vessels, left circumflex artery and poor acoustic window in growing children. Catheter angiography is the gold standard for evaluation of coronary artery abnormalities in older children and adults; however it also has inherent limitations - including complications related to its invasive nature, higher radiation exposure, and inability to evaluate intramural abnormalities. Thus serial invasive coronary angiography studies are not feasible in children. There have been major advances in computed tomography (CT) coronary imaging so that it is now possible to delineate the coronary artery anatomy with higher temporal resolution and motion-free images at all heart rates with acceptable radiation exposure. There is, however, a paucity of literature with regard to the use of this technique in children with KD. In this review, we discuss the application of computed tomography coronary angiography (CTCA) in children with KD with special reference to strategies aimed at reducing the effective radiation dose.
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Affiliation(s)
- Manphool Singhal
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Pankaj Gupta
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Surjit Singh
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Niranjan Khandelwal
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
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Singhal M, Singh S, Gupta P, Sharma A, Khandelwal N, Burns JC. Computed Tomography Coronary Angiography for Evaluation of Children With Kawasaki Disease. Curr Probl Diagn Radiol 2017; 47:238-244. [PMID: 29203262 DOI: 10.1067/j.cpradiol.2017.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to assess the feasibility of computed tomography coronary angiography (CTCA) on a 128-slice, dual source scanner in children with acute and convalescent phase Kawasaki disease (KD). MATERIALS AND METHODS A prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n = 37) or retrospective (n = 12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan. RESULTS Median age (36 boys and 13 girls) was 7 years. Median dose-length product value and median effective CT radiation dose was 32mGycm (interquartile range [IQR]: 21-74) and 0.54 miliSieverts (mSv) (IQR: 0.77-3.2) for all scans, and 27mGycm (IQR: 18.5-33.75) and 0.48mSv (IQR: 0.18-1.17) for prospectively triggered scans (n = 37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n = 27) and stenoses (n = 3). In the acute phase (n = 12), aneurysms were detected in 5 children (18 segments). CONCLUSION CTCA allows comprehensive evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego (UCSD) School of Medicine and Rady Children's Hospital San Diego, La Jolla, CA
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Phuong LK, Bonetto C, Buttery J, Pernus YB, Chandler R, Goldenthal KL, Kucuku M, Monaco G, Pahud B, Shulman ST, Top KA, Ulloa-Gutierrez R, Varricchio F, de Ferranti S, Newburger JW, Dahdah N, Singh S, Bonhoeffer J, Burgner D. Kawasaki disease and immunisation: Standardised case definition & guidelines for data collection, analysis. Vaccine 2016; 34:6582-6596. [PMID: 27863715 DOI: 10.1016/j.vaccine.2016.09.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Linny Kimly Phuong
- Monash Children's Hospital, Clayton, Melbourne, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Jim Buttery
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Merita Kucuku
- Department of Vaccines Control, National Agency for Medicines and Medical Devices, Tirana, Albania
| | | | | | | | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Surjit Singh
- Post Graduate Institute of Medical Education and Research (PGIMER) - Chandigarh, India
| | - Jan Bonhoeffer
- The Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland.
| | - David Burgner
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Department of Paediatrics, Melbourne University, Parkville, Victoria, Australia
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Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:475-92. [DOI: 10.1016/j.jcct.2015.07.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
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Abstract
Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. Two guidelines exist regarding the follow-up of patients after KD, by the American Heart Association and the Japanese Circulation Society. After the acute phase, CAA-negative patients are checked for cardiovascular risk assessment or with ECG and echocardiography until 5 years after the disease. In CAA-positive patients, monitoring includes myocardial perfusion imaging, conventional angiography and CT-angiography. However, the invasive nature and high radiation exposure do not reflect technical advances in cardiovascular imaging. Newer techniques, such as cardiac MRI, are mentioned but not directly implemented in the follow-up. Cardiac MRI can be performed to identify CAA, but also evaluate functional abnormalities, ischemia and previous myocardial infarction including adenosine stress-testing. Low-dose CT angiography can be implemented at a young age when MRI without anaesthesia is not feasible. CT calcium scoring with a very low radiation dose can be useful in risk stratification years after the disease. By incorporating newer imaging techniques, detection of CAA will be improved while reducing radiation burden and potential complications of invasive imaging modalities. Based on the current knowledge, a possible pathway to follow-up patients after KD is introduced. Key Points • Kawasaki disease is a paediatric vasculitis with coronary aneurysms as major complication. • Current guidelines include invasive, high-radiation modalities not reflecting new technical advances. • Cardiac MRI can provide information on coronary anatomy as well as cardiac function. • (Low-dose) CT-angiography and CT calcium score can also provide important information. • Current guidelines for follow-up of patients with KD need to be revised.
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Zhu H, Yu SF, Bai YX, Liang YY, Su XW, Pan JY. Kawasaki disease in children: Epidemiology, clinical symptoms and diagnostics of 231 cases in 10 years. Exp Ther Med 2015; 10:357-361. [PMID: 26170962 DOI: 10.3892/etm.2015.2487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/13/2015] [Indexed: 12/15/2022] Open
Abstract
The present study was a retrospective analysis of the dynamic changes and clinical characteristics of 231 cases of Kawasaki disease (KD) in pediatric patients admitted to the People's Hospital of Inner Mongolia between January 2003 and December 2012. A total of 37.23% of the cases occurred in the first 5 years, compared with 62.77% in the latter 5 years. The age distribution ranged from 3 months to 10 years, with a peak age of <1 year. The male-to-female ratio was 2.12:1, and the reoccurrence rate was 1.3%. Among the patient cohort, 7.8% were Mongolian children. The most common clinical symptom was fever (87.6%), while perianal skin peeling was the most rare (14.1%). With regard to the analyzed biomarkers, 90.4% of patients had abnormal platelet (PLT) counts; the next highest abnormality rates were associated with erythrocyte sedimentation rate (ESR) (74.46%) and white blood cell (WBC) counts (59.74%), followed by levels of C-reactive protein (CRP) (57.58%), creatinine kinase-MB (40.26%) and hemoglobin (Hb) (38.53%). In conclusion, the present study has found that approximately two-thirds of cases of KD over a 10-year period occurred in the latter 5 years. Changes in a number of experimental indicators, including PLT, ESR and WBC, could be used in the diagnosis of the condition and to reflect the success of the clinical treatment.
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Affiliation(s)
- Hua Zhu
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Shao-Fei Yu
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Yu-Xin Bai
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Yan-Yan Liang
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Xue-Wen Su
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
| | - Jing-Ying Pan
- Department of Pediatrics, People's Hospital of Inner Mongolia, Hohhot, Inner Mongolia Autonomous Region 010010, P.R. China
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Hwang EH, Ju JK, Cho MJ, Lee JW, Lee HD. Giant coronary aneurysm caused by Kawasaki disease: consistency between catheter angiography and electrocardiogram gated dual-source computed tomography angiography. KOREAN JOURNAL OF PEDIATRICS 2015; 58:501-4. [PMID: 26770226 PMCID: PMC4705331 DOI: 10.3345/kjp.2015.58.12.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 11/30/2022]
Abstract
We present the case of a 5-year-old child with coronary complications due to Kawasaki disease; this patient unintentionally underwent both dual-source computed tomography (DSCT) coronary angiography and invasive coronary angiographic examination in 2 months. This case highlights the strong consistency of the results between DSCT coronary angiography and invasive coronary angiography. Compared to conventional invasive coronary angiography, DSCT coronary angiography offered additional advantages such as minimal invasiveness and less radiation exposure.
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Affiliation(s)
- Eun-Ha Hwang
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Jung-Ki Ju
- Department of Pediatrics, Good Gang-An Hospital, Busan, Korea
| | - Min-Jung Cho
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Ji-Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Doo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
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Kim JW, Goo HW. Coronary artery abnormalities in Kawasaki disease: comparison between CT and MR coronary angiography. Acta Radiol 2013; 54:156-63. [PMID: 23482350 DOI: 10.1258/ar.2012.120484] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although CT coronary angiography (CTCA) and MR coronary angiography (MRCA) are increasingly used in patients with Kawasaki disease, comparison of coronary artery assessibility and diagnostic performance between the two imaging modalities has been rarely performed. PURPOSE To investigate which imaging modality, CTCA or MRCA, is better for evaluating coronary artery abnormalities in patients with Kawasaki disease. MATERIAL AND METHODS Between 2003 and 2011, 56 patients (38 boys/men; age range, 1-24 years) with Kawasaki disease underwent CTCA or MRCA (group A). Of these, 17 underwent both CTCA and MRCA (group B). Visibility of 11 coronary arterial segments in each patient was graded on a four-point scale. Coronary artery aneurysm, stenosis, and occlusion were evaluated by CTCA and MRCA, based on a reference standard obtained from cardiac catheterization, echocardiography, follow-up CTCA and MRCA, and clinical history. Coronary artery assessibility and diagnostic performance were compared between CTCA and MRCA. RESULTS In per-segment analysis, more segments were assessable on CTCA than on MRCA in both groups. In per-patient analysis of group B, no significant difference in the assessibility was found between CTCA (95.0%, 128.3/135 segments) and MRCA (92.4%, 124.8/135 segments) (P > 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTCA vs. MRCA were 93.1% vs. 77.9% (P < 0.001), 99.2% vs. 99.7% (P = 0.65), 96.8% vs. 98.7% (P = 0.65), 98.2% vs. 94.1% (P < 0.001), and 98.0% vs. 94.9% (P = 0.008), respectively, in group A, and 91.8% vs. 70.4% (P < 0.001), 99.5% vs. 99.5% (P = 1.000), 98.5% vs. 98.0% (P = 1.000), 97.2% vs. 91.1% (P = 0.006), and 97.6% vs. 92.3% (P = 0.004), respectively, in group B. CONCLUSION Although CTCA and MRCA show comparable assessibility in per-patient analysis, CTCA shows higher diagnostic performance than MRCA for evaluating coronary artery abnormalities in patients with Kawasaki disease.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Duan Y, Wang X, Cheng Z, Wu D, Wu L. Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease. Br J Radiol 2012; 85:e1190-7. [PMID: 22932064 DOI: 10.1259/bjr/18174517] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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 κ-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 (κ=0.87). 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 Bland-Altman 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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Affiliation(s)
- Y Duan
- Medical School of Shandong University, Shandong Medical Imaging Research Institute, Jinan, China
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Carbone I, Cannata D, Algeri E, Galea N, Napoli A, De Zorzi A, Bosco G, D'Agostino R, Menezes L, Catalano C, Passariello R, Francone M. Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation. Pediatr Radiol 2011; 41:1165-73. [PMID: 21717166 DOI: 10.1007/s00247-011-2141-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 03/03/2011] [Accepted: 03/07/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. OBJECTIVE To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. MATERIALS AND METHODS The study group comprised 12 patients (age 17.6 ± 2.9 years, mean ± SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6 ± 13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. RESULTS Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56 ± 0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n = 32), stenoses (n = 3) and occlusions (n = 9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. CONCLUSION Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.
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Affiliation(s)
- Iacopo Carbone
- Department of Radiological, Onchological and Anatomopathological Sciences, Policlinico Umberto I, Sapienza University of Rome, viale Regina Elena, 324, Rome, 00161, Italy.
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Vastel-Amzallag C, Le Bret E, Paul JF, Lambert V, Rohnean A, El Fassy E, Sigal-Cinqualbre A. Diagnostic accuracy of dual-source multislice computed tomographic analysis for the preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot. J Thorac Cardiovasc Surg 2011; 142:120-6. [DOI: 10.1016/j.jtcvs.2010.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 10/15/2010] [Accepted: 11/05/2010] [Indexed: 12/18/2022]
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