Linear shadows inside coronary arterial lesions on two-dimensional echocardiograhpy in Kawasaki disease patients

Conventional two-dimensional echocardiography (2DE) is not adequately sensitive enough for the detection of stenotic or occlusive coronary lesions that occur in Kawasaki disease. Recently, linear shadows have been detected inside large- or moderate-sized coronary artery lesions (CALs) by high-resolution 2DE at a convalescent or chronic stage.

We evaluated the clinical significance of the linear shadows detected by 2DE and compared the findings with those obtained using coronary angiography (CAG), magnetic resonance imaging (MRI), and intravascular ultrasound (IVUS).

From December 2001 to November 2006, linear shadows were detected in 11 out of 18 CALs in 9 patients at our institution. The outer diameters of the CALs by 2DE were larger than the diameters of CALs by CAG, while the inner diameters between the linear shadows by 2DE correlate with the diameters of CALs by CAG. Remarkably thickened intima was confirmed in 7 out of 9 CALs by MRI, and in every lesion that was examined using IVUS.

The results of this study suggest that linear shadows by 2DE would indicate the existence of a thickened intima. We consider that linear shadows may be useful to estimate the development of stenotic lesions during the process of regression or remodeling of CALs.