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Published on: January 4, 2013
Coronary vessel wall visualization via three-dimensional turbo spin-echo black blood imaging in Kawasaki disease
Koji Matsumoto1, Hajime Yokota2, Hiroki Mukai2
1Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan; Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
Insights
Three-dimensional turbo spin-echo black blood imaging (3D-TSE) is feasible for visualizing normal coronary vessel walls in children with Kawasaki disease. However, accuracy is reduced in aneurysmal regions due to increased bias with magnetic resonance angiography (MRA).
Area of Science:
- Cardiovascular Imaging
- Pediatric Cardiology
- Medical Physics
Background:
- Kawasaki disease can lead to coronary artery aneurysms, increasing the risk of cardiovascular complications.
- Accurate visualization of coronary vessel walls is crucial for monitoring disease progression and treatment efficacy in affected children.
- Traditional coronary angiography has limitations in pediatric populations, necessitating advanced non-invasive imaging techniques.
Purpose of the Study:
- To assess the feasibility of using three-dimensional turbo spin-echo black blood imaging (3D-TSE) for visualizing coronary vessel walls in pediatric patients with Kawasaki disease.
- To evaluate the reproducibility and agreement of 3D-TSE measurements with coronary magnetic resonance angiography (MRA) for internal diameter and wall thickness.
Main Methods:
- Nine pediatric patients with Kawasaki disease underwent cardiac MRI, including coronary MRA and 3D-TSE with axial and sagittal orientations.
- Coronary vessel walls were analyzed in aneurysmal and normal-proximal regions.
- Internal diameter and wall thickness were measured, and reproducibility was assessed using interclass correlation coefficients (ICCs) and Bland-Altman plots.
Main Results:
- 3D-TSE imaging demonstrated higher reproducibility in aneurysmal regions with axial orientation (ICC=0.88) compared to sagittal (ICC=0.81).
- In normal-proximal regions, 3D-TSE-axi showed excellent reproducibility (ICC=0.90), while 3D-TSE-sag had poor agreement (ICC=0.32).
- Significant bias and wide limits of agreement were observed between MRA and 3D-TSE-axi for internal diameter in aneurysmal regions, but narrow limits in normal-proximal regions.
- Wall thickness measurements using 3D-TSE-axi indicated abnormalities in 84.0% of aneurysmal regions and 18.4% of normal-proximal regions.
Conclusions:
- Three-dimensional turbo spin-echo black blood imaging (3D-TSE) is feasible for visualizing normal coronary vessel walls in children with Kawasaki disease.
- In aneurysmal regions, larger diameters correlate with increased bias between 3D-TSE and MRA, suggesting limitations in quantitative accuracy.
- Further refinement of 3D-TSE techniques may be necessary to improve the assessment of coronary vessel walls in complex aneurysmal changes.
Purpose:
To evaluate the feasibility of coronary vessel wall visualization using three-dimensional turbo spin-echo black blood imaging (3D-TSE) in children with Kawasaki disease.
Materials And Methods:
Nine patients (6 girls and 3 boys; mean age ± standard deviation, 5.6 ± 3.3 years; range, 1.4-10.3 years) were included. Coronary magnetic resonance angiography (MRA) with an axial slice orientation and 3D-TSE with axial and sagittal slice orientations (3D-TSE-axi and 3D-TSE-sag) were acquired for the whole heart. Coronary vessel walls were evaluated separately in aneurysm and normal-proximal regions. The internal diameter and wall thickness of the reformatted cross-sectional images were measured in both the regions. Reproducibility between MRA and 3D-TSE was evaluated via interclass correlation coefficients (ICCs) and Bland-Altman plots.
Results:
In total, 164 points (aneurysmal regions, 73; normal-proximal regions, 64; normal-distal regions, 27) were evaluated. The ICC for 3D-TSE-axi was higher than that for 3D-TSE-sag (aneurysmal regions, ICC = 0.88 and 0.81; normal-proximal regions, ICC = 0.90 and 0.32, respectively). Bland-Altman plots of the internal diameter via MRA and 3D-TSE-axi showed a wide 95% limit of agreement (-0.13 to 2.89 mm) and significant fixed and proportional biases (P < 0.001 and P = 0.002) in the aneurysmal regions. However, the 95% limit of agreement was narrow (-0.14 to 0.57 mm) in the normal-proximal regions. If 1 mm was set as the cut-off for a thickened wall, wall thickness via 3D-TSE-axi was found to be abnormal across many points (84.0% of aneurysmal regions; 18.4% of normal-proximal regions).
Conclusions:
3D-TSE imaging of the normal-proximal regions of the coronary vessel in individuals with Kawasaki disease was found to be feasible. However, in aneurysmal regions, larger aneurysmal diameters led to an increased bias between MRA and 3D-TSE.
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