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Magnetic resonance angiography, function and viability evaluation in patients with Kawasaki disease
Sophie Mavrogeni1, George Papadopoulos, Marouso Douskou
1Onassis Cardiac Surgery Center, Athens, Greece. soma@aias.gr
Insights
Magnetic resonance imaging (MRI) noninvasively assesses coronary arteries, function, and viability in Kawasaki disease (KD) patients. This single examination detects aneurysms, scar, and myocardial infarction, aiding in comprehensive patient evaluation.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Diagnostic Radiology
Background:
- Kawasaki disease (KD) can lead to coronary artery abnormalities.
- Contrast-enhanced cardiovascular magnetic resonance (CeCMR) is the gold standard for scar detection.
- Steady-state, free precession (SSFP) cine MRI effectively evaluates myocardial function.
Purpose of the Study:
- To evaluate the capability of MRI for noninvasive assessment of coronary arteries, function, and viability in a single examination for patients with KD.
- To determine the diagnostic accuracy of different MRI sequences in detecting coronary abnormalities and myocardial damage in KD patients.
Main Methods:
- Twenty pediatric patients (7-12 years) with KD underwent cardiac MRI on a 1.5 T system.
- Coronary magnetic resonance angiography (MRA) and SSFP cine sequences were acquired.
- Contrast-enhanced CMR (CeCMR) was performed after gadolinium contrast injection to assess for myocardial scar and viability.
Main Results:
- Coronary aneurysms or ectasia were identified in all patients.
- CeCMR detected transmural or small myocardial scar/necrosis in four patients.
- Left ventricular function was impaired only in patients with antero-apical infarction, correlating with coronary artery territories.
Conclusions:
- Magnetic resonance angiography (MRA), SSFP cine, and CeCMR can be integrated into a single MRI study for comprehensive noninvasive evaluation of coronary arteries, cardiac function, and myocardial infarction in Kawasaki disease.
- This integrated MRI approach offers a powerful tool for diagnosing and managing cardiovascular complications in pediatric KD patients.
Objectives:
We evaluated the ability of magnetic resonance imaging to perform a noninvasive assessment of coronary arteries, function and viability in one examination in a population with Kawasaki disease.
Background:
Magnetic resonance angiography (MRA) can identify coronary abnormalities in patients with Kawasaki disease (KD). Contrast enhanced cardiovascular magnetic resonance (CeCMR) is the current gold standard for scar detection. Steady-state, free precession (SSFP) cine is a reliable technique to evaluate myocardial function and wall motion.
Methods:
Twenty patients with KD aged 7-12 yrs, were examined. Coronary MRA was performed using a 1.5 T system with two ECG-triggered pulse sequences. CeCMR images were acquired 15 minutes after the i.v. injection of 0.1 mmol/kg Gd-DTPA using an inversion recovery sequence. SSFP cines were acquired using 6-mm short-axis slices from the atrioventricular ring to the apex.
Results:
Aneurysms of the coronary arteries were identified in 7 patients and coronary ectasia was present in the remaining 12 patients while 1 patient had both. Transmural anterior-apical scar was detected by ceCMR in two cases, while small inferior necrosis was identified in another 2 cases. Left ventricular function was deteriorated only in the two patients with antero-apical infarction. The presence of myocardial infarction was detected in the territory supplied by the involved coronary artery.
Conclusion:
In Kawasaki disease MRA, SSFP cine and ceCMR are able to perform noninvasive coronary artery evaluation, function and infarct detection in a single study.
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