Sophia Mavrogeni, Abstract Co-Author: Nothing to Disclose

Demosthenes D Cokkinos MD, Presenter: Nothing to Disclose

Giorgos Papadopoulos, Abstract Co-Author: Nothing to Disclose

Marouso Douskou, Abstract Co-Author: Nothing to Disclose

Savas Kaklis, Abstract Co-Author: Nothing to Disclose

George Varlamis, Abstract Co-Author: Nothing to Disclose

Alexios Giakoumelos, Abstract Co-Author: Nothing to Disclose

John Seimenis, Abstract Co-Author: Nothing to Disclose

Evangelos Karanasios, Abstract Co-Author: Nothing to Disclose

Dennis V Cokkinos, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Coronary artery abnormalities in Kawasaki disease (KD) develop in 15-25% of young patients, mostly in the form of aneurysms. Although pediatric disease incidence is low (2-3%), mortality rate due to myocardial infarction is 22%. Magnetic resonance angiography (MRA) can reliably identify coronary aneurysms in affected patients. Gadolinium-enhanced MRI (Gd-enMRI) is the gold standard for scar detection due to myocardial infarction. Our aim is to measure the dimensions of coronary artery aneurysms using MRA and to correlate them with the presence of myocardial infarction measured by Gd-enMRI in a pediatric population with Kawasaki disease.

Fifteen patients, aged 1-12 yrs were studied. Maximal aneurysm diameter and length were recorded. Coronary MRA was performed on a 1.5 T Philips Intera CV MR scanner with 2 ECG-triggered pulse sequences:A 3-dimensional segmented k-space gradient-echo sequence (TE= 2.1 ms, TR= 7.5 ms, flip angle=30°, eff. slice thickness=1.5 mm) employing a T2-weighted preparation prepulse and a frequency selective fat-saturation prepulse. Data acquisition was performed in mid-diastole. All scans were carried out with the patient free breathing using a 2D real time navigator beam. Gd-enMRI images were acquired 15 minutes after the IV injection of 0.2 mmol/kg Gd-DTPA using an inversion recovery gradient echo pulse sequence.

In 6 patients discrete coronary arteries aneurysms (AN) were identified. Diffuse coronary ectasia (EC) alone was present in the remaining 4 patients. Aneurysm diameter ranged from 2 to 9 mm (5.7±2.8), aneurysm length ranged from 4.4 to 16 mm (10.1±5.0), and ectasia length ranged from 2.5 to 4.6 mm (3.8±0.6). Transmural apical scar, due to myocardial infarction, was detected by Gd-enMRI only in 2 cases. Small patchy necrosis was identified in another case. No correlation between aneurysm diameter or ectasia length and myocardial infarction was found.

MRA and Gd-enMRI are reliable diagnostic tools for the non invasive evaluation of coronary arteries and infarct size detection in Kawasaki disease in a single study.They may prove of great value for the serial follow-up of these patients.

J.S.: John Seimenis works for Philips Hellas Medical Systems

Mavrogeni, S, Cokkinos, D, Papadopoulos, G, Douskou, M, Kaklis, S, Varlamis, G, Giakoumelos, A, Seimenis, J, Karanasios, E, Cokkinos, D, et al, , Magnetic Resonance Angiography and Gadolinium-enhanced Magnetic Resonance Imaging Offer a Noninvasive "One Stop" Assessment in Patients with Kawasaki Disease.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407819.html