Coronary magnetic resonance angiography and vessel wall imaging in children with Kawasaki disease

Background: In patients with Kawasaki disease (KD) serial evaluation of the distribution and size of coronary artery aneurysms (CAA) is necessary for risk stratification and therapeutic management. Objective: To apply whole-heart coronary MR angiography (CMRA) and black-blood coronary vessel wall imaging in children with KD. Materialsand methods: Six children (mean age 4.6 years, range 2.5-7.8 years) with KD underwent CMRA using a free-breathing, T2-prepared, three-dimensional steady-state free-precession (3D-SSFP), whole-heart approach with navigator gating and tracking. Vessel walls were imaged with an ECG-triggered and navigator-gated double inversion recovery (DIR) black-blood segmented turbo spin-echo sequence. Results: There was complete agreement between CMRA and conventional angiography (n=6) in the detection of CAA (n=15). Excellent agreement was found between the two techniques in determining the maximal diameter (mean difference 0.2±0.7 mm), length (mean difference 0.1±0.8 mm) and distance from the ostium (mean difference -0.8±2.1 mm) of the CAAs. In all subjects with a CAA, abnormally thickened vessel walls were found (2.5±0.5 mm). Conclusions: CMRA accurately defines CAA in free-breathing sedated children with KD using the whole-heart approach and detects abnormally thickened vessel walls. This technique may reduce the need for serial X-ray coronary angiography, and improve risk stratification and monitoring of therapy.