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Computed Tomography Coronary Angiography for Evaluation of Children With Kawasaki Disease
Manphool Singhal1, Surjit Singh2, Pankaj Gupta1
1Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Computed tomography coronary angiography (CTCA) is feasible for evaluating coronary arteries in children with Kawasaki disease (KD). This imaging technique effectively detects coronary abnormalities, including aneurysms and stenoses, in both acute and convalescent phases.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Cardiovascular Research
Background:
- Kawasaki disease (KD) is a significant cause of pediatric acquired heart disease.
- Coronary artery abnormalities are a major complication of KD.
- Non-invasive imaging is crucial for assessing coronary involvement in KD.
Purpose of the Study:
- To evaluate the feasibility of computed tomography coronary angiography (CTCA) in children with Kawasaki disease.
- To assess the diagnostic performance of CTCA in detecting coronary artery abnormalities in acute and convalescent KD phases.
- To determine radiation dose associated with CTCA in pediatric KD patients.
Main Methods:
- Prospective study of 49 children with KD (acute and convalescent phases).
- CTCA performed using a 128-slice, dual-source scanner with prospective or retrospective ECG gating.
- Coronary artery evaluation by a blinded radiologist, comparing findings with echocardiography.
Main Results:
- CTCA was successfully performed in pediatric KD patients.
- Median effective radiation dose was low, particularly with prospective gating (0.48 mSv).
- CTCA identified coronary abnormalities in 30% of subjects, including aneurysms (27) and stenoses (3), with aneurysms detected in 5 acute-phase patients.
Conclusions:
- CTCA is a feasible and effective imaging modality for comprehensive coronary artery evaluation in children with KD.
- CTCA can detect significant coronary artery abnormalities, aiding in disease management.
- Low radiation doses make CTCA a valuable tool in pediatric cardiology.
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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