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Coronary artery abnormalities in Kawasaki disease: comparison between CT and MR coronary angiography
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Insights
CT coronary angiography (CTCA) offers superior diagnostic performance compared to MR coronary angiography (MRCA) for evaluating coronary artery abnormalities in Kawasaki disease patients. Both methods show similar patient-level assessibility, but CTCA is more accurate.
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Medical Diagnostics
Background:
- Kawasaki disease frequently leads to coronary artery abnormalities, necessitating accurate imaging surveillance.
- CT coronary angiography (CTCA) and MR coronary angiography (MRCA) are utilized, but direct comparisons are limited.
- Assessing the relative strengths of CTCA and MRCA in this specific patient population is crucial for optimal management.
Purpose of the Study:
- To directly compare the diagnostic performance and assessibility of CTCA versus MRCA.
- To determine the preferred imaging modality for evaluating coronary artery abnormalities in pediatric Kawasaki disease patients.
Main Methods:
- A cohort of 56 Kawasaki disease patients (aged 1-24 years) underwent either CTCA or MRCA.
- A subset of 17 patients had both CTCA and MRCA performed for direct comparison.
- Coronary artery segments were assessed for visibility, aneurysm, stenosis, and occlusion, with results validated against a reference standard.
Main Results:
- CTCA demonstrated significantly higher diagnostic performance (sensitivity, accuracy) than MRCA across both patient groups.
- While per-segment assessibility favored CTCA, per-patient assessibility was comparable between the two modalities.
- CTCA showed superior sensitivity (93.1% vs. 77.9%) and accuracy (98.0% vs. 94.9%) in group A.
Conclusions:
- CTCA exhibits superior diagnostic performance for detecting coronary artery abnormalities in Kawasaki disease compared to MRCA.
- Despite comparable patient-level assessibility, CTCA is the preferred modality due to its higher accuracy.
- These findings support the use of CTCA for comprehensive evaluation of coronary artery sequelae in Kawasaki disease.
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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