Abstract
Kawasaki disease (KD) is an acute idiopathic vasculitis affecting infants and children. Coronary artery abnormalities and myocarditis are the major cardiovascular complications of KD. Coronary artery abnormalities develop in 15–25% of untreated KD. Two-dimensional transthoracic echocardiography has hitherto been considered the modality of choice for evaluation of children with KD. There are, however, several limitations inherent to echocardiography - including limited evaluation of distal vessels, left circumflex artery and poor acoustic window in growing children. Catheter angiography is the gold standard for evaluation of coronary artery abnormalities in older children and adults; however it also has inherent limitations - including complications related to its invasive nature, higher radiation exposure, and inability to evaluate intramural abnormalities. Thus serial invasive coronary angiography studies are not feasible in children. There have been major advances in computed tomography (CT) coronary imaging so that it is now possible to delineate the coronary artery anatomy with higher temporal resolution and motion-free images at all heart rates with acceptable radiation exposure. There is, however, a paucity of literature with regard to the use of this technique in children with KD. In this review, we discuss the application of computed tomography coronary angiography (CTCA) in children with KD with special reference to strategies aimed at reducing the effective radiation dose.
Highlights
Kawasaki disease (KD) is a vasculitic disorder in children with a predilection for coronary arteries
As mural changes are an important component of cardiovascular complications in KD, an imaging modality that is capable of evaluating the lumen as well as the wall of coronary arteries is necessary
With dual-source computed tomography (CT) (DSCT), the temporal resolution is improved to 73 ms
Summary
KD is a vasculitic disorder in children with a predilection for coronary arteries. Without appropriate treatment, up to 25% children with KD can develop coronary artery abnormalities (CAA). CTCA is an alternative imaging modality for non-invasive diagnosis and follow-up of children with KD. As mural changes are an important component of cardiovascular complications in KD, an imaging modality that is capable of evaluating the lumen as well as the wall of coronary arteries is necessary. This translated to improved image quality and high sensitivity and specificity in the evaluation of all coronary artery branches and segments.
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