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CT coronary angiogram in children with Kawasaki patients: experience in 52 patients
Boekhren K Borhanuddin1, Haifa Abdul Latiff1, Ahmad K Mohamed Yusof2
1Department of Pediatric Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia.
Insights
Electrocardiogram-gated CT coronary angiography effectively assesses coronary artery lesions in children with Kawasaki disease. Lower heart rates correlate with better image quality, ensuring diagnostic accuracy in pediatric patients.
Area of Science:
- Pediatric cardiology
- Diagnostic imaging
- Cardiovascular research
Background:
- Computed tomography (CT) is valuable for adult coronary artery assessment but limited in children due to high heart rates and lack of standardized protocols.
- Assessing coronary artery lesions in pediatric Kawasaki disease patients using CT requires evaluation of diagnostic quality and influencing factors.
Purpose of the Study:
- To evaluate the diagnostic quality of CT coronary angiography in children with Kawasaki disease.
- To identify factors affecting image quality in pediatric CT coronary angiography for Kawasaki disease.
Main Methods:
- CT coronary angiography was performed on 52 pediatric patients with Kawasaki disease using electrocardiogram-gated protocols.
- General anesthesia was employed for uncooperative patients requiring breathing control.
- Image quality, heart rate, and effective radiation dose were systematically documented.
Main Results:
- Excellent or good image quality was achieved in 97% of patients.
- Coronary artery aneurysms were identified in 25 patients; thrombus was present in 11.
- Lower heart rates were significantly associated with improved diagnostic imaging quality (p = 0.007).
Conclusions:
- Electrocardiogram-triggered CT coronary angiography offers valuable diagnostic assessment of coronary artery lesions in pediatric Kawasaki disease.
- The technique demonstrates good diagnostic capability despite challenges with pediatric heart rates.
Background:
CT is an accepted non-invasive imaging tool to assess the coronary arteries in adults; however, its utilisation in children is limited by high heart rate and lack of standardised protocol. We sought to assess diagnostic quality and factors that affect image quality of CT in assessing coronary artery lesions in Kawasaki patients less than 18 years of age.
Methodology:
CT coronary angiography was performed on patients with Kawasaki disease diagnosed with coronary aneurysm or suspected to have coronary stenosis. Studies were performed using electrocardiogram-gated protocols. General anaesthesia was used in patients who were not cooperative for breathing control. Heart rate, image quality, and effective radiation dose were documented.
Results:
Fifty-two Kawasaki patients underwent CT coronary angiography to assess coronary artery lesions. Median heart rate was 88 beats per minute (range 50-165 beats/minute). Image quality was graded as excellent in 34 (65%) patients, good in 17 (32%), satisfactory in 1, and poor in 1 patient. Coronary artery aneurysm was found in 25 (bilateral = 6, unilateral = 19, multiple = 11). Thrombus was found in 11 patients resulting in partial and total occlusion in 8 and 3 patients, respectively. Coronary stenosis was noted in 2 patients. The effective radiation dose was 1.296 millisievert (median 0.81 millisievert). Better diagnostic imaging quality was significantly related to lower heart rate (p = 0.007).
Conclusion:
Electrocardiogram-triggered CT coronary angiography provides a good diagnostic assessment of coronary artery lesions in children with Kawasaki disease.
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