Abstract
BackgroundKawasaki disease (KD) is a vasculitis with formation of coronary artery aneurysms (CAAs) that can lead to myocardial ischemia. Echocardiography is the primary imaging modality for the coronary arteries despite limited visualization. Coronary angiography (CAG) is the gold standard yet invasive with high-radiation exposure. To date however, state-of-the-art CT scanners enable high-quality low-dose coronary computed tomographic angiography (cCTA) imaging. The aim of our study in KD is to report (i) the diagnostic yield of cCTA compared to echocardiography, and (ii) the radiation dose.Methods and resultsWe collected data of KD patients who underwent cCTA. cCTA findings were compared with echocardiography results. In 70 KD patients (median age 15.1 years [0.5–59.5 years]; 78% male; 38% giant CAA), the cCTA identified 61 CAAs, of which 34 (56%, with a Z score > 3, in 22 patients) were not detected by echocardiography. In addition, the left circumflex (aneurysmatic in 6 patients) was always visible upon cCTA and not detected upon echocardiography. Calcifications, plaques, and/or thrombi were visualized by cCTA in 25 coronary arteries (15 patients). Calcifications were seen as early as 2.7 years after onset of disease. In 5 patients, the cCTA findings resulted in an immediate change of treatment. The median effective dose (ED) in millisievert differed significantly (p < 0.01) between third-generation dual-source and other CT scanners (1.5 [0.3–9.4] (n = 56) vs 3.8 [1.7–20.0] (n = 14)).ConclusionsThe diagnostic yield of third-generation dual-source cCTA combined with reduced radiation exposure makes cCTA a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for KD.Key Points• cCTA is a favorable diagnostic modality to complete the diagnosis and long-term treatment indications for Kawasaki disease.• Kawasaki disease patients with proven coronary artery involvement on echocardiography require additional imaging.
Highlights
Kawasaki disease (KD) is the most common acquired pediatric heart disease in Western society, which mainly occurs in young children
The most precarious complication of this inflammation is the formation of coronary artery aneurysms (CAAs) that can lead to myocardial ischemia and infarction
The American Heart Association (AHA) guidelines recommend risk stratification according to Z score
Summary
Kawasaki disease (KD) is the most common acquired pediatric heart disease in Western society, which mainly occurs in young children It is an acute vasculitis where the mediumand small-sized arteries become inflamed. Even with increased spatial and temporal resolution offered by the newer machines, echocardiography can only detect the proximal sections of the coronary artery tree due to limited ultrasound windows. Notwithstanding this limitation, echocardiography remains the primary imaging modality in the AHA guidelines of 2017, due to its great ease of application in the acute phase of the disease and long-term follow-up in young children. The aim of our study in KD is to report (i) the diagnostic yield of cCTA compared to echocardiography, and (ii) the radiation dose
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