Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology

D. van Stijn–Bringas Dimitriades, R. N. Planken, M. Groenink, G. J. Streekstra, T. W. Kuijpers, I. M. Kuipers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Kawasaki 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 results: We 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)). Conclusions: The 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.

Original languageEnglish
Pages (from-to)432-441
Number of pages10
JournalEuropean Radiology
Volume30
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020
Externally publishedYes

Cite this

van Stijn–Bringas Dimitriades, D. ; Planken, R. N. ; Groenink, M. ; Streekstra, G. J. ; Kuijpers, T. W. ; Kuipers, I. M. / Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology. In: European Radiology. 2020 ; Vol. 30, No. 1. pp. 432-441.
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title = "Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology",
abstract = "Background: Kawasaki 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 results: We 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)). Conclusions: The 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.",
keywords = "Computed tomography angiography, Coronary artery disease, Echocardiography, Kawasaki disease, Pediatrics",
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Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology. / van Stijn–Bringas Dimitriades, D.; Planken, R. N.; Groenink, M.; Streekstra, G. J.; Kuijpers, T. W.; Kuipers, I. M.

In: European Radiology, Vol. 30, No. 1, 01.01.2020, p. 432-441.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Coronary artery assessment in Kawasaki disease with dual-source CT angiography to uncover vascular pathology

AU - van Stijn–Bringas Dimitriades, D.

AU - Planken, R. N.

AU - Groenink, M.

AU - Streekstra, G. J.

AU - Kuijpers, T. W.

AU - Kuipers, I. M.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Kawasaki 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 results: We 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)). Conclusions: The 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.

AB - Background: Kawasaki 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 results: We 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)). Conclusions: The 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.

KW - Computed tomography angiography

KW - Coronary artery disease

KW - Echocardiography

KW - Kawasaki disease

KW - Pediatrics

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31428828

U2 - 10.1007/s00330-019-06367-6

DO - 10.1007/s00330-019-06367-6

M3 - Article

VL - 30

SP - 432

EP - 441

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 1

ER -