Efficacy of Magnetic Resonance Coronary Angiography for Evaluation of Coronary Arterial Lesion in Infant to Adult Patients with Kawasaki Disease

摘要

{Background and Objective} Coronary angiography (CAG) has been validated as the standard method for the follow-up of the coronary arterial lesions (CAL) due to Kawasaki disease, which start with aneurysms and progress to stenotic lesions frequently. However, patients with CAL need to be studied repeatedly throughout the life, and CAG is associated with substantial amount of risk, especially in small infants. This study examined the validity of magnetic resonance coronary angiography (MRCA) in evaluation of the morphology of CAL due to Kawasaki disease. {Patients and Method} Seventeen patients of Kawasaki disease (age;12288;4 months-24 years; mean:9 years) underwent MRCA examinations. Methods used to visualize CAL; induced 3D true FISP in 10 patients, 3D-FLASH in 9, and 3D FLASH-IR in 2, and MRCA under free respiration using navigator echo 3D-FLASH was done in 6 children who could not hold their breath. Three infants were sedated with Tricloril (1mg/Kg) during the examination. MRCA findings were compared with those of 2D echocardiography in 9 patients and with CAG findings in 8 patients. {Results} Twelve of 13 aneurysms (92%) were demonstrated by MRCA, however it failed to detect a slightly dilated lesion. Four stenotic lesions of more than 50% were all clearly visualized, and CABG patency in 2 patients (100%) and 34 out of 36 of normal coronary arterial branches (94%) (seg.1-4, 5-7 & 11) were also documented. An aneurysm which could not be shown by 2D echo was readily demonstrated by MRCA. {Conclusion} Feasibility of noninvasive demonstration of CAL of Kawasaki disease was confirmed including in young infants. It was suggested that MRCA could reduce the number of CAG in follow-up of Kawasaki disease patients. Its potential to screen premature arteriosclerotic changes in Kawasaki disease patients was also suggested.