ABSTRACT
BACKGROUND: Kawasaki disease (KD) is a systemic vasculitis; systemic arteries other than the coronary arteries should therefore also be evaluated. This study investigated the feasibility of evaluating coronary aneurysms, systemic artery aneurysms (SAAs), and cerebrovascular diseases in patients with KD using non-contrast magnetic resonance angiography (NC-MRA). METHODS: Coronary artery protocols, including coronary magnetic resonance angiography (MRA) and vessel wall imaging, were performed in 57 examinations of 28 patients. Systemic artery protocol, including SAA scans and head MRA, along with coronary artery protocol, were performed in 42 examinations of 42 patients. The image quality of the SAAs was evaluated on a 4-point scale. Examination time and sedation dosage were compared between the protocols. The presence of SAAs and cerebrovascular disease was also evaluated. RESULTS: The image quality score of SAAs was 4 (interquartile range [IQR]: 4-4) for the aorta, 4 (IQR: 3-4) for the subclavian artery, 4 (IQR: 3-4) for the renal artery, and 3 (IQR: 3-4) for the iliac artery. No differences were found between examination time (47.0 [IQR: 43.0-61.0] min vs. 51.0 [IQR: 45.0-60.0] min, p = 0.48) and sedative dose (4.63 [IQR: 3.93-5.79] mg/kg vs. 4.21 [IQR: 3.56-5.71] mg/kg, p = 0.37) between the protocols. Systemic artery protocol detected SAAs in three patients (7.1%), and cerebrovascular disease was not detected. CONCLUSIONS: Evaluating the coronary and systemic arteries in patients with KD using NC-MRA on a single examination was possible without compromising examination time or sedation dose. The systemic artery protocol was useful in finding SAAs.
Subject(s)
Coronary Aneurysm , Mucocutaneous Lymph Node Syndrome , Humans , Magnetic Resonance Angiography/methods , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Renal Artery/pathology , Coronary Aneurysm/diagnosis , Iliac Artery , Contrast MediaABSTRACT
Kawasaki disease (KD) is described as a syndrome that causes both coronary and systemic artery aneurysms (SAAs). This report describes the pitfall for SAAs' evaluation when using electrocardiogram (ECG)-gated subtracted three-dimensional fast spin echo (3D FSE) sequence of magnetic resonance imaging in KD patients. A 12-year-old male was diagnosed with KD at 3 months of age. We acquired ECG-gated 3D FSE images in the diastole and systole phases with coronal sections. Subtraction was then performed from diastolic phase imaging to systolic phase imaging. A 15.5 mm right axillary artery aneurysm and an 8.0 mm left axillary artery aneurysm were identified with ECG-gated 3D FSE in the diastolic phase. However, we observed signal loss in the right axillary artery aneurysm when subtraction was performed to selectively detect arteries; further, the brachial artery was poorly detected. ECG-gated subtracted 3D FSE sequence of magnetic resonance imaging can compromise the image quality of both aneurysm and peripheral artery images when detecting SAAs.
ABSTRACT
Kawasaki disease (KD) involves coronary aneurysms and can infrequently cause systemic artery aneurysms (SAAs). Therefore, patients with KD should be evaluated for both coronary and systemic arterial aneurysms. This report describes 2 cases of SAA evaluated using the diastolic phase image of electrocardiogram-gated three-dimensional fast spin echo during noncontrast magnetic resonance angiography. The first case was a 1-year-old male who diagnosed with KD at 2 months of age. Multiple right axillary artery aneurysms measuring 6.0 mm and 2.5 mm and left axillary artery aneurysms measuring 12.0 mm, 4.0 mm, and 3.0 mm were observed by scanning for 94 seconds. The second case was a 13-year-old male who diagnosed with KD at 4 months of age, with a 7.0-mm right axillary artery aneurysm observed by scanning for 101 seconds. Electrocardiogram-gated three-dimensional fast spin echo in the diastolic phase can help evaluate SAA in patients with KD and does not require a prolonged scanning time or contrast medium.
