Coronary artery imaging in Kawasaki disease: recent updates in imaging techniques and clinical indications

Coronary artery involvement in Kawasaki disease should be evaluated throughout all disease stages. Generally, multimodality imaging is necessary for both the acute and chronic phases of coronary artery abnormalities. This review summarizes current clinical indications and recent technical advances in coronary artery imaging in Kawasaki disease with an emphasis on the roles of computed tomography and magnetic resonance imaging. Echocardiography remains the first-line modality in all disease stages for evaluating coronary artery lesions and ventricular function. Recent technical developments in coronary computed tomography angiography can provide the accurate diagnosis of coronary artery lesions including stenosis and thrombus at substantially reduced radiation dose, supporting its selective use in serial follow-up. Cardiac magnetic resonance imaging offers the comprehensive evaluation of inducible myocardial ischemia, ventricular function, inflammation, and fibrosis. Invasive catheter angiography is reserved for complex or interventional cases. This review also addresses technical considerations and potential pitfalls for each imaging modality. Continued technical developments and their optimization with standardized imaging protocols and reports are expected to enhance diagnostic precision and eventually improve clinical outcomes in children with Kawasaki disease.